Wave Reflections, Assessed With a Novel Method for Pulse Wave Separation, Are Associated With End-Organ Damage and Clinical Outcomes

Weber, Thomas; Wassertheurer, Siegfried; Rammer, M; Haiden, Anton; Hametner, Bernhard; Eber, Bernd

doi:10.1161/hypertensionaha.112.194571

Cited by 170 publications

(150 citation statements)

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“…cardiovascular events and RM and P b have also been observed in a study of 725 patients (55-72 years) undergoing coronary angiography 6 and between reflection index (RM/[1+RM]) and P b in another study of 1272 individuals (30-79 years) drawn from a community-based survey in Taiwan. 7 The results of these studies seem reasonably consistent ( Figure).…”

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confidence: 67%

“…Zamani et al 4 circumvented the requirement for flow measurement by using a scaled representative average aortic velocity waveform derived from the Asklepios population-based study. Other studies have used an estimate of aortic flow based on a Windkessel model 6 or have assumed a triangular shape for aortic flow. 7 Whichever assumption is used will introduce some uncertainty into the estimates of P b and P f .…”

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confidence: 99%

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Ahead of the Curve

Hughes

2014

Hypertension

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See related article, pp 958-964T he history of blood pressure (BP) waveform analysis is almost as undulatory as the waveform itself. The development of the sphygmograph in the mid-19th century led to a relatively brief, albeit intense, interest in the interpretation of the BP waveform.1 This was perhaps more an art than a science, and interest in the sphygmograph and the waveform declined after the introduction of the cuff-based sphygmomanometer. More recently, interest in pulse waveform analysis has reemerged, and the relative merits of estimated aortic (central) as opposed to brachial systolic and pulse pressure have been widely discussed. Although some issues remain unresolved, evidence from systematic reviews suggests that central pulse pressure may be a better predictor of cardiovascular events 2 and that central BP can be differentially modified by antihypertensive therapy, with β-blockers being comparatively less effective on central than peripheral BP.3 However, whatever the merits of measurement of central systolic or pulse pressure, a single number is unlikely to be an adequate descriptor of the morphology of a waveform, and the waveform may contain additional valuable and quantifiable information.In this issue, Zamani et al 4 report the results from ≈6000 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). BP waveforms were recorded using a noninvasive radial tonometric device and analyzed using a technique that separates them into forward (P f ) and backward (P b ) components. Reflection magnitude (RM) was calculated as the ratio of peak P b /peak P f . RM and P b were found to predict all-cause mortality, cardiovascular mortality, and noncardiovascular mortality in unadjusted models. Notably, the association with all-cause mortality was independent of conventional risk factors. It is also of interest, in terms of mechanisms, that this association was independent of a wide range of measures of subclinical atherosclerosis.These findings extend previous data from MESA where RM predicted cardiovascular end points and was strongly predictive of new-onset chronic heart failure.5 Associations betweenThe opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.From 7 The results of these studies seem reasonably consistent (Figure).Some technical considerations regarding the approach used by Zamani et al 4 and in other studies are worth consideration. Strictly, pressure separation requires measurement of both pressure and flow waveforms at a given location. Zamani et al 4 circumvented the requirement for flow measurement by using a scaled representative average aortic velocity waveform derived from the Asklepios population-based study. Other studies have used an estimate of aortic flow based on a Windkessel model 6 or have assumed a triangular shape for aortic flow.7 Whichever assumption is used will introduce some uncertainty into the estimates of P b and P f . A previous study by Kips et al 8 suggests that the correlation between RM c...

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confidence: 67%

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confidence: 99%

Ahead of the Curve

Hughes

2014

Hypertension

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“…In addition, in the study of Weber et al, 1 a novel method for the assessment of wave reflections based on an adopted Windkessel model, a flow curve estimation from the radial pressure waveforms, and wave separation analysis was applied in patients undergoing coronary angiography. The amplitude of reflected wave was significantly associated with the combined effects of cardiovascular end points.…”

Section: T He Eighth International Workhop On Structure Andmentioning

confidence: 99%

Introduction to the Eighth International Workshop on Structure and Function of the Vascular System

Struijker‐Boudier

Blacher²,

Lévy³

et al. 2012

Hypertension

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T he Eighth International Workshop on Structure and Function of the Vascular System was held in Paris, France, from February 16 through February 18, 2012. In the first editions of this workshop during the 1990s, the focus was on methodologies to assess vascular structure and function in humans, as well as how these changes contribute to cardiovascular risk. We now have well-standardized approaches to assess both large artery and microvascular structure and function. Thus, the focus of the workshop has shifted toward mechanistic studies on how mechanical factors affect arterial remodeling and target-organ damage. In addition, the question of whether pulse wave velocity is an adequate marker for (cardio)vascular disease can now be raised with more experimental evidence to find an answer.During the 3-day symposium, 5 sessions were held. The first dealt with arterial mechanical properties and target-organ damage. In recent years, most therapeutic trials have been focused on their own specific topic, diabetes mellitus or hypertension or hypercholesterolemia. Studies associating several cardiovascular risk factors have been performed only to a limited degree. The most frequent association refers to hypertension and diabetes mellitus type 2. Each of these 2 cardiovascular risk factors increases independently arterial stiffness, but the association has never been specifically investigated in humans. Factors associated with arterial stiffness differ markedly in hypertension (age, blood pressure [BP], and heart rate) and diabetes mellitus (advanced glycation end products and insulin resistance). Michel Safar showed that, for the same mean arterial BP, arterial stiffness is much higher in diabetes mellitus than in hypertension. On the other hand, the risk of stroke is much higher in hypertension and that of coronary heart disease much higher in diabetes mellitus.Nico Westerhof and Michael O'Rourke provided evidence in this workshop that the association of hypertension and diabetes mellitus requires the reduction of arterial stiffness but also of wave reflections. Westerhof proposed a model associating compliance, resistance, and inertance and O'Rourke a model related to pulse pressure amplification.Athanase Protogerou discussed how the noninvasive assessment of 24-hour aortic ambulatory BP provided the opportunity to investigate the interaction between the timedependence and arterial site-dependence of BP variability. In addition, in the study of Weber et al, 1 a novel method for the assessment of wave reflections based on an adopted Windkessel model, a flow curve estimation from the radial pressure waveforms, and wave separation analysis was applied in patients undergoing coronary angiography. The amplitude of reflected wave was significantly associated with the combined effects of cardiovascular end points. Clearly, such methods improve substantially the accuracy of cardiovascular assessments. In the last presentation of this session, Véro-nique Regnault suggested that hypertension and diabetes mellitus may confer, per s...

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“…113 Recently, Pb and AIx have been shown to be independently predictive of CV events, with Pb further predictive of all CV events and strongly predictive of congestive heart failure development following a median follow-up of 7.61 years. 114 Additional findings suggest that Pb predicts CV mortality independent of conventional risk factors in men and women 115 and highrisk patients, 116 and is associated with hypertensive end organ damage. 116 Moreover, changes in pressure from wave reflections are strong determinants of change in LV mass index following antihypertensive treatment, independent of changes in conventionally measured brachial BP.…”

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confidence: 97%

“…114 Additional findings suggest that Pb predicts CV mortality independent of conventional risk factors in men and women 115 and highrisk patients, 116 and is associated with hypertensive end organ damage. 116 Moreover, changes in pressure from wave reflections are strong determinants of change in LV mass index following antihypertensive treatment, independent of changes in conventionally measured brachial BP. 87,93,117 Taken together, these findings suggest that pressure from wave reflections with subsequent increases in late systolic load contributes to altered ventricular-vascular coupling, increased LV work, reduced coronary perfusion, and, ultimately, LVH (Figure 1).…”

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confidence: 97%

Arterial stiffness as a noninvasive tissue biomarker of cardiac target organ damage

Augustine¹,

Lefferts²,

Hughes³

et al. 2014

CBF

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Abstract:The primary prevention of cardiovascular (CV) disease is hindered by the inadequacy of traditional risk factors to stratify CV risk. The presence of cardiac target organ damage (cTOD), as detected by measures of left ventricular (LV) hypertrophy and dysfunction, is associated with future CV outcomes, but is not currently assessed in asymptomatic individuals. Arterial stiffness contributes to cTOD and may represent a biomarker that can detect vascular dysfunction before the clinical manifestations of cTOD. Measurement of arterial stiffness may provide insight into premature risk for cTOD and afford opportunity for early intervention to prevent further damage. The purpose of this review is to examine the utility of arterial stiffness as a noninvasive biomarker of subclinical cTOD. To this end, we will examine the evidence supporting the association between arterial stiffness and measures of cTOD. We will then explore the developmental origins of arterial stiffness and cTOD and outline the progression of CV damage that occurs with age. We discuss the mechanistic role of pressure from wave reflections as a crucial link between arterial stiffness and cTOD. Finally, we examine these associations in context by exploring sex and racial differences in arterial stiffness as related to cTOD. Our comprehensive examination of the literature suggests that early identification of arterial stiffness would be a useful biomarker of future cTOD risk.

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Wave Reflections, Assessed With a Novel Method for Pulse Wave Separation, Are Associated With End-Organ Damage and Clinical Outcomes

Cited by 170 publications

References 35 publications

Ahead of the Curve

Ahead of the Curve

Introduction to the Eighth International Workshop on Structure and Function of the Vascular System

Arterial stiffness as a noninvasive tissue biomarker of cardiac target organ damage

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