Aortic input impedance in heart failure: comparison with normal subjects and its changes during vasodilator therapy*

Merillon, J. P.; Fontenier, G.; Lerallut, J.F.; Jaffrin, Michel Y.; Chastre, Jean; Assayag, Patrick; Motté, G; Gourgon, R

doi:10.1093/oxfordjournals.eurheartj.a061690

Cited by 65 publications

(38 citation statements)

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“…The primary effect of reducing systemic vascular resistance appears related to its dilating effect at the arteriolar level. Other effects on aortic input impedance have suggested an effect on large artery function (23)(24)(25)(26)(27). This study documents the significant reduction in pulse wave velocity, increase in arterial compliance, and decrease in systemic vascular resistance after nitroprusside.…”

Section: Discussionsupporting

confidence: 68%

Arterial mechanical properties in dilated cardiomyopathy. Aging and the response to nitroprusside.

Carroll¹,

Shroff²,

Wirth³

et al. 1991

J. Clin. Invest.

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The effects of aging on arterial mechanical properties and the response to nitroprusside were examined in 25 patients with dilated cardiomyopathy. High-fidelity pressures were recorded with a multisensor catheter. Pulse wave velocity was determined between two sensors in the thoracic aorta. Arterial compliance was determined by an analysis of the diastolic waveform and cardiac output.At baseline, despite a similar systemic vascular resistance, the pulsatile load (e.g., arterial compliance) and wave transmission characteristics (e.g., pulse wave velocity) were altered with aging. Arterial compliance was reduced in older (> 50 yr, n = 8) versus younger (< 35 yr, n = 8) patients (0.51±0.17 vs.1.33±0.63 ml/mmHg, P < 0.01) and intermediate in those 35-50 yr of age (n = 9,0.72±0.40 ml/mmHg). There was a positive correlation between age and pulse wave velocity (r = +0.90).Nitroprusside infusion decreased resistance, increased arterial compliance, and lowered pulse wave velocity in all groups. Yet, advancing age was associated with a greater fall in wave velocity for a given fall in aortic pressure. The slope (K) of the relation between pulse wave velocity and aortic diastolic pressure progressively increased with age (0.01±0.03, 0.06±0.02, and 0.09±0.03 m/s-mmHg). Multiple linear regression analysis revealed a significant relation between K and age.These data demonstrate that in older patients with dilated cardiomyopathy the left ventricle is coupled to an arterial circulation that has a greater pulsatile load, despite a similar steady load. Furthermore, these age-related changes in the arterial system affect the hemodynamic response to pharmacologicallyinduced vasodilatation. (J. Clin.

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Section: Discussionsupporting

confidence: 68%

Arterial mechanical properties in dilated cardiomyopathy. Aging and the response to nitroprusside.

Carroll¹,

Shroff²,

Wirth³

et al. 1991

J. Clin. Invest.

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“…Physiologic or therapeutic interventions designed to decrease the magnitude of the reflected wave or alter its timing may be beneficial in patients with heart failure. Because aortic characteristic impedance is not altered by nitroprusside, as we and others'8, 21. 24 have shown, the significant effects of nitro-720 prusside on vascular hydraulic load reside in decreases in input resistance and wave reflections.…”

Section: Discussionmentioning

confidence: 50%

Arterial wave reflection in heart failure.

Laskey¹,

Kussmaul²

1987

Circulation

123

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Arterial wave reflection may adversely influence both left ventricular afterload and ejection performance. Therefore, using multisensor catheter manometers, we derived wave reflection indexes from ascending aortic pressure and velocity recordings in 17 subjects with clinical heart failure secondary to idiopathic dilated cardiomyopathy and 11 control subjects free of detectable cardiovascular disease. Patients were studied at rest as well as during submaximal supine bicycle exercise. Eight of the subjects with cardiomyopathy were also studied during infusion of nitroprusside at rest and on exercise. Reflection indexes decreased on exercise in normal subjects but did not consistently do so in the subjects with heart failure. In both groups the reflected wave on exercise returned earlier during the ejection period. Infusion of nitroprusside at rest in subjects with heart failure had dramatic, and significant, effects on the magnitude and timing of arterial wave reflections. THE PRESENCE of arterial wave reflections may be inferred from characteristic alterations in the pressure pulse as it propagates along the aorta. 1-6 Both the magnitude and timing of the reflected wave(s) are important in assessing their potential physiologic significance. Since a reflected pressure wave adds to the forward wave, a wave returning during systole would increase ventricular afterload. Reflected flow waves, however, subtract from the forward flow pulse. Therefore a wave returning during systole diminishes net forward flow and is disadvantageous to ventricular ejection.Changes in systemic vascular resistance have been shown to result in corresponding changes in the reflection properties of the arterial tree. A decrease in peripheral resistance may decrease wave reflections, whereas an increase in peripheral resistance enhances wave reflections.7-9 However, reflections may diminish in the absence of alterations in peripheral resis- acteristic feature of congestive heart failure.1t We reasoned that physiologic or pharmacologic decreases in systemic vascular resistance might result in corresponding, and hopefully beneficial, changes in the reflection characteristics of the arterial tree. Maneuvers that alter the magnitude of reflected waves may also effect a change in their timing. Thus the overall effect(s) of systemic vasodilation may be difficult to predict. To this end, we compared the magnitude and timing of arterial wave reflections in normal subjects, at rest and on exercise, with those in subjects with congestive heart failure. The effects of nitroprusside in the latter subjects were also analyzed to compare physiologic and pharmacologic arteriolar vasodilation in heart failure. MethodsPatients. Seventeen patients (12 men, five women), 24 to 66 years old (mean 44 + 12) with clinical signs and symptoms of congestive heart failure (NYHA class III to IV) were referred to the cardiac catheterization laboratory for endomyocardial biopsy and to rule out the presence of coronary artery disease. Each patient had a dilated, diff...

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“…Using pulse wave velocity as a measure of elastic behaviour, conflicting data have been observed in chronic heart failure. Arnold et al [5] reported increased pulse wave velocity and decreased brachial artery compliance, while earlier studies of Merillon et al [29] and Eliakim et al [19] could not demonstrate differences between chronic heart failure patients and controls. In addition, using characteristic impedance as a study parameter resulted in conflicting data.…”

Section: Discussionmentioning

confidence: 99%

Inverse relationship between aldosterone and large artery compliance in chronically treated heart failure patients

Duprez

Buyzere

Rietzschel

et al. 1998

European Heart Journal

169

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Aims The purpose of this study was to examine, in chronically treated heart failure patients vs control subjects, the influence of neurohumoral activation and aldosterone escape on arterial elastic behaviour, assessed by noninvasive mathematical lumped-parameter modelling of the compliance of the arterial system. Methods and ResultsRadial arterial pulse waves were recorded non-invasively for 30 s with an arterial tonometer sensor array in 13 chronic heart failure patients (mean age, 59 2·5 years) in New York Heart Association class II. The patients had been taking digoxin, furosemide, captopril and aspirin for more than 3 months. Thirteen healthy subjects (mean age, 50 4·0 years) acted as controls. Compliance of the proximal (aorta and major branches, C1) and distal parts (C2) of the circulation were derived from a third order four-element modified Windkessel model which can reproduce arterial pressure waveforms, including both exponential and oscillatory sections. Active renin, angiotensin II and aldosterone levels were determined on venous blood samples in the supine position and after 30 min active standing. There was decreased proximal (C1, 1·51 0·11 ml . mmHg 1 , P<0·01) and distal (C2, 0·050 0·011 ml . mmHg 1 ) arterial compliance in the chronic heart failure patients vs controls (C1, 1·71 0·16 ml . mmHg 1 ; C2, 0·054 0·006 ml . mmHg 1 ). The chronic heart failure patients were characterized by an aldosterone escape phenomenon which was inversely correlated with the proximal arterial compliance in both supine (r= 0·795, P=0·002) and standing (r= 0·628, P=0·029) positions.Conclusions In chronically treated heart failure patients with full angiotensin-converting enzyme-inhibition and diuretics, there is decreased compliance of the aorta and its major branches, which is inversely correlated with the aldosterone escape phenomenon.

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Aortic input impedance in heart failure: comparison with normal subjects and its changes during vasodilator therapy*

Cited by 65 publications

References 0 publications

Arterial mechanical properties in dilated cardiomyopathy. Aging and the response to nitroprusside.

Arterial mechanical properties in dilated cardiomyopathy. Aging and the response to nitroprusside.

Arterial wave reflection in heart failure.

Inverse relationship between aldosterone and large artery compliance in chronically treated heart failure patients

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