Photoplethysmographic assessment of pulse wave reflection

Chowienczyk, Phil; Kelly, Raymond P.; MacCallum, Helen; Millasseau, Sandrine; Andersson, Tomas; Gosling, R. G.; Ritter, James M.; Änggård, Erik

doi:10.1016/s0735-1097(99)00441-6

Cited by 316 publications

(113 citation statements)

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“…27 Previous studies have shown similar changes in the arterial pressure waveform after NTG, 28,29 but the effect of endothelium-dependent NO dilators has not been reported. Nevertheless, comparable changes in the volume waveform after infusion of ACh into rabbits 30 and of NTG and albuterol into humans 11 have been described. However, unlike Chowienczyk et al 11 and relevant to wider application of the present technique, we included a suitable placebo and showed that the responses to albuterol and NTG are repeatable.…”

Section: Discussionmentioning

confidence: 89%

“…Nevertheless, comparable changes in the volume waveform after infusion of ACh into rabbits 30 and of NTG and albuterol into humans 11 have been described. However, unlike Chowienczyk et al 11 and relevant to wider application of the present technique, we included a suitable placebo and showed that the responses to albuterol and NTG are repeatable. We also measured plasma albuterol concentrations, which were relatively stable between 5 and 20 minutes (Figure 1).…”

Section: Discussionmentioning

confidence: 89%

“…Furthermore, the degree of inhibition produced by LNMMA, Ϸ50%, is consistent with data from the forearm vascular bed 31 and systemic studies on the volume waveform. 11 However, in the present study, we included a suitable placebo aerosol and control vasoconstrictor to investigate the potential confounding effect of baseline changes in heart rate, MAP, and AIx after LNMMA. Hypercholesterolemia is the condition most consistently associated with endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…10 We hypothesized that PWA might provide a simple method for assessing endothelial vasomotor function. Chowienczyk et al 11 demonstrated that albuterol, a ␤ 2 -agonist, in part reduces wave reflection by activation of the L-arginine-NO pathway and suggested that such methodology might be applied to the assessment of endothelial function. The aim of this series of experiments was to provide robust validation of the noninvasive assessment of endothelial function by PWA combined with provocative administration of NTG and albuterol.…”

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confidence: 99%

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Pulse-Wave Analysis

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MacCallum

et al. 2002

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Abstract-Current methods for assessing vasomotor endothelial function are impractical for use in large studies. We tested the hypothesis that pulse-wave analysis (PWA) combined with provocative pharmacological testing might provide an alternative method. Radial artery waveforms were recorded and augmentation index (AIx) was calculated from derived aortic waveforms. Thirteen subjects received sublingual nitroglycerin (NTG), inhaled albuterol, or placebo. Twelve subjects received NTG, albuterol, and placebo separately during an infusion of N G -monomethyl-L-arginine (LNMMA) or norepinephrine. Twenty-seven hypercholesterolemic subjects and 27 controls received NTG followed by albuterol. Endothelial function was assessed by PWA and forearm blood flow in 27 subjects. Albuterol and NTG both significantly and repeatably reduced AIx (PϽ0.001). Only the response to albuterol was inhibited by LNMMA (Ϫ9.8Ϯ5.5% vs Ϫ4.7Ϯ2.7%; Pϭ0.02). Baseline AIx was higher in the hypercholesterolemic subjects, who exhibited a reduced response to albuterol (Pϭ0.02) but not to NTG when compared with matched controls. The responses to albuterol and acetylcholine were correlated (rϭ0.5, Pϭ0.02). Consistent with an endothelium-dependent effect, the response to albuterol was substantially inhibited by LNMMA. Importantly, the response to albuterol was reduced in subjects with hypercholesterolemia and was correlated to that of intra-arterial acetylcholine. This methodology provides a simple, repeatable, noninvasive means of assessing endothelial function in vivo. , that regulate vessel tone and prevent the development of atheroma. 1 Endothelial dysfunction is associated with a range of risk factors for cardiovascular disease, including hypercholesterolemia, 2,3 and some therapies that improve clinical outcome also reverse endothelial dysfunction. 4 Vasomotor responses in the peripheral and coronary circulations are correlated, 5 and coronary endothelial dysfunction is associated with cardiovascular risk. 6 However, no direct link between improved endothelial function and reduced risk has been made, and the prognostic significance of endothelial dysfunction has not been assessed in a major observational study.Established methods for assessing vasomotor endothelial function center on measuring the response to an endothelium-dependent, NO-mediated stimulus such as acetylcholine (Ach) 2,3 or reactive hyperemia, and a direct (endotheliumindependent) nitrovasodilator, like sodium nitroprusside (SNP) or nitroglycerin (NTG). However, current methods are not suitable for inclusion in large-scale trials. Therefore, new and relatively simple, noninvasive techniques are required to assess the predictive value of endothelial dysfunction. 7 Arterial stiffness depends, in part, on smooth muscle tone. 8 The shape of the arterial pressure waveform provides a measure of systemic arterial stiffness 9 and can be assessed noninvasively by using the technique of pulse-wave analysis (PWA). 10 We hypothesized that PWA might provide a simple method for assessing endotheli...

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pulse-Wave Analysis

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MacCallum

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“…Also, analysis of pulse waves obtained from digital photoplethysmography has been used to determine increased arterial stiffness and impaired vascular reactivity (23,26). Our results indicated an impaired arterial vascular response during reactive hyperemia, with progressive loss of renal allograft function.…”

Section: Discussionmentioning

confidence: 71%

Impaired Renal Allograft Function is Associated with Increased Arterial Stiffness in Renal Transplant Recipients

Kneifel

Scholze

Burkert

et al. 2006

American Journal of Transplantation

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It is important whether impairment of renal allograft function may deteriorate arterial stiffness in renal transplant recipients. In a cross-sectional study, arterial vascular characteristics were non-invasively determined in 48 patients with renal allograft using applanation tonometry and digital photoplethysmography. Mean age was 51 ± 2 years (mean ± SEM), and studies were performed 17 ± 1 months after transplantation. The stage of chronic kidney disease was based on the glomerular filtration rate. We observed a significant association between the stage of chronic kidney disease and arterial stiffness of large arteries S1 and small arteries S2 in renal transplant recipients (each p < 0.05 by non-parametric Kruskal-Wallis test between groups). Multivariate linear regression analysis showed that male gender of patients with renal allograft (p < 0.01) reduced glomerular filtration rate (p = 0.01), and older age of kidney donor (p = 0.04) were independently associated with an increase of large artery stiffness S1. Furthermore, a significant association between the stage of chronic kidney disease and arterial vascular reactivity during reactive hyperemia was observed (p < 0.05 by non-parametric KruskalWallis test between groups). It is concluded that impairment of renal allograft function is associated with an increased arterial stiffness in renal transplant recipients.

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Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study

et al. 2020

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IMPORTANCE Previous research has linked a history of depression with arterial stiffness (AS) during midlife. OBJECTIVE To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS). DESIGN, SETTINGS, AND PARTICIPANTS This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019. EXPOSURES Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference. MAIN OUTCOMES AND MEASURES Peripherally assessed AS index (ASI) using digital photoplethysmography. RESULTS Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association was for waist circumference, accounting for 25% of the association between depression and ASI levels (direct association: β = 0.26; 95% CI, 0.18-0.34; indirect association: β = 0.09; 95% CI, 0.06-0.11). Among men, hypertriglyceridemia accounted for 19% of the association between depression and ASI (direct association: β = 0.22; 95% CI, 0.05-0.40; indirect association: β = 0.05; 95% CI, 0.02-0.08). CONCLUSIONS AND RELEVANCE One-third of the association of depression with elevated ASI levels during midlife may be accounted for by combined MetS and inflammatory processes. Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.

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Photoplethysmographic assessment of pulse wave reflection

Abstract: The IP(DVP) is influenced by pressure wave reflection. The effects of albuterol on IP(DVP) are mediated in part through the nitric oxide pathway and are impaired in patients with type II diabetes.

Cited by 316 publications

References 25 publications

Pulse-Wave Analysis

Pulse-Wave Analysis

Impaired Renal Allograft Function is Associated with Increased Arterial Stiffness in Renal Transplant Recipients

Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study

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