Wave intensity of aortic root pressure as diagnostic marker of left ventricular systolic dysfunction

Hametner, Bernhard; Parragh, Stephanie; Weber, Thomas; Wassertheurer, Siegfried

doi:10.1371/journal.pone.0179938

Cited by 20 publications

(21 citation statements)

References 37 publications

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“…There are many studies devoted to determining the relationship between the indicators of CAP and the risk of AKI and cardiovascular complications [6,8,9,14], but there are not enough works that would determine the significance of these indicators in the perioperative period. Some studies have identified a close direct correlation between CAP and AKI [15], but in our study we did not find such a relationship, possibly due to the small sample size.…”

Section: R E S U L T S a N D Discussionmentioning

confidence: 99%

“…It is difficult to predict cardiac events (acute coronary syndrome (ACS) or arrhythmias (HR)) or acute kidney injury (AKI) based on the results of standard preoperative examination of patients with coronary artery disease (CHD). However, a number of studies have shown that this category of adverse effects was often associated with impaired organ perfusion in patients with increased central aortic pressure (CAP) and arterial stiffness (AF) [4,5,6]. And these indicators with a sufficient degree of reliability can be assessed by non-invasive methods and do not require significant labor costs [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Аrterial Stiffness and Central Aortal Pressure as Significant Predictors of Complications After Off-Pump Coronary Artery Bypass Grafting

Turovets¹,

Popov²,

Ekstrem³

et al. 2021

ArveMED

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Some studies have shown that an increase in arterial stiffness and central aortic pressure increase the risk of postoperative complications for off-pump coronary artery bypass grafting (off-pump CABG). AIM: To determine the significance of arterial stiffness and central aortic pressure indicators for predicting acute kidney injury (AKI) and cardiac events in patients after off-pump CABG. MATERIALS AND METHODS: An analysis of off-pump CABG outcomes was carried out in 196 patients (mean age 62.7 ± 5.3 years) without clinical signs of chronic kidney disease. The patients were divided into a test (n = 56) and control (n = 140) groups, depending on the presence or absence of AKI, acute coronary syndrome (ACS), or cardiac arrhythmias in the early postoperative period. Pulse wave velocity indicators (PWV) were processed on the carotidfemoral (cf PWV) and brachio-ankle (baPWV) segments, and the results of measuring central aortic pressure (CAP). RESULTS: It has been proven that the incidence of AKI is significantly higher in patients with higher cf PWV (n <0.001), baPWV (n = 0.034) and systolic aortic pressure (SAP) (n = 0.013). ACS was more often observed in patients with higher SAP (n <0.001) and diastolic (DAP) (n = 0.005) aortic pressure, and cardiac arrhythmias in patients with higher SAP and office systolic pressure (n < 0.001). Based on the results of logistic regression analysis, it was determined (by regression coefficients — B) that an increase in cf PWV by 1 m/s increases the risk of AKI by 85.0%. An increase in SAP by one unit significantly increases the risk of ACS by 111.0% and cardiac arrhythmias by 58.0%. It was shown that the measurement of CAP has a greater diagnostic value than the office measurement of blood pressure. CONCLUSION: Arterial stiffness is an independent predictor of AKI for off-pump CABG. A decrease in PWV value is accompanied by a decrease in the incidence of AKI. CAP indices have a more significant prognostic value with respect to the likelihood of cardiac events after an off-pump CABG than the data of measurement of blood pressure.

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Section: R E S U L T S a N D Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Аrterial Stiffness and Central Aortal Pressure as Significant Predictors of Complications After Off-Pump Coronary Artery Bypass Grafting

Turovets¹,

Popov²,

Ekstrem³

et al. 2021

ArveMED

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“…The method used to derive the flow velocity waveform from the measured pressure has some similarities with the approach used to derive flow waveforms in the ARCSolver method, which is based on a 3-element Windkesel model plus a minimal work criterion (Hametner et al, 2013). The ARCSolver method has been reported to outperform a simple triangular flow assumption in terms of pressure separation (Hametner et al, 2013), and it has been used for wave intensity analysis in one study (Hametner et al, 2017), although we are not aware of any validation studies using this approach.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Estimation of Aortic Wave Intensity Using Non-invasive Pressure Recordings in the Absence of Flow Velocity in Man

et al. 2020

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Background: Wave intensity analysis provides valuable information on ventriculoarterial function, hemodynamics, and energy transfer in the arterial circulation. Widespread use of wave intensity analysis is limited by the need for concurrent measurement of pressure and flow waveforms. We describe a method that can estimate wave intensity patterns using only non-invasive pressure waveforms (pWIA). Methods: Radial artery pressure and left ventricular outflow tract (LVOT) flow velocity waveforms were recorded in 12 participants in the Southall and Brent Revisited (SABRE) study. Pressure waveforms were analyzed using custom-written software to derive the excess pressure (P xs) which was scaled to peak LVOT velocity and used to calculate wave intensity. These data were compared with wave intensity calculated using the measured LVOT flow velocity waveform. In a separate study, repeat measures of pWIA were performed on 34 individuals who attended two clinic visits at an interval of ≈1 month to assess reproducibility and reliability of the method. Results: P xs waveforms were similar in shape to aortic flow velocity waveforms and the time of peak P xs and peak aortic velocity agreed closely. Wave intensity estimated using pWIA showed acceptable agreement with estimates using LVOT velocity tracings and estimates of wave intensity were similar to values reported previously in the literature. The method showed fair to good reproducibility for most parameters. Conclusion: The P xs is a surrogate of LVOT flow velocity which, when appropriately scaled, allows estimation of aortic wave intensity with acceptable reproducibility. This may enable wider application of wave intensity analysis to large studies.

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“…Previous works found that AP and AIx are lower for patients with systolic heart failure (SHF) as well as reduced EF, which is one of the main characteristics of SHF. 16,36,37 Possible reasons for this decrease in AP and AIx are changes in HR and ED. 16 Additional to a decreased contractility, heart failure with reduced ejection fraction (HFrEF) is often accompanied with a dilated ventricle.…”

Section: Discussionmentioning

confidence: 99%

Simulating re-reflections of arterial pressure waves at the aortic valve using difference equations

Hametner

Kastinger

Wassertheurer

2020

Proc Inst Mech Eng H

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Re-reflections of arterial pressure waves at the aortic valve and their influence on aortic wave shape are only poorly understood so far. Therefore, the aim of this work is to establish a model enabling the simulation of re-reflection and to test its properties. A mathematical difference equation model is used for the simulations. In this model, the aortic blood pressure is split into its forward and backward components which are calculated separately. The respective equations include reflection percentages representing reflections throughout the arterial system and a reflection coefficient at the aortic valve. While the distal reflections are fixed, different scenarios for the reflection coefficient at the valve are simulated. The results show that the model is capable to provide physiological pressure curves only if re-reflections are assumed to be present during the whole cardiac cycle. The sensitivity analysis on the reflection coefficient at the aortic valve shows various effects of re-reflections on the modelled blood pressure curve. Higher levels of the reflection coefficient lead to higher systolic and diastolic pressure values. The augmentation index is notably influenced by the systolic level of the reflection coefficient. This difference equation model gives an adequate possibility to simulate aortic pressure incorporating re-reflections at the site of the aortic valve. Since a strong dependence of the aortic pressure wave on the choice of the reflection coefficient have been found, this indicates that re-reflections should be incorporated into models of wave transmission. Furthermore, re-reflections may also be considered in methods of arterial pulse wave analysis.

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Wave intensity of aortic root pressure as diagnostic marker of left ventricular systolic dysfunction

Cited by 20 publications

References 37 publications

Аrterial Stiffness and Central Aortal Pressure as Significant Predictors of Complications After Off-Pump Coronary Artery Bypass Grafting

Аrterial Stiffness and Central Aortal Pressure as Significant Predictors of Complications After Off-Pump Coronary Artery Bypass Grafting

Feasibility of Estimation of Aortic Wave Intensity Using Non-invasive Pressure Recordings in the Absence of Flow Velocity in Man

Simulating re-reflections of arterial pressure waves at the aortic valve using difference equations

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