Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects

Saba, Pier Sergio; Roman, Mary J.; Pini, Riccardo; Spitzer, Mariane C.; Ganau, Antonello; Devereux, Richard B.

doi:10.1016/0735-1097(93)90772-s

Cited by 247 publications

(153 citation statements)

References 44 publications

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“…[23][24][25] This is in agreement with studies showing that arterial stiffness is strongly correlated with left ventricular hypertrophy. 26,27 However, in the present study SBP, both clinic and during 24-h monitoring, was also able to detect hypertensives with increased LVM, in a way very similar to that of PP. We have also found that these patients have an early impairment of diastolic function, in particular of diastolic filling, as suggested by the increase of the late diastolic wave (A wave).…”

Section: Discussionsupporting

confidence: 53%

Clinic and ambulatory pulse pressure segregate a cluster of cardiovascular risk factors

et al. 2002

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Office pulse pressure (PP) has been found to be independently associated with cardiovascular morbidity and mortality. While there is evidence that 24 h blood pressure (BP) is a better marker of the cardiovascular complications of hypertension than office BP, this information is still lacking in regard to PP. The aim of the present study was, therefore, to evaluate possible differences between office and 24 h PP in their relationship with cardiovascular risk profile. This cross-sectional study was performed in a group of 175 (104 M, 71 F) hypertensives (43 never treated before the study) free of clinical evidence of target organ disease. BP was measured at rest and during 24 h monitoring; cardiac structure and function was studied by ultrasounds; biochemical analyses were performed to evaluate some parameters of lipid and carbohydrate metabolism.Patients were divided into tertiles of office PP and of 24 h PP. Those in the highest tertile of PP had a significantly higher office and 24 h systolic BP along with a reduction in peripheral insulin sensitivity. Regarding cardiac structure and function, a significantly higher prevalence of concentric left ventricular hypertrophy (23 vs 55%; P ¼ 0.05) and an initial impairment of diastolic function with increase of the A wave was detected in hypertensives with higher PP. No difference between office and 24 h PP in detecting patients at higher cardiovascular risk was observed. In conclusion, office and 24 h pulse pressures were both able to segregate patients with a cluster of cardiovascular risk factors.

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Section: Discussionsupporting

confidence: 53%

Clinic and ambulatory pulse pressure segregate a cluster of cardiovascular risk factors

et al. 2002

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“…14 Changes in amplitude and timing of wave reflections play a key role in aortic hemodynamics and, on a broader level, give us information on how the arterial vasculature affects the heart. [15][16][17][18][19] The SphygmoCor BPAS-1/A device (model SPT-301, PWV Medical Pty Ltd) calculates a number of parameters of ventriculo-arterial coupling and wave reflectance, of which the augmentation index (AIx) is preeminent. 11,20,21 Another approach in analyzing the arterial pulse is to regard the waveform as a basic pattern of exponential decay on which damped oscillations are superimposed, building on the "Grundform" -"Grundschwingung" concept pioneered by Otto Frank.…”

mentioning

confidence: 99%

A Comparison Between Systolic and Diastolic Pulse Contour Analysis in the Evaluation of Arterial Stiffness

et al. 2001

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Abstract-Several methodologically independent measures of arterial stiffness derived from either the systolic or diastolic segments of the arterial pulse have been proposed. The exact nature of the large and small artery elasticity indices (C1 and C2, respectively) derived from diastolic pulse contour analysis remains largely unexplored, although C2 has controversially been termed to be "oscillatory" and "reflective." We investigated the relation between C2 and, respectively, a prototype of arterial reflectivity (ie, the augmentation index, AIx) and a covariate of arterial reflectivity (body height). A validated transfer function is used to transform a tonometrically obtained radial pressure wave into an ascending aortic pressure wave, from which AIx is derived using systolic pulse contour analysis. Diastolic pulse contour analysis using a modified Windkessel model is used to derive C1 and C2. H emodynamics research has shifted away from a steadyflow approach toward a pulsatile flow approach, because the former was less predictive in relation to cardiovascular morbidity and mortality. [1][2][3][4][5] The growing importance of pulsatile pressure indices (systolic blood pressure [SBP] and pulse pressure) paralleled the notion that not only increases in systemic vascular resistance (SVR) but also increases in arterial stiffness are important in the pathophysiology of hypertension. 6,7 This interest in the arterial cushioning function of pulsatile flow has given us a myriad of arterial stiffness indices generated by a wide array of methodologically varied noninvasive measurement techniques. 8 -10 Several working definitions of arterial stiffness have been introduced: parameters of compliance or distensibility, which essentially express changes in mono-dimensional, bidimensional, or tridimensional space for a given pressure difference; parameters quantifying speed of wave propagation along an arterial segment (pulse-wave velocity); and parameters of global vascular elastic behavior derived from the arterial pressure pulse waveform.Given the complexity of the latter approach, simplified mathematical models have been developed. 9 The arterial pressure pulse waveform can be regarded as the result of incident (anterograde) and reflected (retrograde) pressure waves. [11][12][13] Wave reflection occurs at sites of discontinuity in calibre (bifurcations, branching points, and arterioles) or discontinuity in elastic properties (atherosclerosis) along the arterial tree. 14 Changes in amplitude and timing of wave reflections play a key role in aortic hemodynamics and, on a broader level, give us information on how the arterial vasculature affects the heart. [15][16][17][18][19] The SphygmoCor BPAS-1/A device (model SPT-301, PWV Medical Pty Ltd) calculates a number of parameters of ventriculo-arterial coupling and wave reflectance, of which the augmentation index (AIx) is preeminent. 11,20,21 Another approach in analyzing the arterial pulse is to regard the waveform as a basic pattern of exponential decay on which damped oscil...

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“…Saba et al [19] have shown that the LV weight/body weight ratio is larger in subjects with type A in comparison with those with type C arteries under equivalent normal blood pressures. Morita et al [20] compared the impedances of dogs with aortofemoral bypasses with those of control dogs and demonstrated that the primary change was a 2.5-fold increase in characteristic impedance.…”

Section: Discussionmentioning

confidence: 99%

Low Compliance Rather than High Reflection of Arterial System Decreases Stroke Volume in Arteriosclerosis: A Simulation.

Sugimachi

Shishido²,

Sunagawa³

2001

JJP

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Although it has been well established that ventricular performance indices, such as cardiac output and stroke volume, depend highly on the afterloading properties of the arterial system, the question of what arterial system mechanical characteristics, dynamic properties in particular, affect ventricular performance has not been well resolved. Various investigators have suggested that the left ventricles of aged subjects suffer as a result of early and enhanced arterial reflection because of arterial sclerosis [1], and that arterial reflections deteriorate pump function. Arterial reflection originates from the mismatch between the impedance43Japanese Journal of Physiology, 51, 43-51, 2001 Key words: arterial impedance, left ventricular pump function, computer simulation, ventricular arterial coupling.Abstract: Although various investigators have suggested that the left ventricles of aged subjects suffer from high-frequency reflection, arterial reflection is larger in the low-frequency range because of a larger impedance mismatch. It has not been quantified whether high-frequency reflection rather than low-frequency reflection has larger deleterious effects on stroke volume. We used a computer simulation method to evaluate how increases in high-and low-frequency arterial reflections associated with age-related arterial sclerosis affect left ventricular (LV) pump function. Low-frequency reflections derive principally from the total arterial compliance, and high-frequency reflections result from impedance fluctuations in the high-frequency range. We numerically coupled a time-varying elastance LV model with a variety of arterial impedances to quantitatively evaluate the effects of low-and high-frequency reflections on LV pump performance. When we simultaneously increased low-and high-frequency reflections to levels of sclerotic impedance (type A in Murgo et al., Circulation 62: 105-116, 1980), stroke volume decreased by 4.4%. Further increases of the reflections up to 8 times of the type A impedance lowered stroke volume by 15.9%. This trend was clearly seen with selective increases in low-frequency reflections (3.5 and 20.2% decrease in stroke volume, respectively), but not with those in high-frequency reflections (1.0% decrease and 0.9% increase in stroke volume, respectively). Thus we conclude that the detrimental effect of increases in arterial reflections associated with arterial sclerosis on stroke volume is mild and mainly attributable to decreased compliance rather than to increased high-frequency reflections.

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Relation of arterial pressure waveform to left ventricular and carotid anatomy in normotensive subjects

Cited by 247 publications

References 44 publications

Clinic and ambulatory pulse pressure segregate a cluster of cardiovascular risk factors

Clinic and ambulatory pulse pressure segregate a cluster of cardiovascular risk factors

A Comparison Between Systolic and Diastolic Pulse Contour Analysis in the Evaluation of Arterial Stiffness

Low Compliance Rather than High Reflection of Arterial System Decreases Stroke Volume in Arteriosclerosis: A Simulation.

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