Novel Pressure Wave Separation Analysis for Cardiovascular Function Assessment Highlights Major Role of Aortic Root.


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Type
Article
Change log
Authors
Vennin, Samuel 
Li, Ye 
Mariscal-Harana, Jorge 
Charlton, Peter H 
Fok, Henry 
Abstract

OBJECTIVE: A novel method was presented to separate the central blood pressure wave (CBPW) into five components with different biophysical and temporal origins. It includes a time-varying emission coefficient ( γ) that quantifies pulse wave generation and reflection at the aortic root. METHODS: The method was applied to normotensive subjects with modulated physiology by inotropic/vasoactive drugs (n = 13), hypertensive subjects (n = 158), and virtual subjects (n = 4,374). RESULTS: γ is directly proportional to aortic flow throughout the cardiac cycle. Mean peak γ increased with increasing pulse pressure (from <30 to >70 mmHg) in the hypertensive (from 1.6 to 2.5, P < 0.001) and in silico (from 1.4 to 2.8, P < 0.001) groups, dobutamine dose (from baseline to 7.5 μg/kg/min) in the normotensive group (from 2.1 to 2.7, P < 0.05), and remained unchanged when peripheral wave reflections were suppressed in silico. This was accompanied by an increase in the percentage contribution of the cardiac-aortic-coupling component of CBPW in systole: from 11% to 23% (P < 0.001) in the hypertensive group, 9% to 21% (P < 0.001) in the in silico group, and 17% to 23% (P < 0.01) in the normotensive group. CONCLUSION: These results suggest that the aortic root is a major reflection site in the systemic arterial network and ventricular-aortic coupling is the main determinant in the elevation of pulsatile pulse pressure. SIGNIFICANCE: Ventricular-aortic coupling is a prime therapeutic target for preventing/treating systolic hypertension.

Description
Keywords
Aorta, Blood Pressure, Heart Rate, Humans, Hypertension, Pulse Wave Analysis, Systole
Journal Title
IEEE Trans Biomed Eng
Conference Name
Journal ISSN
0018-9294
1558-2531
Volume Title
Publisher
Institute of Electrical and Electronics Engineers (IEEE)
Sponsorship
British Heart Foundation (FS/20/20/34626)
This work was supported by the British Heart Foundation (BHF) [PG/17/50/32903, PG/15/104/31913, FS/20/20/34626], Clinical Research Facility and Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in partnership with King’s College London, Wellcome/Engineering Physical Sciences Research Council (EPSRC) Centre for Medical Engineering at King’s College London [WT 203148/Z/16/Z], and National Institute for Health Research (NIHR) BioResource, Department of Health through the National Institute for Health Research (NIHR) Cardiovascular MedTech Co-operative at GSTT. It contributed to the AIM HY (Ancestry and biological Informative Markers in stratification of HYpertension) stratified medicines programme of hypertension funded by the Medical Research Council and the British Heart Foundation.