Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Abstract

IntroductionCurrent evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice.AimThe aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics.MethodsA total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study.ResultsModel-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed.ConclusionIn conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures.

Noninvasive Cardiac Output and Central Systolic Pressure From Cuff-Pressure and Pulse Wave Velocity

“…Approaches comparable to ours have been developed to address the challenges of patient-specific hemodynamic monitoring. Tosello et al [66] have proposed a new technique for determining central blood pressure using a multiscale mathematical model which is adjusted based on age, height, weight, brachial pressure, left-ventricular end-systolic and enddiastolic volumes and aortic pulse wave velocity. The estimation derived from their method presented low performance (significant overestimation of 7.8 mmHg for cSBP prediction) when compared against data from the SphygmoCor device.…”

Central pulse pressure is inversely associated with proximal aortic remodelling

“…The association between Z-score and central pulse pressure was evaluated by taking into account the confounding effect of the main determinants of central haemodynamics. Indeed, in addition to anthropometric and demographic variables, heart rate during the invasive measurement of central blood pressure as well as aortic stiffness and stroke volume were considered [26][27][28].…”

Cardiovascular deconditioning during long-term spaceflight through multiscale modeling

“…Our goal is to quantitatively describe in detail the cardiovascular response through a comprehensive 0D-1D multiscale model, which has been successfully tested by heart pacing and open-loop response 31 . The 0D-1D heart-arterial hemodynamics of the complete model has been previously validated to subject-specific and pathological conditions 25,28,[32][33][34] . The physical-based model combines a 1D description of the arterial tree together with a lumped parameterization of the remaining regions, i.e., venous return, heart chambers, pulmonary circulation, and baroreceptor regulation (see the Methods for more detail and for the limitations of the present approach).…”