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1
Liu, Chengyu, Tao Zhuang, Lina Zhao, et al. "Modelling Arterial Pressure Waveforms Using Gaussian Functions and Two-Stage Particle Swarm Optimizer." BioMed Research International 2014 (2014): 1–10. http://dx.doi.org/10.1155/2014/923260.
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Changes of arterial pressure waveform characteristics have been accepted as risk indicators of cardiovascular diseases. Waveform modelling using Gaussian functions has been used to decompose arterial pressure pulses into different numbers of subwaves and hence quantify waveform characteristics. However, the fitting accuracy and computation efficiency of current modelling approaches need to be improved. This study aimed to develop a novel two-stage particle swarm optimizer (TSPSO) to determine optimal parameters of Gaussian functions. The evaluation was performed on carotid and radial artery pressure waveforms (CAPW and RAPW) which were simultaneously recorded from twenty normal volunteers. The fitting accuracy and calculation efficiency of our TSPSO were compared with three published optimization methods: the Nelder-Mead, the modified PSO (MPSO), and the dynamic multiswarm particle swarm optimizer (DMS-PSO). The results showed that TSPSO achieved the best fitting accuracy with a mean absolute error (MAE) of 1.1% for CAPW and 1.0% for RAPW, in comparison with 4.2% and 4.1% for Nelder-Mead, 2.0% and 1.9% for MPSO, and 1.2% and 1.1% for DMS-PSO. In addition, to achieve target MAE of 2.0%, the computation time of TSPSO was only 1.5 s, which was only 20% and 30% of that for MPSO and DMS-PSO, respectively.
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Salvi, Paolo, Filippo Valbusa, Anna Kearney-Schwartz, et al. "Non-Invasive Assessment of Arterial Stiffness: Pulse Wave Velocity, Pulse Wave Analysis and Carotid Cross-Sectional Distensibility: Comparison between Methods." Journal of Clinical Medicine 11, no. 8 (2022): 2225. http://dx.doi.org/10.3390/jcm11082225.
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Background: The stiffening of large elastic arteries is currently estimated in research and clinical practice by propagative and non-propagative models, as well as parameters derived from aortic pulse waveform analysis. Methods: Common carotid compliance and distensibility were measured by simultaneously recording the diameter and pressure changes during the cardiac cycle. The aortic and upper arm arterial distensibility was estimated by measuring carotid–femoral and carotid–radial pulse wave velocity (PWV), respectively. The augmentation index and blood pressure amplification were derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the common carotid artery. Results: 75 volunteers were enrolled in this study (50 females, average age 53.5 years). A significant inverse correlation was found between carotid distensibility and carotid–femoral PWV (r = −0.75; p < 0.001), augmentation index (r = −0.63; p < 0.001) and central pulse pressure (r = −0.59; p < 0.001). A strong correlation was found also between the total slope of the diameter/pressure rate carotid curves and aortic distensibility, quantified from the inverse of the square of carotid–femoral PWV (r = 0.67). No correlation was found between carotid distensibility and carotid–radial PWV. Conclusions: This study showed a close correlation between carotid–femoral PWV, evaluating aortic stiffness by using the propagative method, and local carotid cross-sectional distensibility.
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van Houwelingen, Marc J., Daphne Merkus, Jan Hofland, et al. "A novel approach to assess hemorrhagic shock severity using the arterially determined left ventricular isovolumic contraction period." American Journal of Physiology-Heart and Circulatory Physiology 305, no. 12 (2013): H1790—H1797. http://dx.doi.org/10.1152/ajpheart.00504.2013.
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Recently, the ventilatory variation in pre-ejection period (ΔPEP) was found to be useful in the prediction of fluid-responsiveness of patients in shock. In the present study we investigated the behavior of the ventilation-induced variations in the systolic timing intervals in response to a graded hemorrhage protocol. The timing intervals studied included the ventilatory variation in ventricular electromechanical delay (ΔEMD), isovolumic contraction period (determined from the arterial pressure waveform, ΔAIC), pulse travel time (ΔPTT), and ΔPEP. ΔAIC and ΔPEP were evaluated in the aorta and carotid artery (annotated by subscripts Ao and CA) and were compared with the responses of pulse pressure variation (ΔPPAo) and stroke volume variation (ΔSV). The graded hemorrhage protocol, followed by resuscitation using norepinephrine and autologous blood transfusion, was performed in eight anesthetized Yorkshire X Landrace swine. ΔAICAo, ΔAICCA, ΔPEPAo, ΔPEPCA, ΔPPAo, ΔPPCA, and ΔSV showed significant increases during the graded hemorrhage and significant decreases during the subsequent resuscitation. ΔAICAo, ΔAICCA, ΔPEPAo, and ΔPEPCA all correlated well with ΔPPAo and ΔSV (all r ≥ 0.8, all P < 0.001). ΔEMD and ΔPTT did not significantly change throughout the protocol. In contrast with ΔPEPAo, which was significantly higher than ΔPEPCA ( P < 0.01), ΔAICAo was not different from ΔAICCA. In conclusion, ventilation-induced preload variation principally affects the arterially determined isovolumic contraction period (AIC). Moreover, ΔAIC can be determined solely from the arterial pressure waveform, whereas ΔPEP also requires ECG measurement. Importantly, ΔAIC determined from either the carotid or aortic pressure waveform are interchangeable, suggesting that, in contrast with ΔPEP, ΔAIC may be site independent.
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Shibata, Shigeki, and Benjamin D. Levine. "Biological aortic age derived from the arterial pressure waveform." Journal of Applied Physiology 110, no. 4 (2011): 981–87. http://dx.doi.org/10.1152/japplphysiol.01261.2010.
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Indexes for arterial stiffness are, by their nature, influenced by the ambient blood pressure due to the curvilinear nature of arterial compliance. We developed a new concept of the “Modelflow aortic age,” which is, theoretically, not influenced by the ambient blood pressure and provides an easily understood context (biological vs. chronological age) for measures of arterial stiffness. The purpose of the present study was to validate this pressure-independent index for aortic stiffness in humans. Twelve sedentary elderly (65–77 yr), 11 Masters athletes (65–73 yr), and 12 sedentary young individuals (20–42 yr) were studied. Modelflow aortic ages were comparable with chronological ages in both sedentary groups, indicating that healthy sedentary individuals have age-appropriate aortas. In contrast, Masters athletes showed younger Modelflow aortic ages than their chronological ages. The coefficient of variation of sedentary subjects was three times smaller with the Modelflow aortic age (21%) than with other indexes, such as static systemic arterial stiffness (61%), central pulse wave velocity (61%), or carotid β-stiffness index (58%). The typical error was very small and two times smaller in the Modelflow aortic age (<7%) than in static systemic arterial stiffness (>13%) during cardiac unloading by lower body negative pressure. The Modelflow aortic age can more precisely and reliably estimate aortic stiffening with aging and modifiers, such as life-long exercise training compared with the pressure-dependent index of static systemic arterial stiffness, and provides a physiologically relevant and clinically compelling context for such measurements.
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Edwards, David G., Matthew S. Roy, and Raju Y. Prasad. "Wave reflection augments central systolic and pulse pressures during facial cooling." American Journal of Physiology-Heart and Circulatory Physiology 294, no. 6 (2008): H2535—H2539. http://dx.doi.org/10.1152/ajpheart.01369.2007.
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Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.
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Holewijn, Suzanne, Jenske J. M. Vermeulen, Majorie van Helvert, Lennart van de Velde, and Michel M. P. J. Reijnen. "Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair." Journal of Endovascular Therapy 28, no. 3 (2021): 434–41. http://dx.doi.org/10.1177/15266028211007460.
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Purpose: To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. Materials and Methods: A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. Results: CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. Conclusion: Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Reesink, Koen D., Evelien Hermeling, M. Christianne Hoeberigs, Robert S. Reneman, and Arnold P. G. Hoeks. "Carotid artery pulse wave time characteristics to quantify ventriculoarterial responses to orthostatic challenge." Journal of Applied Physiology 102, no. 6 (2007): 2128–34. http://dx.doi.org/10.1152/japplphysiol.01206.2006.
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Central blood pressure waveforms contain specific features related to cardiac and arterial function. We investigated posture-related changes in ventriculoarterial hemodynamics by means of carotid artery (CA) pulse wave analysis. ECG, brachial cuff pressure, and common CA diameter waveforms (by M-mode ultrasound) were obtained in 21 healthy volunteers (19–30 yr of age, 10 men and 11 women) in supine and sitting positions. Pulse wave analysis was based on a timing extraction algorithm that automatically detects acceleration maxima in the second derivative of the CA pulse waveform. The algorithm enabled determination of isovolumic contraction period (ICP) and ejection period (EP): ICP = 43 ± 8 (SD) ms (4-ms precision), and EP = 302 ± 16 (SD) ms (5-ms precision). Compared with the supine position, in the sitting position diastolic blood pressure (DBP) increased by 7 ± 4 mmHg ( P < 0.001) and R-R interval decreased by 49 ± 82 ms ( P = 0.013), reflecting normal baroreflex response, whereas EP decreased to 267 ± 19 ms ( P < 0.001). Shortening of EP was significantly correlated to earlier arrival of the lower body peripheral reflection wave ( r2 = 0.46, P < 0.001). ICP increased by 7 ± 7 ms ( P < 0.001), the ICP-to-EP ratio increased from 14 ± 3% (supine) to 19 ± 3% ( P < 0.001) and the DBP-to-ICP ratio decreased by 7% ( P = 0.023). These results suggest that orthostasis decreases left ventricular output as a result of arterial wave reflections and, presumably, reduced cardiac preload. We conclude that CA ultrasound and pulse wave analysis enable noninvasive quantification of ventriculoarterial responses to changes in posture.
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Yildiz, Mustafa. "Arterial Distensibility in Chronic Inflammatory Rheumatic Disorders." Open Cardiovascular Medicine Journal 4, no. 1 (2010): 83–88. http://dx.doi.org/10.2174/1874192401004010083.
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The pulse wave velocity (PWV), as an indicator of arterial distensibility, may play an important role in the stratification of patients based on the cardiovascular risk. PWV inversely correlates with arterial distensibility and relative arterial compliance. Decreased arterial distensibility alters arterial blood pressure and flow dynamics, and disturbes coronary perfusion. Systemic immune and inflammatory diseases, such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with increased morbidity and mortality, predominantly due to adverse cardiovascular events. Systemic inflammation in these disorders may alter arterial compliance and arterial distensibility and, through this effect, lead to accelerated atherosclerosis. We have demonstrated an increase in the carotid-femoral (aortic) PWV that is a technique in which large artery elasticity is assessed from analysis of the peripheral arterial waveform, in patients with chronic inflammatory conditions such as RA, SLE, familial Mediterranean fever (FMF), Wegener’s granulomatosis (WG), sarcoidosis, psoriasis and psoriatic arthritis except Behçet’s disease (BD). In this review, the issue of arterial stiffness in RA, SLE, as well as WG, psoriasis, FMF, BD, sarcoidosis, systemic sclerosis (SS) and Takayasu's arteritis (TA) is overviewed.
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Paré, Mathilde, Rémi Goupil, Catherine Fortier, et al. "Increased Excess Pressure After Creation of an Arteriovenous Fistula in End-Stage Renal Disease." American Journal of Hypertension 35, no. 2 (2021): 149–55. http://dx.doi.org/10.1093/ajh/hpab161.
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ABSTRACT BACKGROUND Reservoir-wave analysis (RWA) separates the arterial waveform into reservoir and excess pressure (XSP) components, where XSP is analogous to flow and related to left ventricular workload. RWA provides more detailed information about the arterial tree than traditional blood pressure (BP) parameters. In end-stage renal disease (ESRD), we have previously shown that XSP is associated with increased mortality and is higher in patients with arteriovenous fistula (AVF). In this study, we examined whether XSP increases after creation of an AVF in ESRD. METHODS Before and after a mean of 3.9 ± 1.2 months following creation of AVF, carotid pressure waves were recorded using arterial tonometry. XSP and its integral (XSPI) were derived using RWA through pressure wave analysis alone. Aortic stiffness was assessed by carotid–femoral pulse wave velocity (CF-PWV). RESURLTS In 38 patients (63% male, age 59 ± 15 years), after AVF creation, brachial diastolic BP decreased (79 ± 10 vs. 72 ± 12 mm Hg, P = 0.002), but the reduction in systolic BP, was not statistically significant (133 ± 20 vs. 127 ± 26 mm Hg, P = 0.137). However, carotid XSP (14 [12–19] to 17 [12–22] mm Hg, P = 0.031) and XSPI increased significantly (275 [212–335] to 334 [241–439] kPa∙s, P = 0.015), despite a reduction in CF-PWV (13 ± 3.6 vs. 12 ± 3.5 m/s, P = 0.025). CONCLUSIONS Creation of an AVF resulted in increased XSP in this population, despite improvement in diastolic BP and aortic stiffness. These findings underline the complex hemodynamic impact of AVF on the cardiovascular system.
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Bentley, Gisele J., James R. Cox, Catherine Liao, Alberto Avolio, Ahmad Qasem, and Mark Butlin. "P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS." Journal of Hypertension 42, Suppl 3 (2024): e129. http://dx.doi.org/10.1097/01.hjh.0001063600.27122.5e.
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Background: Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women. Methods: A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (< 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals. Results: The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p <0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p<0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)]. Conclusions: Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.
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Tomasova, Lenka, Marian Grman, Anton Misak, Lucia Kurakova, Elena Ondriasova, and Karol Ondrias. "Cardiovascular “Patterns” of H2S and SSNO−-Mix Evaluated from 35 Rat Hemodynamic Parameters." Biomolecules 11, no. 2 (2021): 293. http://dx.doi.org/10.3390/biom11020293.
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This work is based on the hypothesis that it is possible to characterize the cardiovascular system just from the detailed shape of the arterial pulse waveform (APW). Since H2S, NO donor S-nitrosoglutathione (GSNO) and their H2S/GSNO products (SSNO−-mix) have numerous biological actions, we aimed to compare their effects on APW and to find characteristic “patterns” of their actions. The right jugular vein of anesthetized rats was cannulated for i.v. administration of the compounds. The left carotid artery was cannulated to detect APW. From APW, 35 hemodynamic parameters (HPs) were evaluated. H2S transiently influenced all 35 HPs and from their cross-relationships to systolic blood pressure “patterns” and direct/indirect signaling pathways of the H2S effect were proposed. The observed “patterns” were mostly different from the published ones for GSNO. Effect of SSNO−-mix (≤32 nmol kg−1) on blood pressure in the presence or absence of a nitric oxide synthase inhibitor (L-NAME) was minor in comparison to GSNO, suggesting that the formation of SSNO−-mix in blood diminished the hemodynamic effect of NO. The observed time-dependent changes of 35 HPs, their cross-relationships and non-hysteresis/hysteresis profiles may serve as “patterns” for the conditions of a transient decrease/increase of blood pressure caused by H2S.
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Balis, Peter, Andrea Berenyiova, Anton Misak, et al. "The Phthalic Selenoanhydride Decreases Rat Blood Pressure and Tension of Isolated Mesenteric, Femoral and Renal Arteries." Molecules 28, no. 12 (2023): 4826. http://dx.doi.org/10.3390/molecules28124826.
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Phthalic selenoanhydride (R-Se) solved in physiological buffer releases various reactive selenium species including H2Se. It is a potential compound for Se supplementation which exerts several biological effects, but its effect on the cardiovascular system is still unknown. Therefore, herein we aimed to study how R-Se affects rat hemodynamic parameters and vasoactive properties in isolated arteries. The right jugular vein of anesthetized Wistar male rats was cannulated for IV administration of R-Se. The arterial pulse waveform (APW) was detected by cannulation of the left carotid artery, enabling the evaluation of 35 parameters. R-Se (1–2 µmol kg−1), but not phthalic anhydride or phthalic thioanhydride, transiently modulated most of the APW parameters including a decrease in systolic and diastolic blood pressure, heart rate, dP/dtmax relative level, or anacrotic/dicrotic notches, whereas systolic area, dP/dtmin delay, dP/dtd delay, anacrotic notch relative level or its delay increased. R-Se (~10–100 µmol L−1) significantly decreased the tension of precontracted mesenteric, femoral, and renal arteries, whereas it showed a moderate vasorelaxation effect on thoracic aorta isolated from normotensive Wistar rats. The results imply that R-Se acts on vascular smooth muscle cells, which might underlie the effects of R-Se on the rat hemodynamic parameters.
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Misak, Anton, Lucia Kurakova, Andrea Berenyiova, et al. "Patterns and Direct/Indirect Signaling Pathways in Cardiovascular System in the Condition of Transient Increase of NO." BioMed Research International 2020 (May 28, 2020): 1–16. http://dx.doi.org/10.1155/2020/6578213.
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Aim. To study “patterns” and connections of signaling pathways derived from the rat arterial pulse waveform (APW) under the condition of transient NO increase. Methods and Results. The right jugular vein of anesthetized Wistar rats was cannulated for administration of NO donor S-nitrosoglutathione. The left carotid artery was cannulated to detect APW. From rat APW, 35 hemodynamic parameters (HPs) and several their crossrelationships were evaluated. We introduced a new methodology to study “patterns” and connections of different signaling pathways, which are suggested from hysteresis and nonhysteresis crossrelationships of 35 rat HPs. Here, we show parallel time-dependent patterns of 35 HPs and some of their crossrelationships under the condition of transient increase of NO bioavailability by administration of S-nitrosoglutathione. Approximate nonhysteresis relationships were observed between systolic blood pressure and at least 11 HPs suggesting that these HPs, i.e., their signaling pathways, responding to NO concentration, are directly connected. Hysteresis relationships were observed between systolic blood pressure and at least 14 HPs suggesting that the signaling pathways of these HPs are indirectly connected. Totally, from the crossrelationships of 35 HPs, one can obtain 595 “patterns” and indication of direct or indirect connections between the signaling pathways. Conclusion. We described the procedure leading virtually to 595 relationships, from which “patterns” for transient NO increase and direct or indirect connections of signaling pathways can be suggested. From a clinical perspective, this approach may be used in animal models and in humans to create a data bank of patterns of crossrelationships of HPs for different cardiovascular conditions. By comparison with unknown patterns of studied APW with the data bank patterns, it would be possible to determine cardiovascular conditions of the studied subject from the recorded arterial blood pressure. Additionally, it can help to find molecular mechanism of particular (patho-) physiological conditions or drug action and may have predictive or diagnostic value.
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Bartoloni, Elena, Giacomo Pucci, Francesca Cannarile, et al. "Central Hemodynamics and Arterial Stiffness in Systemic Sclerosis." October 18, 2016. https://doi.org/10.1161/hypertensionaha.116.08345.
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Although microvascular disease is a hallmark of systemic sclerosis (SSc), a higher prevalence of macrovascular disease and a poorer related prognosis have been reported in SSc than in the general population. The simultaneous assessment of prognostically relevant functional properties of larger and smaller arteries, and their effects on central hemodynamics, has never been performed in SSc using the state-of-the-art techniques. Thirty-four women with SSc (aged 61±15 years, disease duration 17±12 years, and blood pressure 123/70±18/11 mm Hg) and 34 healthy women individually matched by age and mean arterial pressure underwent the determination of carotid-femoral (aortic) and carotid-radial (upper limb) pulse wave velocity (a direct measure of arterial stiffness), aortic augmentation (a measure of the contribution of reflected wave to central pulse pressure), and aortobrachial pulse pressure amplification (brachial/aortic pulse pressure) through applanation tonometry (SphygmoCor). Patients and controls did not differ by carotid-femoral or carotid-radial pulse wave velocity. Aortic augmentation index corrected for a heart rate of 75 bpm (AIx@75) was higher in women with SSc (30.9±16% versus 22.2±12%; P =0.012). Patients also had a lower aortobrachial amplification of pulse pressure (1.22±0.18 versus 1.33±0.25; P =0.041). SSc was an independent predictor of AIx@75 (direct) and pulse pressure amplification (inverse). Among patients, age, mean arterial pressure, and C-reactive protein independently predicted carotid-femoral pulse wave velocity. Age and mean arterial pressure were the only predictors of AIx@75. Women with SSc have increased aortic augmentation and decreased pulse pressure amplification (both measures of the contribution of reflected wave to central waveform) but no changes in aortic or upper limb arterial stiffness. Microvascular involvement occurs earlier than large artery stiffening in SSc.
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Manoj, Rahul, Raj Kiran V, P. M. Nabeel, Mohanasankar Sivaprakasam, and Jayaraj Joseph. "Arterial pressure pulse wave separation analysis using a multi-gaussian decomposition model." Physiological Measurement, May 10, 2022. http://dx.doi.org/10.1088/1361-6579/ac6e56.
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Abstract Objective: Methods for separating the forward-backward components from blood pulse waves rely on simultaneously measured pressure and flow velocity from a target artery site. Modelling approaches for flow velocity simplify the wave separation analysis (WSA), providing a methodological and instrumentational advantage over the former; however, current methods are limited to the aortic site. In this work, a multi-Gaussian decomposition (MGD) modelled WSA (MGDWSA) is developed for a non-aortic site asuch as the carotid artery. While the model is an adaptation of the existing wave separation theory, it does not rely on the information of measured or modelled flow velocity. Approach: The proposed model decomposes the arterial pressure waveform using weighted and shifted multi-Gaussians, which are then uniquely combined to yield the forward (PF(t)) and backward (PB(t)) pressure wave. A study using the database of healthy (virtual) subjects was used to evaluate the performance of MGDWSA at the carotid artery and was compared against reference flow-based WSA methods. Main Results: The MGD modelled pressure waveform yielded a root-mean-square error (RMSE) < 0.35 mmHg. Reliable forward-backward components with a group average RMSE < 2.5 mmHg for PF(t) and PB(t) were obtained. When compared with the reference counterparts, the pulse pressures (ΔPF and ΔPB), as well as reflection quantification indices, showed a statistically significant strong correlation (r > 0.96, p < 0.0001) and (r > 0.83, p < 0.0001) respectively, with an insignificant (p > 0.05) bias. Significance: This study reports WSA for carotid pressure waveforms without assumptions on flow conditions. The proposed method has the potential to adapt and widen the vascular health assessment techniques incorporating pulse wave dynamics.
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Ayer, Julian G., Albert Avolio, Guy Marks, Jason A. Harmer, and David S. Celermajer. "Abstract 2994: Gender-Related Differences in the Central Arterial Pressure Waveform Begin in Childhood and are Independent of Height." Circulation 118, suppl_18 (2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_802.
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Introduction Women develop age-related LV hypertrophy and symptomatic heart failure to a greater extent than men. Contributing to this may be a higher pulsatile afterload in women, with a higher central arterial systolic augmentation pressure (AP, peak pressure minus pressure at systolic shoulder) and augmentation index (AIx, ratio of AP to pulse pressure). It is unclear if these differences are due to gender per se or shorter female stature. We studied 8-year old children to determine if gender-related differences in carotid pressure augmentation are present in early life and if so, whether they are independent of height (Ht). Methods 406 children (age 8.0 ± 0.1, 49% girls) had anthropometry, brachial systolic and diastolic BP (SBP, DBP), heart rate (HR) and carotid and radial pressure waveforms (by applanation tonometry, calibrated to mean BP and DBP) assessed. Carotid ultrasound evaluated arterial elasticity [Carotid Artery Compliance (CAC), Stiffness Index (SI) and Young’s Elastic Modulus (YEM)]. Results Boys and girls had a similar Ht (129 ± 6 v 128 ± 6 cm), BMI (17.6 ± 3.1 v 17.5 ± 3.0), SBP (100 ± 7 v 101 ± 5 mmHg), DBP (59 ± 6 v 60 ± 5 mmHg) and HR (80 ± 10 v 82 ± 10 bpm). The carotid AP and AIx were significantly higher in girls (−4 ± 3 v −6 ± 4 mmHg and −12 ± 8 v −16 ± 9 respectively, p < 0.001), indicating greater systolic pressure augmentation. Time to onset of the reflected wave ( Tr ) and time to peak of the reflected wave were shorter in girls (154 ± 19 v 163 ± 18 msec, p < 0.001 and 206 ± 23 v 212 ± 22 msec, p = 0.03 respectively), indicating earlier wave reflection. Girls had a higher velocity index (Vr) estimated from Ht ( Vr = Ht /Tr , 8.4 ± 1.0 v 8.0 ± 0.9 m/sec, p = 0.001). Ejection duration, maximum rate of pressure rise and time to systolic peak (indicating effect of ventricular ejection on the carotid waveform) were not significantly different between genders. Boys, however, had stiffer carotid arteries than girls [lower CAC (5.8 ± 1.5 v 6.2 ± 1.8 %/10 mmHg, p = 0.016), higher SI (2.7 ± 0.7 v 2.5 ± 0.7, p = 0.012) and YEM (735 ± 217 v 681 ± 237, p = 0.021)]. Conclusion Even in the first decade of life, girls demonstrate greater central arterial pressure augmentation than boys, with earlier wave reflection. This is independent of height and may contribute to cardiovascular morbidity in females, later in life.
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Mitchell, Gary F., Jian Rong, Martin G. Larson, et al. "Vascular Age Assessed From an Uncalibrated, Noninvasive Pressure Waveform by Using a Deep Learning Approach: The AI-VascularAge Model." Hypertension, October 30, 2023. http://dx.doi.org/10.1161/hypertensionaha.123.21638.
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Background: Aortic stiffness, assessed as carotid-femoral pulse wave velocity, provides a measure of vascular age and risk for adverse cardiovascular disease outcomes, but it is difficult to measure. The shape of arterial pressure waveforms conveys information regarding aortic stiffness; however, the best methods to extract and interpret waveform features remain controversial. Methods: We trained a convolutional neural network with fixed-scale (time and amplitude) brachial, radial, and carotid tonometry waveforms as input and negative inverse carotid-femoral pulse wave velocity as label. Models were trained with data from 2 community-based Icelandic samples (N=10 452 participants with 31 126 waveforms) and validated in the community-based Framingham Heart Study (N=7208 participants, 21 624 waveforms). Linear regression rescaled predicted negative inverse carotid-femoral pulse wave velocity to equivalent artificial intelligence vascular age (AI-VA). Results: The AI-VA model predicted negative inverse carotid-femoral pulse wave velocity with R 2 =0.64 in a randomly reserved Icelandic test group (n=5061, 16%) and R 2 =0.60 in the Framingham Heart Study. In the Framingham Heart Study (up to 18 years of follow-up; 479 cardiovascular disease, 200 coronary heart disease, and 213 heart failure events), brachial AI-VA was associated with incident cardiovascular disease adjusted for age and sex (model 1; hazard ratio, 1.79 [95% CI, 1.50–2.40] per SD; P <0.0001) or adjusted for age, sex, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, prevalent diabetes, hypertension treatment, and current smoking (model 2; hazard ratio, 1.50 [95% CI, 1.24–1.82] per SD; P <0.0001). Similar hazard ratios were demonstrated for incident coronary heart disease and heart failure events and for AI-VA values estimated from carotid or radial waveforms. Conclusions: Our results demonstrate that convolutional neural network–derived AI-VA is a powerful indicator of vascular health and cardiovascular disease risk in a broad community-based sample.
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Beeckman, Simeon, Smriti Badhwar, Yanlu Li, et al. "Heart-carotid pulse-wave velocity via laser-doppler vibrometry as a biomarker for arterial stiffening: a feasibility study." Physiological Measurement, April 10, 2025. https://doi.org/10.1088/1361-6579/adcb85.
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Abstract Objective: Large artery stiffening leads to an increase in cardiovascular risk and organ damage of the kidneys, brain or the heart. Biomarkers that allow for early detection of this phenomenon are a point of interest in research, with pulse-wave velocity (PWV) having been proven useful in predicting and monitoring arterial stiffness. We previously introduced a laser doppler vibrometry (LDV) prototype which can measure carotid-femoral PWV (cfPWV). In this work, we assesss the feasibility of using the same device to infer heart-carotid pulse-transit time (hcPTT) as a first step towards measuring heart-carotid PWV (hcPWV). The advantage of hcPWV over cfPWV is that the ascending aorta, which is the most distensible segment of the aorta contributing most to total arterial compliance, is included in the arterial pathway. Approach: Signals were simultaneously acquired from a location on the chest (near either the base or the apex of the heart) and the right carotid artery for 100 patients (45% female). Fiducial points on the heart waveforms are associated with opening and closure (second heart sound; S2) of the aortic valve, which can be combined with, respectively, the foot and dicrotic notch of the carotid waveform to retrieve hcPTT. Considering two distinct heart-signal measurement sites, four hcPTT estimations are evaluated in about 94% of all measurements. Main results: Correlations between these and known predictors of arterial stiffness i.e. age, blood pressure and cfPTT via applanation tonometry indicated that combining S2 from a heart- measurement site located at the base of the heart, with the carotid dicrotic notch yields hcPTT providing convincing correlations with known determinants of arterial stiffness (ρ = 0.377 with age). Significance: We conclude that LDV may provide a corollary biomarker of arterial stiffness, encompassing the ascending aorta.
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Sakuragi, Satoru, Richard D. Telford, and Walter P. Abhayaratna. "Abstract 4962: Influence of Adiposity on Carotid Wave Reflection and Arterial Stiffness: A Longitudinal Study in Healthy Children." Circulation 120, suppl_18 (2009). http://dx.doi.org/10.1161/circ.120.suppl_18.s1031.
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Background: The relationship between childhood obesity and adverse cardiovascular outcomes during adulthood may be mediated through the promotion of impaired vascular function. Wave reflection is an index of arterial function that is determined by arterial stiffness and is predictive of adverse cardiovascular events in adults. We hypothesized that baseline and changes in adiposity during childhood have an adverse influence on future levels of wave reflection and arterial stiffness. Methods: In 514 healthy children (mean age 8.3±0.4, 50% boys); percentage body fat (%BF) was quantitated by dual-energy x-ray absorptiometry during a baseline assessment in 2005 and during a follow-up assessment in 2007. Baseline insulin resistance was evaluated using a homeostasis model assessment (HOMA-IR). Cardiorespiratory fitness (CRF) was assessed using a 20 meter shuttle run. Carotid artery wave reflection and carotid-femoral pulse wave velocity (PWV) was assessed in 2007 using applanation tonometry (SphygmoCor, Atcor Medical, Sydney, Australia). The second peak of carotid systolic blood pressure (SBP2) was obtained from the carotid arterial waveform. Results: In univariable analysis, baseline %BF was positively associated with carotid SBP2 and PWV measured in 2007. In multivariable analysis, baseline %BF and change in %BF was associated with carotid SBP2 after adjustment for age, sex, baseline blood pressure, heart rate, height, HOMA-IR, total cholesterol and CRF (Table ). Baseline %BF was also independently associated with PWV (Table ). Conclusion: Baseline adiposity was positively related to future carotid wave reflection and arterial stiffness. In addition, subsequent increase in adiposity over a 2-year period was associated a greater degree of wave reflection. Relationship between baseline and change in percent body fat and future wave reflection (carotid SBP2) and arterial stiffness (PWV) in multivariate models
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Milkovich, Nicholas, Anastasia Gkousioudi, Francesca Seta, Béla Suki, and Yanhang Zhang. "Harmonic Distortion of Blood Pressure Waveform as a Measure of Arterial Stiffness." Frontiers in Bioengineering and Biotechnology 10 (March 30, 2022). http://dx.doi.org/10.3389/fbioe.2022.842754.
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Aging and disease alter the composition and elastic properties of the aortic wall resulting in shape changes in blood pressure waveform (BPW). Here, we propose a new index, harmonic distortion (HD), to characterize BPW and its relationship with other in vitro and in vivo measures. Using a Fourier transform of the BPW, HD is calculated as the ratio of energy above the fundamental frequency to that at the fundamental frequency. Male mice fed either a normal diet (ND) or a high fat, high sucrose (HFHS) diet for 2–10 months were used to study BPWs in diet-induced metabolic syndrome. BPWs were recorded for 20 s hourly for 24 h, using radiotelemetry. Pulse wave velocity (PWV), an in vivo measure of arterial stiffness, was measured in the abdominal aorta via ultrasound sonography. Common carotid arteries were excised from a subset of mice to determine the tangent modulus using biaxial tension-inflation test. Over a 24-h period, both HD and systolic blood pressure (SBP) show a large variability, however HD linearly decreases with increasing SBP. HD is also linearly related to tangent modulus and PWV with slopes significantly different between the two diet groups. Overall, our study suggests that HD is sensitive to changes in blood pressure and arterial stiffness and has a potential to be used as a noninvasive measure of arterial stiffness in aging and disease.
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Hsu, Pai F., Shao Y. Chuang, Hao M. Cheng, et al. "Abstract 9349: Wave Reflection but Not Arterial Stiffness is Much Highly Correlated with Ambulatory Blood Pressure Parameters Including Blood Pressure Variability and Morning Blood Pressure Surge." Circulation 124, suppl_21 (2011). http://dx.doi.org/10.1161/circ.124.suppl_21.a9349.
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Background: With growing evidences that blood pressure (BP) variability, daily BP peak or morning BP surge are independently related to organ damage and future cardiovascular events. We try to invest the role of arterial stiffness and wave reflection, cardiac output in the association of those ambulatory BP parameters. Methods: A sample of 1156 normotensive and untreated hypertensive Taiwanese participants (546 women aged 30-79 years) was drawn from a community-based survey. All participants were recorded with 24 hours ambulatory blood pressure monitors. Besides, serum laboratory data, carotid-femoral pulse wave velocity (PWV, current gold standard for arterial stiffness), amplitude of the backward pressure wave decomposed from a calibrated tonometry-derived carotid pressure waveform (Pb, a transit-time independent index for wave reflections), and hemodynamic data include cardiac output were collected. Results: Mean 24 hours, day, and night systolic blood pressure (SBP), diastolic blood pressure (DBP), SBP standard deviation (SBPsd), DBP standard deviation (DBPsd), are all highly correlated to Pb, PWV, cardiac output (CO) and augmented pressure (r=0.506,0.274, 0.167, 0.419, all p<0.01 with regard to 24 hour SBPsd). At multi-variates regression models, Pb remains the strongest predictor for early morning BP surge, SBPsd, and DBPsd even after adjusting possible confounders include age, sex, cholesterol, triglycerides, creatinine, and body weight index. Conclusion: Reflective wave Pb is the strongest independent factor for predicting daily BP variability, (SBPsd, DBPsd) and even mean-SBP, DBP, morning BP surge but not central arterial stiffness.
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Yavarimanesh, Mohammad, Hao-Min Cheng, Chen-Huan Chen, et al. "Abdominal aortic aneurysm monitoring via arterial waveform analysis: towards a convenient point-of-care device." npj Digital Medicine 5, no. 1 (2022). http://dx.doi.org/10.1038/s41746-022-00717-3.
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AbstractAbdominal aortic aneurysms (AAAs) are lethal but treatable yet substantially under-diagnosed and under-monitored. Hence, new AAA monitoring devices that are convenient in use and cost are needed. Our hypothesis is that analysis of arterial waveforms, which could be obtained with such a device, can provide information about AAA size. We aim to initially test this hypothesis via tonometric waveforms. We study noninvasive carotid and femoral blood pressure (BP) waveforms and reference image-based maximal aortic diameter measurements from 50 AAA patients as well as the two noninvasive BP waveforms from these patients after endovascular repair (EVAR) and from 50 comparable control patients. We develop linear regression models for predicting the maximal aortic diameter from waveform or non-waveform features. We evaluate the models in out-of-training data in terms of predicting the maximal aortic diameter value and changes induced by EVAR. The best model includes the carotid area ratio (diastolic area divided by systolic area) and normalized carotid-femoral pulse transit time ((age·diastolic BP)/(height/PTT)) as input features with positive model coefficients. This model is explainable based on the early, negative wave reflection in AAA and the Moens-Korteweg equation for relating PTT to vessel diameter. The predicted maximal aortic diameters yield receiver operating characteristic area under the curves of 0.83 ± 0.04 in classifying AAA versus control patients and 0.72 ± 0.04 in classifying AAA patients before versus after EVAR. These results are significantly better than a baseline model excluding waveform features as input. Our findings could potentially translate to convenient devices that serve as an adjunct to imaging.
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Sugawara, Jun, Tsubasa Tomoto, and Hirofumi Tanaka. "Comparisons of Proximal Aortic Pulse Wave Velocity Measurements: Carotid‐Femoral vs. Heart‐Brachial PWV." FASEB Journal 31, S1 (2017). http://dx.doi.org/10.1096/fasebj.31.1_supplement.1017.14.
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The proximal aorta (e.g., the ascending aorta and aortic arch) is the most elastic segment of the arterial tree directly connected with the left ventricle and plays the dominant role in buffering the cyclic mechanical forces of cardiac pulsations. Carotid‐femoral pulse wave velocity (cfPWV) is considered as the reference standard measurement for large elastic artery stiffness but the most proximal segments of the aorta are omitted in its measurement. The primary aim of the present study was to compare two indices of arterial stiffness that differ in the contribution of proximal aortic segments. To do so, using the cross‐sectional study design, we compared cfPWV (mainly reflecting stiffness of the abdominal aorta) and heart‐brachial PWV (hbPWV; including the proximal aortic stiffness) in relation to aging‐related change and to central hemodynamic indices. In a total of 190 adults (92 men and 98 women) aged 53±15 yrs were studied. Pulse transition times were obtained between carotid and femoral pressure waveforms (via applanation tonometry) for cfPWV and between the second heart sound and the dicrotic notch of brachial pressure waveforms (via air‐plethysmography) for hbPWV, respectively. Arterial path lengths were measured directly by MRI. Central aortic hemodynamic indices were estimated from carotid arterial pressure waveform by general transfer function‐based pulse wave analysis. cfPWV and hbPWV were significantly correlated with age (r=0.68 and r=0.79, both P<0.0001). Aging‐related increases (calculated from the slope of regression lines) were 9.9%/decade in cfPWV and 14.7%/decade in hbPWV. Aortic augmentation index (an index of left ventricular after load) was significantly correlated with cfPWV (r=0.45) and more strongly with hbPWV (r=0.50). Likewise, aortic systolic tension‐time integral and diastolic pressure‐time integral (indices of myocardial oxygen demand and supply) were correlated with hcPWV (r=0.49 and r=0.53, P<0.0001 for both) and more strongly with hbPWV (r=0.50 and r=0.57, P<0.0001 for both). Our findings suggest that a measure of PWV including the ascending aorta exhibits a greater age‐related increase and stronger associations with central hemodynamic indices than cfPWV. Prospective data linking hbPWV to clinical endpoints are needed.Support or Funding InformationThis study was supported by JSPS KAKENHI Grant Number JP25702045 and JP26670116.
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Shoemaker, Leena N., Tyson Matern, Farah Kamar, et al. "Blood pressure in human large cerebral arteries: A feasibility study." Journal of Applied Physiology, February 7, 2025. https://doi.org/10.1152/japplphysiol.00825.2024.
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Background: The lack of direct measures of brain blood pressure (BBP) has severely restricted understanding of cerebral pressure-flow relationships and their control. We sought to evaluate the feasibility of directly measuring BBP and its pulsatility between the aorta and middle cerebral artery (MCA) during elective endovascular surgical procedures. Methods: We report five case studies (four female, 61 ± 13 years; Mean ± SD) of patients undergoing cerebrovascular interventional procedures for aneurysm and stenoses using direct BBP measures with the COMET 2 pressure guidewire system (Boston Scientific). Patients were supine, intubated and under anesthesia. The sensor wire was inserted via the femoral artery, measuring, as feasible, BP in aorta to-MCA vascular segments, referenced to the radial artery BP waveform (arterial catheter). Results: Mean arterial pressure varied between the radial (80 ± 18 mmHg), internal carotid artery (ICA; 70 ± 25 mmHg) and MCA (62 ± 29 mmHg) and marked interindividual heterogeneity was observed. Pulse pressure was higher in the radial artery (68 ± 23 mmHg) compared to the intracranial ICA (ICAi; 43 ± 29 mmHg) and MCA (M1; 25 ± 12 mmHg) segments. Conclusions: Direct measures of BBP in humans are feasible in this interventional surgery model. Although limited by the small sample size, the results suggest a heterogenous pattern of change between systemic and brain measures of blood pressure and pulse pressure.
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Niroumandi, Soha, Derek Rinderknecht, Coskun Bilgi, et al. "Abstract 18846: A Noninvasive Smartphone Assessment of Aortic Arch Pulse Wave Velocity and Total Arterial Compliance." Circulation 148, Suppl_1 (2023). http://dx.doi.org/10.1161/circ.148.suppl_1.18846.
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Introduction: Several clinical studies including a large multiethnic population (Dallas Heart Study) have shown that total arterial compliance (TAC) and aortic arch pulse wave velocity (PWV aa ) are predictors of cardiovascular disease (CVD) events. Dallas Heart Study also showed that PWV aa predicts brain white matter hyperintensity volume independent of cardiovascular risk factors. Recently, Intrinsic Frequency (IF) analysis of carotid pressure waveform from the Framingham Heart Study was used to predict heart failure (HF) events and CVD (Hypertension, 2021 PMID: 33390053). Aim: Our goal was to show the IF method can determine PWV aa and TAC when applied on carotid pulse waveforms obtained from a standard iPhone camera. Methods: The clinical cohort consisted of 120 individuals (40% women) with ages from 20-92 yrs (mean 53 ± 18), including 54 healthy and 66 patients with CVD (22 HF). Phase-contrast magnetic resonance imaging (PC-MRI) and carotid pressure tonometry data were used to compute TAC. PWV aa values were obtained using PC-MRI flow in ascending and descending aorta (not achieved in 1 patients). A custom Apple iPhone 5S application was used to obtain carotid pulse waves by holding the camera against the neck. IF parameters of iPhone waveforms (calibrated by cuff brachial pressures) were used in machine learning algorithms (IF-iPhone). The models of TAC and PWV aa were developed using 100 participants (99 for PWV aa ) and blindly tested on an additional 20 individuals. Results: In blind tests, iPhone-IF models showed Pearson correlations of r=0.89 and r=0.84 with the measured values of TAC and PWV aa , respectively (Fig.1). Conclusions: Assessment of PWV aa and TAC can be accurately achieved using an unmodified smartphone (iPhone). PWV aa evaluation with an iPhone can be used to identify, predict, and quantify risk of vascular brain damage. A Noninvasive iPhone-based method can be used in a clinical or home setting to routinely assess TAC in the general population or in HF.
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Djuric, B., K. Zikic, N. Milosevic, Z. Nestorovic, and D. Zikic. "Aging related changes in cardiovascular system in healthy female population: photoplethysmography method and DFA analysis." Cardiovascular Research 120, Supplement_1 (2024). http://dx.doi.org/10.1093/cvr/cvae088.148.
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Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science Technological Development and Innovation Background The cardiovascular system undergoes dynamic changes during the biological aging in humans, leading to chronic cardiovascular and cerebrovascular diseases. Purpose Developing the novel method for non-invasive monitoring of age induced changes in arterial vessels. Methodology The pilot study was performed on 58 women, in good health, non-smokers, between the ages of 20 and 70, divided into three age groups. All subjects underwent arterial blood pressure measurement using a photoplethysmography sensor. Recordings were performed in left carotid artery and the left index finger area. Arterial blood flow waveform was then analyzed using DFA analysis, calculating the values of the scalar coefficients α1 and α2. Based on the waveform time interval shift between the standing and supine positions, the pulse wave velocity (PWV) ratio was determined. Results Systolic and diastolic arterial pressure showed a slight linear increase with the age, but without significant difference between the three age categories (p &gt; 0.5). Also, the PWV ratio between the supine and standing positions did not show a statistically significant increase between the age groups. Only scalar coefficients ratio α1/α2 demonstrated a significant difference in value between all age categories. Conclusion In subjects included in this pilot study, only the scalar coefficients ratio varied significantly with the age, indicating the occurrence of structural changes in the cardiovascular system caused by biological aging.
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Huang, Chieh-Chun, Shih-Hsien Sung, Wei-Ting Wang, et al. "Examining arterial pulsation to identify and risk-stratify heart failure subjects with deep neural network." Physical and Engineering Sciences in Medicine, February 15, 2024. http://dx.doi.org/10.1007/s13246-023-01378-6.
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AbstractHemodynamic parameters derived from pulse wave analysis have been shown to predict long-term outcomes in patients with heart failure (HF). Here we aimed to develop a deep-learning based algorithm that incorporates pressure waveforms for the identification and risk stratification of patients with HF. The first study, with a case–control study design to address data imbalance issue, included 431 subjects with HF exhibiting typical symptoms and 1545 control participants with no history of HF (non-HF). Carotid pressure waveforms were obtained from all the participants using applanation tonometry. The HF score, representing the probability of HF, was derived from a one-dimensional deep neural network (DNN) model trained with characteristics of the normalized carotid pressure waveform. In the second study of HF patients, we constructed a Cox regression model with 83 candidate clinical variables along with the HF score to predict the risk of all-cause mortality along with rehospitalization. To identify subjects using the HF score, the sensitivity, specificity, accuracy, F1 score, and area under receiver operating characteristic curve were 0.867, 0.851, 0.874, 0.878, and 0.93, respectively, from the hold-out cross-validation of the DNN, which was better than other machine learning models, including logistic regression, support vector machine, and random forest. With a median follow-up of 5.8 years, the multivariable Cox model using the HF score and other clinical variables outperformed the other HF risk prediction models with concordance index of 0.71, in which only the HF score and five clinical variables were independent significant predictors (p < 0.05), including age, history of percutaneous coronary intervention, concentration of sodium in the emergency room, N-terminal pro-brain natriuretic peptide, and hemoglobin. Our study demonstrated the diagnostic and prognostic utility of arterial waveforms in subjects with HF using a DNN model. Pulse wave contains valuable information that can benefit the clinical care of patients with HF.
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Aghilinejad, Arian, and Morteza Gharib. "Assessing Pressure Wave Components for Aortic Stiffness Monitoring through Spectral Regression Learning." European Heart Journal Open, May 21, 2024. http://dx.doi.org/10.1093/ehjopen/oeae040.
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Abstract Aims The aging process notably induces structural changes in the arterial system, primarily manifesting as increased aortic stiffness, a precursor to cardiovascular events. While wave separation analysis is a robust tool for decomposing the components of blood pressure waveform, its relationship with cardiovascular events, such as aortic stiffening, is incompletely understood. Furthermore, its applicability has been limited due to the need for concurrent measurements of pressure and flow. Our aim in this study addresses this gap by introducing a spectral regression learning method for pressure-only wave separation analysis. Methods and results Leveraging data from the Framingham Heart Study (2,640 individuals, 55% women), we evaluate the accuracy of pressure-only estimates, their interchangeability with reference method based on ultrasound-derived flow waves, and their association with Carotid-femoral pulse wave velocity. Method-derived estimates are strongly correlated with the reference ones for forward wave amplitude (R2=0.91), backward wave amplitude (R2=0.88), reflection index (R2=0.87), and moderately correlated with time delay between forward and backward waves (R2=0.38). The proposed pressure-only method shows interchangeability with reference method through covariate analysis. Adjusting for age, sex, body size, mean blood pressure, and heart rate, results suggest that both pressure-only and pressure-flow evaluations of wave separation parameters yield similar model performance for predicting Carotid-femoral pulse wave velocity with forward wave amplitude as the only significant factor (p &lt; 0.001; 95% confidence interval, 0.056-0.097). Conclusions We propose an interchangeable pressure-only wave separation analysis method and demonstrate its clinical applicability in capturing aortic stiffening. The proposed method provides valuable non-invasive tool for assessing cardiovascular health.
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Wang, Kang-Ling, Hao-Min Cheng, Shao-Yuan Chuang, et al. "Abstract 5151: Waveform Reflections and Arterial Stiffness in the Prediction of 15.1-Year All-Cause and Cardiovascular Mortalities: A Community-Based Study." Circulation 120, suppl_18 (2009). http://dx.doi.org/10.1161/circ.120.suppl_18.s1061-c.
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Background- The role of arterial wave reflection, usually assessed by the transit-time dependent augmentation index (AI) and augmented pressure (Pa), in the prediction of cardiovascular events may have been underestimated. We investigated whether the transit-time independent measurements of reflected wave magnitude predict cardiovascular outcomes independently of arterial stiffness indexed by carotid-femoral pulse wave velocity (PWV). Method- A total of 1272 participants (47.0% women) from a community-based survey were studied. Carotid pressure waveforms derived by tonometry were decomposed to generate forward wave amplitude (Pf), backward wave amplitude (Pb), and reflection index (RI, = [Pb/(Pf+Pb)]), in addition to AI, Pa, and reflected wave transit time (RWTT). Results During a median follow-up of 15.1 years, 225 deaths occurred, including 64 cardiovascular origins. In univariate Cox proportional hazards regression analysis, PWV, Pa and Pb predicted all-cause and cardiovascular mortalities in both men and women whereas AI, RWTT and RI were predictive only in men. In multi-variate Cox analysis accounting for age, height, and heart rate, Pb predicted all-cause mortality in women and cardiovascular mortality in both men and women, whereas Pa only predicted cardiovascular mortality in men but not in women. When PWV and Pb were jointly entered into the multivariate model accounting for age, sex, height, heart rate, and brachial mean blood pressure, Pb (hazard ratio 1.066, 95% confidence interval 1.023–1.110) but not PWV (1.086, 0.993–1.189), independently predicted cardiovascular mortality. Conclusion- Pb, a transit-time independent measurement of reflected wave magnitude, predicted long term cardiovascular mortality in men and women independently of PWV.
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Armstrong, Matthew K., Shivangi Jain, Virginia Nuckols, et al. "Abstract P230: Central Artery Pulsatile Hemodynamics Are Associated With Cerebral Total, Periventricular, And Deep White Matter Lesions: Role Of Reservoir-excess Pressure Components." Hypertension 80, Suppl_1 (2023). http://dx.doi.org/10.1161/hyp.80.suppl_1.p230.
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Introduction: Accumulating evidence suggests that increased central, rather than peripheral, blood pressure (BP) may be a better predictor of cardiovascular risk. The shape of the central BP waveform is determined by ventricular-arterial interactions that can be quantified via novel hemodynamic analyses, from which some parameters have been implicated in the development of cardiac, vascular, and renal dysfunction. Comparatively, the potential effect of central pulsatile hemodynamics on brain structure has been understudied. Thus, we sought to determine the association of novel central hemodynamic parameters with cerebral white matter lesions. Methods: Central BP waveforms were measured in 130 healthy adults (age 63±6y; 58% female) via non-invasive carotid tonometry and modeled using reservoir-excess pressure analysis to separate the central BP waveform into a reservoir (Rp TI ) and excess (Ep TI ) pressure component. Systolic (Sk) and diastolic (Dk) rate constants were estimated from the rate of increase and decrease of the Rp TI component, respectively. Total, periventricular, and deep cerebral white matter lesion volumes (WMLV) were estimated from T2 weighted and FLAIR MRI and adjusted for total intracranial volume. Results: Both Sk and Ep TI were correlated with total (Sk: r = -0.19, p = 0.033; Ep TI : r = 0.21, p = 0.016), periventricular (Sk: r = -0.18, p = 0.037; Ep TI : r = 0.23, p = 0.009), and deep (Sk: r = -0.28, p = 0.002; Ep TI : r = 0.20, p = 0.027) WMLV. The association of Sk with total ( B = -0.032; 95% confidence interval [CI] = -0.054, -0.010; p = 0.0056), periventricular ( B = -0.030; 95%CI = -0.051, -0.009; p = 0.0063), and deep ( B = -0.064; 95%CI = -0.101, -0.028; p <0.001) WMLV remained significant in multivariable analyses adjusting for age, sex, BMI, peripheral pulse pressure, carotid-femoral pulse wave velocity, heart rate, and non-HDL cholesterol. Additionally, the association between Ep TI and deep WMLV persisted in multivariable analysis ( B = 0.158; 95%CI = 0.045, 0.271; p = 0.007). Conclusion: Pulsatile components of central artery hemodynamics are associated with cerebral WMLV independent of traditional cardiovascular risk factors. In particular, Sk may represent a novel biomarker of early central BP-related cerebral white matter damage.
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Bia, Daniel, Yanina Zócalo, Ramiro Sánchez, et al. "Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods." Frontiers in Physiology 14 (January 16, 2023). http://dx.doi.org/10.3389/fphys.2023.1113972.
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Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established.Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% (“033”), 41.2% (“0412”) or 33% corrected for heart rate (“033HR”).Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes.Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The “033HR” and “0412” calibration schemes ensured the lowest mean error, and the “033” method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods.Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.
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Shibata, Shigeki, Naoki Fujimoto, Jeffrey L. Hastings, et al. "Abstract 18213: Advanced Glycation End-Product Inhibition With Alagebrium Slows Age-Related Large Vessel Arterial Stiffening in Healthy Elderly Humans." Circulation 128, suppl_22 (2013). http://dx.doi.org/10.1161/circ.128.suppl_22.a18213.
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Background: Lifelong exercise training maintains youthful compliance of the central arteries, while even prolonged (1 yr) and intense training started later in life failed to reverse age-related central arterial stiffening, possibly because of accumulation of irreversible advanced glycation end-products (AGE). Alagebrium breaks AGE crosslinks and improves central arterial compliance in animals. However, little is known how Alagebrium would affect central arterial compliance in previously sedentary elderly humans. Moreover, it is unclear whether a strategy of exercise training combined with Alagebrium would improve central arterial compliance. Methods: Sixty two healthy elderly subjects were randomized into 4 groups: a) Sedentary+placebo; b) Sedentary+Alagebrium (200mg/day); c) Exercise+placebo; and d) Exercise+Alagebrium. Fifty seven/62 subjects (67±6 yrs; 37f/20m) completed 1 yr of intervention followed by repeat measurements. Arterial compliance were evaluated with Modelflow generated aortic age (A-age), central and peripheral pulse wave velocity (PWVs), carotid artery, and ascending and descending aorta beta stiffness indices (Beta indices), and augmentation index (AI). A-age was calculated from the finger blood pressure waveform (BMEYE) and stroke volume (Thermodilution) ( Shibata 2010 ). Central blood pressure, PWVs and AI were measured with applantation of tonometry (SphygmoCor). Aortic and carotid arterial geometries were assessed with MRI and ultrasound, respectively. Results: A-age increased less over the 1 yr intervention in the Alagebrium groups (Medication х Time effect p=0.066). Also, AI increased significantly less in the Alagebrium groups (Medication х Time effect p=0.034). However, exercise training did not impact on any of these indices. There were no significant differences in either Beta indices or PWVs. No subject developed aortic dilatation or had any CV complications (safety endpoint). Conclusion: Breaking of AGE cross links with Alagebrium was safe, and slowed but did not reverse age related large vessel arterial stiffening in elderly humans without an additive effect of exercise training. The absence of concordant changes in all indices suggests that these effects were modest.
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Singh, R. P., S. Tewari, A. Kapoor, et al. "P41 Correlation of doppler ultrasound assessment of carotid femoral pulse wave velocity with coronary artery disease." European Heart Journal 41, Supplement_1 (2020). http://dx.doi.org/10.1093/ehjci/ehz872.035.
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Abstract Funding Acknowledgements self Background Arterial stiffness is an important cardiovascular risk factor. Carotid femoral pulse wave velocity (cfPWV) is simple noninvasive method to determine aortic stiffness. Arterial stiffness measures, cfPWV in particular, have been found to be correlate with stroke and peripheral artery disease. Usually SphygmoCor or Complior are used to calculate cfPWV. Doppler ultrasound can serve as an alternative to these methods. Purpose To assess cfPWV using doppler ultrasound and study its correlation with coronary artery disease and its severity. Methods cfPWV was assessed by ultrasound Doppler in patient aged 20-70 years undergoing coronary angiography. cfPWV was measured by sequential recordings of arterial pressure waveform at the carotid and femoral arteries with a Doppler ultrasound with ECG gating and calculated as the distance between the carotid and the femoral sampling site divided by the time interval. Result Of the 358 subjects studied, 243 had coronary artery disease(CAD) (&gt;50% diameter stenosis) and were further divided into single, double or triple vessel disease groups. 115 patients had mild CAD (&lt; 50% stenosis) or no CAD and served as controls. Baseline characteristics were similar except diabetes (more common in CAD group)(39.09% v/s 27.82%). cfPWV was found to increase with age in all groups. cfPWV was not significantly affected by sex, diabetes, dyslipidemia, BMI, smoking or hypothyroidism. Mean cfPWV was significantly higher in patients with CAD (8.99 v/s 6.51 m/s, p &lt; 0.001) and hypertensives (8.71 v/s 7.83 m/s, p &lt; 0.001). Patients with triple vessel disease(TVD) had significantly higher cfPWV (10.12 m/s) than those with double(DVD)(8.84 m/s) or single vessel disease(SVD)(8.28m/s)(p &lt; 0.001). Multinomial logistic regression revealed an odds ratio of 2.00, 2.375 and 3.368 respectively for SVD, DVD and TVD groups in comparison to controls (p &lt; 0.001). cfPWV value &gt; 7.25 m/s predicted CAD with sensitivity 78.6 % and specificity 74.8% (AUC =0.848, P &lt; 0.001). Conclusion Carotid femoral pulse wave velocity can be measured noninvasively by ultrasound Doppler. cfPWV increases with age and hypertension and has strong correlation with coronary artery disease and its severity. The cfPWV can be an independent risk factor and may be utilized for cardiovascular risk prediction. Abstract P41 Figure. cfPWV in various subgroups.
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Scheuermann, Britton, Shannon Parr, Stephen Hammond, Vanessa-Rose Turpin, Olivia Kunkel, and Carl Ade. "Age-related impacts of wave transmission at the aorta-carotid bifurcation on local and global measures of arterial stiffness." Physiology 38, S1 (2023). http://dx.doi.org/10.1152/physiol.2023.38.s1.5734426.
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Wave reflections in the periphery have been key in the understanding of aging-related changes in global arterial stiffness, as measured by carotid-femoral pulse-wave velocity (cfPWV). However, recent investigations have demonstrated benefits of using local measures of aortic arch PWV (aaPWV) in addition to considering cfPWV. The contribution of proximal wave reflections at the aorta-carotid bifurcation to aaPWV, as well as to the increasing discordance between aaPWV and cfPWV previously observed with aging, remain poorly understood. The purpose of the present investigation was to examine the impact of transmission of pressure and flow at the aorta-carotid bifurcation on aaPWV and cfPWV in healthy younger and older individuals. We hypothesized that aging-related stiffening of the carotid artery would enhance pressure transmission at the aorta-carotid bifurcation and redirect flow transmission towards a greater relative flow in the distal aortic arch, increasing cfPWV but having minimal impact on aaPWV. We recruited 15 participants, stratified into young adults (YA; n = 8, 4 women; age 20 ± 2.7 years) and older adults (OA; n = 7, 4 women; age 53 ± 2.2 years). Both aaPWV and cfPWV were assessed with ultrasound (Logiq S8, GE Healthcare) via the conventional foot-to-foot velocity waveform method. Carotid artery PWV (caPWV) was calculated using the Bramwell-Hill equation using M-mode scans and carotid pressure waveforms. Carotid, proximal, and distal aortic impedances were derived using estimated blood density, PWV values, and vessel cross-sectional areas. These impedance values allowed for calculation of the pressure and flow transmission coefficients describing the aorta-carotid bifurcation. Sex and BMI were not significantly different between groups (p > 0.05). YA had significantly lower cfPWV (5.2 ± 0.6 vs. 6.8 ± 0.8 m/s, p < 0.05) and caPWV (10.6 ± 0.9 vs. 16.9 ± 1.2 m/s, p < 0.05); however, aaPWV was similar between groups (p > 0.05). This resulted in a reduced pressure transmission coefficient in YA (0.91 ± 0.07 vs. 0.99 ± 0.05, p < 0.05) as well as a greater transmission of flow into the carotid artery relative to the distal aortic arch, represented as the carotid flow transmission coefficient over the distal aortic flow transmission coefficient (0.70 ± 0.20 vs. 0.41 ± 0.1, p <0.05). Linear regression indicated a significant association between caPWV and cfPWV in the entire group, even after adjustment for age, sex and BMI (β = 0.597, p = 0.01) whereas caPWV was not associated with aaPWV in univariate or multivariate analyses. Consistent with our hypothesis, present analyses suggest a role for pressure and flow transmission at the aorta-carotid bifurcation in the dissociation between local stiffness of the proximal aorta (aaPWV) and global arterial stiffness (cfPWV). This highlights the systemic nature of cfPWV, and suggests a need for specificity in the measure of arterial stiffness used and the target outcome of a given study. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.
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Hao, Zhili, MD Mahfuzur Rahman, Jason Au, Chloe Athaide, and Lauren Jutlah. "Axial Wall Displacement At the Common Carotid Artery is Associated with the Lamb Waves." Journal of Engineering and Science in Medical Diagnostics and Therapy, November 16, 2022, 1–40. http://dx.doi.org/10.1115/1.4056267.
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Abstract As compared with its radial wall displacement, axial wall displacement at the common carotid artery (CCA) carries independent clinical values, but its physical mechanisms are unclear. This study aims to investigate whether axial wall displacement at the CCA is solely from Young waves. A pulse wave propagation theory is utilized to identify two types of waves, Young waves and Lamb waves, in an artery, and identifies two sources for axial wall displacement, wall shear stress and radial wall displacement gradient with a factor of the difference between axial and circumferential initial tension, which reveals the influence of axial initial tension on the waveform of axial wall displacement. Theoretical expressions are derived for calculating the waveforms of axial wall displacement and its two sources in the Young waves. With the measured pulsatile pressure and blood velocity at the CA of three healthy adults as the inputs, the waveforms of axial wall displacement in the Young waves are calculated at different values of axial initial tension, and are found to greatly differ from their measured counterparts. As such, the Lamb waves may contribute to axial wall displacement at the CCA and the associated physical and physiological implications are discussed. Given the clinical values of axial wall displacement at the CCA, the Lamb waves may play a non-negligible role in determining arterial health and needs to be further studied for a comprehensive assessment of arterial wall mechanics.
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Heffernan, Kevin, Lee Stoner, Michelle L. Meyer, et al. "Associations between estimated and measured carotid-femoral pulse wave velocity in older Black and White adults: the atherosclerosis risk in communities (ARIC) study." Journal of Cardiovascular Aging, 2022. http://dx.doi.org/10.20517/jca.2021.22.
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Introduction: Aortic stiffness offers important insight into vascular aging and cardiovascular disease (CVD) risk. The referent measure of aortic stiffness is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated (ePWV) from age and mean arterial pressure. Few studies have directly compared the association of ePWV to measured cfPWV, particularly in non-White adults. Moreover, whether ePWV and cfPWV correlate similarly with CVD risk remains unexplored. Aim: (1) To estimate the strength of the agreement between ePWV and cfPWV in both Black and White older adults; and (2) to compare the associations of ePWV and cfPWV with CVD risk factors and determine whether these associations were consistent across races. Methods and Results: We evaluated 4478 [75.2 (SD 5.0) years] Black and White older adults in the Atherosclerosis Risk in Communities (ARIC) Study. cfPWV was measured using an automated pulse waveform analyzer. ePWV was derived from an equation based on age and mean arterial pressure. Association and agreement between the two measurements were determined using Pearson’s correlation coefficient (r), standard error of estimate (SEE), and Bland-Altman analysis. Associations between traditional risk factors with ePWV and cfPWV were evaluated using linear mixed regression models. We observed weak correlations between ePWV and cfPWV within White adults (r = 0.36) and Black adults (r = 0.31). The mean bias for Bland-Altman analysis was low at -0.17 m/s (95%CI: -0.25 to -0.09). However, the inspection of the Bland-Altman plots indicated systematic bias (P < 0.001), which was consistent across race strata. The SEE, or typical absolute error, was 2.8 m/s suggesting high variability across measures. In models adjusted for sex, prevalent diabetes, the number of prevalent cardiovascular diseases, and medication count, both cfPWV and ePWV were positively associated with heart rate, triglycerides, and fasting glucose, and negatively associated with body mass index (BMI) and smoking status in White adults (P < 0.05). cfPWV and ePWV were not associated with heart rate, triglycerides, and fasting glucose in Black adults, while both measures were negatively associated with BMI in Black adults. Conclusions: Findings suggest a weak association between ePWV and cfPWV in older White and Black adults from ARIC. There were similar weak associations between CVD risk factors with ePWV and cfPWV in White adults with subtle differences in associations in Black adults. One sentence summary: Estimated pulse wave velocity is weakly associated with measured carotid-femoral pulse wave velocity in older Black and White adults in ARIC.
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Bruno, R. M., N. Di Lascio, A. Al Hussaini, et al. "P2538Arterial stiffness and remodeling from large to small arteries in patients with spontaneous coronary artery dissection: evidence for a systemic subclinical involvement." European Heart Journal 40, Supplement_1 (2019). http://dx.doi.org/10.1093/eurheartj/ehz748.0866.
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Abstract Background and aim Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in women aged 50 years or less (22–43%). Its etiology is still unknown, though an association with systemic diseases such as fibromuscular dysplasia and collagenopathies has been found. This study is aimed at investigating the presence of subclinical structural and functional alterations in extracoronary districts in SCAD patients. Methods The design was a case-control study. Carotid, radial and digital arteries were scanned by standard or ultrahigh frequency ultrasound; clips were analyzed by automated image analysis software for diameter, intima-media thickness (IMT) and local distensibility. Applanation tonometry was used to obtain carotid-femoral pulse wave velocity, a measure of regional, aortic stiffness, and carotid pressure waveform. Results 30 patients previously diagnosed with SCAD (27 women, age 51±10 years, 8 treated hypertensives, 4 smokers, mean BP 83±11mmHg, BMI 25±5kg/mq) and 30 controls, matched for age, sex and CV risk factors by propensity score, were enrolled. 18 SCAD patients underwent PTCA and 6 had a diagnosis of extracoronary fibromuscular dysplasia. In the left radial artery, wall thickness, cross-sectional area (2.96±1.07 vs 1.79±1.41mm2, p=0.008), and wall inhomogeneity were increased, especially in the outer layer, whereas diameter, wall/lumen ratio and distensibility were comparable to controls. In the left common carotid artery, an increased carotid stiffness was shown in SCAD (5.99±0.89 m/s vs 5.6±0.85, 0.03), while IMT tended to be increased bilaterally (0.63±0.12 vs 0.59±0.10mm, p=0.08). Aortic stiffness was similar in the two groups (7.0±1.9 vs 6.7±1.7m/s, p=0.60). Carotid (20.4±14.2 vs 11.9±15.0%, p=0.03), but not aortic augmentation index, was increased bilaterally. Conclusions SCAD patients showed a peculiar pattern of alterations in vascular remodeling and stiffness in extracoronary arterial segments such as the carotid and radial arteries, supporting the hypothesis that a systemic susceptibility is present even in the absence of systemic diseases.
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Heusinkveld, Maarten H. G., Robert J. Holtackers, Bouke P. Adriaans, et al. "Complementing sparse vascular imaging data by physiological adaptation rules." Journal of Applied Physiology, October 29, 2020. http://dx.doi.org/10.1152/japplphysiol.00250.2019.
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Introduction:Mathematical modeling of pressure and flow waveforms in blood vessels using pulse wave propagation (PWP)-models has tremendous potential to support clinical decision-making. For a personalized model outcome, measurements of all modeled vessel radii and wall thicknesses are required. In clinical practice, however, data sets are often incomplete. To overcome this problem, we hypothesized that the adaptive capacity of vessels in response to mechanical load could be utilized to fill in the gaps of incomplete patient-specific data sets. Methods:We implemented homeostatic feedback loops in a validated PWP model to allow adaptation of vessel geometry to maintain physiological values of wall stress and wall shear stress. To evaluate our approach, we gathered vascular MRI and ultrasound data sets of wall thicknesses and radii of central and arm arterial segments of ten healthy subjects. Reference models (i.e. termed RefModel, n=10) were simulated using complete data, whereas adapted models (AdaptModel, n=10) used data of one carotid artery segment only while the remaining geometries in this model were estimated using adaptation. We evaluated agreement between RefModel and AdaptModel geometries, as well as between pressure and flow waveforms of both models. Results:Limits of agreement (bias±2SD of difference) between AdaptModel and RefModel radii and wall thicknesses were 0.2±2.6 mm and -140±557 μm, respectively. Pressure and flow waveform characteristics of the AdaptModel better resembled those of the RefModels as compared to the model in which the vessels were not adapted.Conclusions:Our adaptation-based PWP-model enables personalization of vascular geometries even when not all required data is available.
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Calvez, Valentin, Marco Palladino, Giulio Montefusco, et al. "Abstract P517: Dialysis Vintage Longer Than Sixty Months Contributes to Increased Arterial Stiffness and Impaired Diastolic Function in Patients with End-stage Renal Disease." Hypertension 70, suppl_1 (2017). http://dx.doi.org/10.1161/hyp.70.suppl_1.p517.
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Hemodialysis (HD) may induce vascular stiffness through several mechanisms. We sought to determine the role of dialysis vintage (DV) on the development of cardiovascular alterations. We studied 14 patients in chronic HD and 24 newly diagnosed never treated hypertensive patients and 16 normotensive controls. The patients in HD were divided in two groups according to DV: <60-months (DV<60,n=7) or >60-months (DV>60,n=7). After HD session, when dry weight was reached, we evaluated peripheral blood pressure (pBP), the parameters derived by tonometric analysis of the pulse waveform (central blood pressure-cBP-, Subendocardial Viability Ratio-SEVR-, carotid-femoral pulse wave velocity-cf-PWV-) and those derived from echocardiography: ejection fraction (EF-for systolic function) and E/e’ (for diastolic function), and the ultrafiltration volume (UV). Calcium/phosphate (Ca/P) levels, serum albumin, and Kt/V were evaluated retrospectively on repeated measurements over the past 5 years. All the groups were similar for sex and BMI, both DV<60 and DV>60 were older than hypertensives and controls (58.33±3.71 and 59.83±7.98 vs 44.14±1.28 and vs 40.63±2.05 years, respectively, P<0.05). Both DV<60 and DV>60 presented similar levels of Ca/P, serum albumin, Kt/V and UV. pBP was increased and similar to hypertensives in DV>60 vs DV<60 (systolic-pBP: 154.2±4.5 vs 132.5±5.18 mmHg, P<0.01 and diastolic-pBP: 90.4±49 vs 78.5±3.3 mmHg, P<0.01). Likewise cBP was increased and similar to hypertensive patients in DV>60 vs DV<60 (systolic-cBP: 140.8±8.4 vs 111.2±3.36 mmHg, P<0.001 and diastolic-cBP: 88.2±3.73 vs 72.33±7.78 mmHg, respectively, P<0.05). cf-PWV was similar in normotensives, hypertensives and DV<60, and increased only in DV>60 vs DV<60 (9.6±1.4 vs 7.13±1.4 m/s, p<0.05). SEVR and EF were preserved and similar in all the groups. E/e’ was significantly increased only in the groups in HD, however it was higher in DV>60 vs DV<60 (9.16±1.14 vs 6.96±0.72, P<0.01). In conclusion, only patients with DV>60 presented increased aortic stiffness. This was associated to higher BP and diastolic dysfunction. Hence, chronic HD, particularly after 60 months, may play a putative role in developing cardiovascular alterations in patients with end-stage renal disease.