An updated clinical primer on large artery mechanics: implications of pulse waveform analysis and arterial tonometry

O’Rourke, Michael; Adji, Audrey

doi:10.1097/01.hco.0000166595.44711.6f

Cited by 112 publications

(79 citation statements)

References 67 publications

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“…Other haemodynamic parameters are associated with stroke in epidemiological studies, 43 and amphetamine appears to alter some of these. Central BP (rather than peripheral brachial BP) is more relevant to the cerebral circulation and amphetamine increased this.…”

Section: Discussionmentioning

confidence: 99%

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

et al. 2007

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Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post-ischaemic stroke into a phase II randomized (1:1), double-blind, placebo-controlled trial. Subjects received dexamphetamine (5 mg initially, then 10 mg for 10 subsequent doses with 3-or 4-day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer (FM)), and functional scales (Barthel index (BI) and modified Rankin score (mRS)). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 min after, the first two doses. Thirty-three subjects were recruited, aged 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. Sixteen patients were randomized to placebo and seventeen to amphetamine. Amphetamine did not improve motor function at 90 days; mean (s.d.) FM 37.6 (27.6) vs control 35.2 (27.8) (P ¼ 0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate (HR), were 11.2 mm Hg (P ¼ 0.03), 9.5 mm Hg (P ¼ 0.04) and 7 beats per minute (P ¼ 0.02) higher, respectively, with amphetamine, compared with control. A nonsignificant reduction in myocardial perfusion (BUI) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics.

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Section: Discussionmentioning

confidence: 99%

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

et al. 2007

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“…16,17 The arterial pulse wave is generated by the sum of the forward pressure wave, timing of the reflected wave and the magnitude of the reflected wave along the arterial tree. 18 Arterial wave reflection occurs in the peripheral arteries due to changes in the arterial properties or in the architecture of the arterial tree. 18 Reflected waves can be measured as the augmentation pressure or AI, which has emerged as a surrogate marker for cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…18 Arterial wave reflection occurs in the peripheral arteries due to changes in the arterial properties or in the architecture of the arterial tree. 18 Reflected waves can be measured as the augmentation pressure or AI, which has emerged as a surrogate marker for cardiovascular disease. 11,19 Noninvasive measurement of AI can be performed by direct pulse wave measurement of the common carotid artery or synthesized wave form of the radial artery using the generalized transfer function.…”

Section: Discussionmentioning

confidence: 99%

Comparison of arterial stiffness indices measured by the Colins and SphygmoCor systems

et al. 2012

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Arterial stiffness is a known independent predictor of cardiovascular mortality. The Colins system is an easy device and has gained widespread use, but the cutoff value for high-risk central arterial stiffness is not well established. We investigated the correlation between arterial stiffness measured by the Colins system with conventional measurements from the SphygmoCor system. Arterial pulse wave velocity (PWV) and augmentation indices (AIs) were measured on a single visit using two different devices in 948 patients with hypertension or coronary artery disease. INTRODUCTIONArterial stiffening results from changes in the central arteries that are accompanied by arterial dilatation, elastin degradation, increased collagen and vascular smooth muscle cell proliferation in the intima media of the arterial wall. 1,2 Studies have shown that increased pulse wave velocity (PWV), an index of arterial stiffness, is an independent predictor of cardiovascular mortality in both the general population and in patients with hypertension. 3-5 Carotid-femoral PWV (cfPWV), which is the ratio of the distance between the carotid artery-femoral artery and the pulse wave transit time, is considered the conventional method for measuring PWV. Studies have shown that a PWV of more than 12 m s À1 is associated with increased risk of both all-cause mortality and cardiovascular mortality. 6,7 Although the measurement of heart-femoral PWV (hfPWV) and brachial-ankle PWV (baPWV) using the Colins system (VP-2000 pulse wave unit) has gained widespread popularity and usage in the clinical setting in East Asia due to its ease of use, the measurement of baPWV has been criticized because it contains components of peripheral vascular stiffness.

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“…[1][2][3][4] Importantly, the recent Conduit Artery Function Evaluation (CAFÉ ) study showed that a greater decrease of central blood pressure (BP) with antihypertensive treatment is associated with reduced cardiovascular events, independent of peripheral BP changes. 5 Likewise, there are data showing that the reversal of endothelial dysfunction, that is present in hypertensive patients, 6 may benefit prognosis.…”

Section: Introductionmentioning

confidence: 99%

Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

et al. 2007

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An updated clinical primer on large artery mechanics: implications of pulse waveform analysis and arterial tonometry

Abstract: Pulse wave analysis will assist in a better understanding of hypertension as well as in establishing the extent of cardiovascular disease and for monitoring therapy.

Cited by 112 publications

References 67 publications

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Comparison of arterial stiffness indices measured by the Colins and SphygmoCor systems

Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

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