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Assessment of arterial pressure wave reflection: Methodological considerations

Artery Research volume 2, pages 122–131 (2008)Cite this article

Summary

Cardiovascular risk assessment more and more makes use of the diagnostic information hidden in the arterial waves propagating in the cardiovascular system. An important factor determining the morphology of the arterial waves is wave reflection which becomes more significant with increasing age and can be related to an augmented risk for cardiovascular disease. This paper describes three currently existing techniques to analyze wave reflections with their pros and cons to give the reader more insight into this still debated field. The first method is the augmentation index which only requires information on the pressure wave but although commonly used, hasn’t yet revealed any strong prognostic value in the general population, possibly due to the composite character of the index. More advanced and unequivocal methods exist, requiring information on both pressure and flow waves and thus having added value from a patho-physiological point of view: impedance analysis and wave intensity analysis. The former consists of decomposing the waves in the frequency domain, and has the disadvantage that the analysis is only valid in a linear system and requires the complex Fourier analysis. A more intuitive approach executed in the time domain is wave intensity analysis which doesn’t have the previously mentioned restrictions but is highly susceptible to noise. We will further discuss how according to our experience both the time and frequency domain methods can stand along each other and can be used in a complementary way.

References

  1. O’Rourke MF, Mancia G. Arterial stiffness. J Hypertens 1999;17:1–4.

    Google Scholar 

  2. Westerhof N, O’Rourke MF. Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy. J Hypertens 1995;13:943–52.

    Google Scholar 

  3. Latham R, Westerhof N, Sipkema P, Rubal B, Reuderink P, Murgo J. Regional wave travel and reflections along the human aorta: a study with six simultaneous micromanometric pressures. Circulation 1985;72:1257–69.

    Google Scholar 

  4. Greenwald SE, Carter AC, Berry CL. Effect of age on the in vitro reflection coefficient of the aortoiliac bifurcation in humans. Circulation 1990;82:114–23.

    Google Scholar 

  5. Milnor WR. Hemodynamics. Baltimore, Maryland: Williams & Wilkins; 1989.

    Google Scholar 

  6. Nichols W, O’Rourke M. McDonald’s blood flow in arteries. Theoretical, experimental and clinical principles. USA: Hodder Arnold - Oxford University Press; 2005.

    Google Scholar 

  7. Murgo JP, Westerhof N, Giolma JP, Altobelli SA. Aortic input impedance in normal man: relationship to pressure wave forms. Circulation 1980;62:105–16.

    Google Scholar 

  8. Segers P, Rietzschel ER, De Buyzere ML, Vermeersch SJ, De Bacquer D, Van Bortel LM, et al. Noninvasive (input) impedance, pulse wave velocity, and wave reflection in healthy middle-aged men and women. Hypertension 2007;49:1248–55.

    Google Scholar 

  9. Kelly R, Hayward C, Avolio A, O’Rourke M. Noninvasive determination of age-related changes in the human arterial pulse. Circulation 1989;80:1652–9.

    Google Scholar 

  10. O’Rourke MF, Avolio A, Qasem A. Clinical assessment of wave reflection. Hypertension 2003;42. e15–6; author reply e15–6. Epub 2003 Sep 22.

    Google Scholar 

  11. Westerhof N, Sipkema P, van den Bos CG, Elzinga G. Forward and backward waves in the arterial system. Cardiovasc Res 1972;6:648–56.

    Google Scholar 

  12. Westerhof N, Stergiopulos N, Noble M. Snapshots of hemodynamics. An aid for clinical research and graduate education. New York: Springer Science + Business Media; 2004.

    Google Scholar 

  13. Parker KH, Jones CJ. Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng 1990;112:322–6.

    Google Scholar 

  14. Davies JE, Whinnett ZI, Francis DP, Manisty CH, Aguado-Sierra J, Willson K, et al. Evidence of a dominant backward-propagating ‘‘suction’’ wave responsible for diastolic coronary filling in humans, attenuated in left ventricular hypertrophy. Circulation 2006;113:1768–78.

    Google Scholar 

  15. Zambanini A, Cunningham SL, Parker KH, Khir AW, Thom SAM, Hughes AD. Wave-energy patterns in carotid, brachial, and radial arteries: a noninvasive approach using wave-intensity analysis. Am J Physiol-Heart Circ Physiol 2005;289:H270–6.

    Google Scholar 

  16. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588–605.

    Google Scholar 

  17. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Abridged version of the expert consensus document on arterial stiffness. Artery Res 2007;1:2–12.

    Google Scholar 

  18. Rietzschel ER, De Buyzere ML, Bekaert S, Segers P, De Bacquer D, Cooman L, et al. Rationale, design, methods and baseline characteristics of the Asklepios Study. Eur J Cardiovasc Prev Rehabil 2007;14:179–91.

    Google Scholar 

  19. Takazawa K, Tanaka N, Takeda K, Kurosu F, Ibukiyama C. Underestimation of vasodilator effects of nitroglycerin by upper limb blood pressure. Hypertension 1995;26:520–3.

    Google Scholar 

  20. Segers P, Rietzschel ER, De Buyzere ML, De Bacquer D, Van Bortel LM, De Backer G, et al. Assessment of pressure wave reflection: getting the timing right!. Physiol Meas 2007;28: 1045–56.

    Google Scholar 

  21. Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 2004;43:1239–45.

    Google Scholar 

  22. O’Rourke MF, Nichols WW. Changes in wave reflection with advancing age in normal subjects. Hypertension 2004;44: e10–1.

    Google Scholar 

  23. Segers P, De Backer JF, Devos D, Rabben SI, Gillebert TC, Van Bortel L, et al. Aortic reflection coefficients and their association with global indices of wave reflection in healthy controls and patients with Marfan disease. Am J Physiol-Heart Circ Physiol 2006;290:H2385–92.

    Google Scholar 

  24. Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000;525: 263–70.

    Google Scholar 

  25. McEniery CM, Yasmin Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol 2005;46:1753–60.

    Google Scholar 

  26. Millasseau SC, Patel SJ, Redwood SR, Ritter JM, Chowienczyk PJ. Pressure wave reflection assessed from the peripheral pulse: is a transfer function necessary? Hypertension 2003;41:1016–20. Epub 2003 Apr 14.

    Google Scholar 

  27. Segers P, Rietzschel E, Heireman S, De Buyzere M, Gillebert T, Verdonck P, et al. Carotid tonometry versus synthesized aorta pressure waves for the estimation of central systolic blood pressure and augmentation index. Am J Hypertens 2005;18: 1168–73.

    Google Scholar 

  28. Bleasdale RA, Parker KH, Jones CJ. Chasing the wave. Unfashionable but important new concepts in arterial wave travel. Am J Physiol Heart Circ Physiol 2003;284:H1879–85.

    Google Scholar 

  29. Khir AW, O’Brien A, Gibbs JS, Parker KH. Determination of wave speed and wave separation in the arteries. J Biomech 2001;34:1145–55.

    Google Scholar 

  30. Savitzky A, Golay MJE. Smoothing and differentiation of data by simplified least squares procedures. Anal Chem 1964;36: 1627–39.

    Google Scholar 

  31. Swillens A, Lanoye L, De Backer J, Stergiopulos N, Verdonck PR, Vermassen F, et al. The effect of an abdominal aortic aneurysm on wave reflection in the aorta. IEEE Trans Biomed Eng 2008;55(5):1602–11.

    Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Mechanics and Biofluid Dynamics, Institute Biomedical Technology (IBiTech), Ghent University, De Pintelaan 185, B-9000, Gent, Belgium

    Abigail Swillens & Patrick Segers

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  1. Abigail Swillens
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  2. Patrick Segers
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Correspondence to Patrick Segers.

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This is an open access article distributed under the CC BY-NC license. https://doi.org/creativecommons.org/licenses/by/4.0/

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Swillens, A., Segers, P. Assessment of arterial pressure wave reflection: Methodological considerations. Artery Res 2, 122–131 (2008). https://doi.org/10.1016/j.artres.2008.05.001

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Artery Research

ISSN: 1876-4401

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