The effects of passive leg raising on arterial wave reflection in healthy adults

Kamran, Haroon; Salciccioli, Louis; Gusenburg, Jeffery; Kazmi, Haris; Ko, Eun Hee; Qureshi, Ghazanfar; Lazar, Jason

doi:10.1097/mbp.0b013e32833128d4

Cited by 13 publications

(12 citation statements)

References 40 publications

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“…Previous studies on PLR in healthy subjects reported transient changes of cardiovascular dynamics by PLR, but failed to show significant lasting effects of PLR [4][5][6][7]. In contrast, the present study revealed significant sustained effects on cardiovascular parameters even at 10 min after the start of PLR.…”

Section: Effects Of Plr On Cardiovascular Parameters and Their Durationcontrasting

confidence: 93%

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Effects of passive leg raising on cardiovascular functions as analyzed by fingertip pulse pressure profiles

Nemoto¹,

Takayo²,

Ito³

et al. 2016

Biomed Res Clin Prac

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Objective: This study investigated the efficacy, duration, and possible adverse effects of passive leg raising (PLR) by examining the cardiovascular responses over the entire course of PLR. Methods/results:Continuous measurements of cardiovascular parameters using a non-invasive finger blood pressure measurement system during PLR were performed on 8 healthy subjects. Blood pressures significantly increased during PLR when legs were raised at 20°, 30°, and 40° angles. This blood pressure increase was observed to be primarily due to an increase in stroke volume, which remained almost constant until the final 10 min of PLR. No significant differences in cardiovascular parameters between the different PLR angles were observed. The return of the legs to the horizontal position after PLR caused transient changes in cardiovascular parameters, including considerable transient decreases in stroke volume and total peripheral vascular resistance. Relevance of these findings to the cases with deteriorated cardiovascular functions, in which, PLR may cause a severe transient decrease in blood pressure leading to transient cerebral ischemic attack, is discussed.Conclusion: PLR caused increases in blood pressure, primarily because of an increase in stroke volume. A 20° PLR angle was sufficient to produce these effects.

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Section: Effects Of Plr On Cardiovascular Parameters and Their Durationcontrasting

confidence: 93%

“…The aim of this procedure is to improve blood circulation by facilitating venous return from the lower limbs [1][2][3][4][5][6][7][8][9][10]. However, several studies have cast doubts on the efficacy and duration of the effects of PLR [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Effects of passive leg raising on cardiovascular functions as analyzed by fingertip pulse pressure profiles

Nemoto¹,

Takayo²,

Ito³

et al. 2016

Biomed Res Clin Prac

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“…Tr was the same for both groups; in general increased arterial stiffness or a reduction in reflection site distance causes a decrease in Tr. Since Tr is related to ejection duration [59], arterial stiffness can change without a change in Tr. Indeed, if Tr is corrected for ejection duration then there is a decrease in this variable.…”

Section: Discussionmentioning

confidence: 99%

Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease

Nichols

Denardo²,

Johnson³

et al. 2013

Journal of Hypertension

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Objective Pulsatile wave reflections augment central aortic systolic blood pressure (BP) and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (WISE) and no obstructive coronary artery disease (CAD). Methods Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, body mass index (BMI), mean arterial BP and heart rate (HR). Results Compared with the reference group, WISE participants had higher aortic systolic and pulse BP and ejection duration (ED). These differences were associated with an increase in, augmentation index (AIx), and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with an increase in SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction (DPTF). Conclusions WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.

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“…Twelve studies were identified and examined to determine whether normalizing AIx to HR influences the interpretation of the findings (Table 1). Eight studies reported significantly improved between-group/condition differences using the AIx@75 versus the AIx alone [23][24][25][26][27][28][29] , two studies reported no significant differences using the AIx but a significant difference using AIx@75 30,31) , one study reported a decrease in significance using the AIx@75 32) and one study reported a change in the direction of the effect 33) . Given these findings, careful interpretation of the physiological significance of normalization to HR is warranted.…”

Section: Validity Of the Aix And Influence Of Normalization To Hrmentioning

confidence: 99%

Should the Augmentation Index be Normalized to Heart Rate?

Stoner

Faulkner

Lowe

et al. 2014

JAT

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Pulse wave analysis (PWA) is widely used to investigate systemic arterial stiffness. The augmentation index (AIx), the primary outcome derived from PWA, is influenced by the mean arterial pressure (MAP), age, gender and heart rate (HR). Gender-and age-specific reference values have been devised, and it is recommended that the MAP be used as a statistical covariate. The AIx is also commonly statistically adjusted to a HR of 75 b·min; however, this approach may be physiologically and statistically inappropriate. First, there appears to be an important physiological chronic interaction between HR and arterial stiffness. Second, the method used to correct to HR assumes that the relationship with AIx is uniform across populations. A more appropriate practice may be to include HR as an independent predictor or covariate; this approach is particularly recommended for longitudinal studies, in which changes in HR may help to explain changes in arterial stiffness.

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The effects of passive leg raising on arterial wave reflection in healthy adults

Abstract: PLR decreases the amplitude and delays the onset of the reflected aortic pressure wave. This decreases wasted LV pressure energy and workload.

Cited by 13 publications

References 40 publications

Effects of passive leg raising on cardiovascular functions as analyzed by fingertip pulse pressure profiles

Effects of passive leg raising on cardiovascular functions as analyzed by fingertip pulse pressure profiles

Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease

Should the Augmentation Index be Normalized to Heart Rate?

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