Application of non-invasive central aortic pressure assessment in clinical trials: Clinical experience and value

Williams, Bryan; Brunel, Patrick; Lacy, Peter; Baschiera, Fabio; Zappe, Dion H.; Kario, Kazuomi; Cockcroft, John R.

doi:10.1016/j.artres.2016.10.154

Cited by 5 publications

(8 citation statements)

References 91 publications

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“…Peripheral systolic blood pressure is the most commonly used measure of circulatory function and cardiovascular risk. However, a significant predictive benefit has been observed when measuring central (aortic) blood pressure (cBP) (Agabiti-Rosei and Muiesan, 2015 ; Williams et al, 2018 ) and it has been suggested that cBP should be a better indicator of risk (Agabiti-Rosei et al, 2007 ; Avolio et al, 2009 ; Sharman et al, 2013 ; McEniery et al, 2014 ; Agabiti-Rosei and Muiesan, 2015 ; Williams et al, 2017 ) since it is more representative of the load exerted on major organs (Herbert et al, 2014 ; Agabiti-Rosei and Muiesan, 2015 ; Williams et al, 2017 ). For instance, elevation of cBP induces coronary arteriosclerosis which in turn can lead to adverse events such as stenosis and myocardial infarction (Agabiti-Rosei et al, 2007 ) and causes chronic kidney disease that can advance to end-stage renal disease (Safar et al, 2002 ; Ohno et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…Understanding the effect of cardiovascular parameters on PP could improve cBP assessment from non-invasive pBP measurements; specially central PP (cPP) assessment which has been shown to be of greater predictive value for cardiovascular outcomes than brachial PP (Safar et al, 2002;Williams et al, 2006). Large PP values have been associated with male sex (Segers et al, 2009;Herbert et al, 2014), higher heart rate (Wilkinson et al, 2002), height (Asmar et al, 1997;Camacho FIGURE 1 | Central and peripheral pressure waveforms. Central pulse pressure, cPP, is mainly determined by the blood flow ejected by the ventricle into the aorta, Q in , and the total arterial compliance, C T (Vennin et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

et al. 2021

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Several studies suggest that central (aortic) blood pressure (cBP) is a better marker of cardiovascular disease risk than peripheral blood pressure (pBP). The morphology of the pBP wave, usually assessed non-invasively in the arm, differs significantly from the cBP wave, whose direct measurement is highly invasive. In particular, pulse pressure, PP (the amplitude of the pressure wave), increases from central to peripheral arteries, leading to the so-called pulse pressure amplification (ΔPP). The main purpose of this study was to develop a methodology for estimating central PP (cPP) from non-invasive measurements of aortic flow and peripheral PP. Our novel approach is based on a comprehensive understanding of the main cardiovascular properties that determine ΔPP along the aortic-brachial arterial path, namely brachial flow wave morphology in late systole, and vessel radius and distance along this arterial path. This understanding was achieved by using a blood flow model which allows for workable analytical solutions in the frequency domain that can be decoupled and simplified for each arterial segment. Results show the ability of our methodology to (i) capture changes in cPP and ΔPP produced by variations in cardiovascular properties and (ii) estimate cPP with mean differences smaller than 3.3 ± 2.8 mmHg on in silico data for different age groups (25–75 years old) and 5.1 ± 6.9 mmHg on in vivo data for normotensive and hypertensive subjects. Our approach could improve cardiovascular function assessment in clinical cohorts for which aortic flow wave data is available.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

et al. 2021

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“…Da mesma maneira, como descrito a seguir, estudos prospectivos observacionais têm demonstrado o valor preditivo de parâmetros hemodinâmicos centrais para eventos CV na população geral, nos idosos e nos pacientes com doença coronária e com doença renal crônica (DRC). 228 …”

Section: Valor Prognóstico Das Medidas Derivadas Dos Parâmetros Centraisunclassified

Diretrizes Brasileiras de Medidas da Pressão Arterial Dentro e Fora do Consultório – 2023

Feitosa,

Barroso,

Mion Junior

et al. 2024

Arq. Bras. Cardiol.

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“…Recent clinical studies have shown that central (aortic) blood pressure (cBP) is a better cardiovascular risk indicator than brachial blood pressure (bBP) ( 1 – 4 ), since cBP is more representative of the load exerted on major organs ( 1 , 5 ). Regardless of gender or disease, cBPs in subjects with similar brachial systolic blood pressure (SBP) may differ by up to 33mmHg, resulting in “a significant overlap of central SBP scores between brachial SBP risk groups” ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Estimating central blood pressure from aortic flow: development and assessment of algorithms

Harana

Charlton

Vennin

et al. 2021

American Journal of Physiology-Heart and Circulatory Physiology

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Central blood pressure (cBP) is a highly prognostic cardiovascular (CV) risk factor whose accurate, invasive assessment is costly and carries risks to patients. We developed and assessed novel algorithms for estimating cBP from non-invasive aortic haemodynamic data and a peripheral BP measurement. These algorithms were created using three blood flow models: the 2-and-3-element Windkessel (0-D) models and a one-dimensional (1-D) model of the thoracic aorta. We tested new and existing methods for estimating CV parameters (ejection time, outflow BP, arterial resistance, compliance, pulse wave velocity, characteristic impedance) required for the cBP algorithms, using 'virtual' subjects (n=19,646) for which reference CV parameters were known exactly. We then tested the cBP algorithms using 'virtual' subjects (n=4,064), for which reference cBP were available free-of-measurement error, and clinical datasets containing invasive (n=10) and non-invasive (n=171) reference cBP waves across a wide-range of CV conditions. The 1-D algorithm outperformed the 0-D algorithms when the aortic vascular geometry was available, achieving central systolic blood pressure (cSBP) errors ≤2.1±9.7mmHg and root-mean-square-errors (RMSEs) ≤6.4±2.8mmHg against invasive reference cBP waves (n=10). When the aortic geometry was unavailable, the 3-element 0-D algorithm achieved cSBP errors ≤6.0±4.7mmHg and RMSEs ≤5.9±2.4mmHg against non-invasive reference cBP waves (n=171), outperforming the 2-element 0-D algorithm. All CV parameters were estimated with mean percentage errors ≤8.2%, except for the aortic characteristic impedance (≤13.4%), which affected the 3-element 0-D algorithm's performance. The freely-available algorithms developed in this work enable fast and accurate calculation of the cBP wave and CV parameters from ultrasound or magnetic resonance imaging data.

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Application of non-invasive central aortic pressure assessment in clinical trials: Clinical experience and value

Cited by 5 publications

References 91 publications

Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

Diretrizes Brasileiras de Medidas da Pressão Arterial Dentro e Fora do Consultório – 2023

Estimating central blood pressure from aortic flow: development and assessment of algorithms

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