Towards a consensus on the understanding and analysis of the pulse waveform: Results from the 2016 Workshop on Arterial Hemodynamics: Past, present and future

Abstract

This paper aims to summarize and map contemporary views on some contentious aspects of arterial hemodynamics that have remained unresolved despite years of research. These were discussed during a workshop entitled Arterial hemodynamics: past, present and future held in London on June 14 and 15, 2016. To do this we formulated a list of potential consensus statements informed by discussion at the meeting in London and quantified the degree of agreement and invited comments from the participants of the workshop. Overall the responses and comments show a high measure of quantitative agreement with the various proposed 'consensus' statements. Taken together, these statements seem a useful basis for proceeding with a more detailed and comprehensive consensus document on the current understanding and approaches to analysis of the pulse waveform. Future efforts should be directed at identifying remaining areas of dispute and future topics for research.

Cuff-Based Oscillometric Measurements of Central Hemodynamics: Factors Influencing Central Augmentation Pressure in Normotensive Japanese Individuals

“…There is no single or limited number of discrete reflection sites in the arterial tree, and summation of wave reflection arising from multiple sites reflects central pressure contour [12]. The arrival time of each reflected wave is dependent on aPWV and reflection site distance from the aortic root.…”

“…Impedance analysis, based on Fourier-transformed pressure and flow waves, is a valid characterization of the arterial system [12]. Murgo et al [13] simultaneously measured ascending aortic pressure and flow velocity to analyze ascending aortic impedance and classified the aortic pressure contour to relate the pattern of the impedance spectral plots.…”

Pulse Wave Analysis and Pulse Wave Velocity for Fistula Assessment

“…They can be superposed, enhanced or damped [30,31]. A peripheral PW is not a harmonic sinusoidal wave but consists of summed ante-and retrograde waves of different frequencies [30][31][32][33]. PWs running through peripheral arteries of reduced elasticity show a gain of high-frequency wave components due to weaker damping, whereas in case of an increased arterial elasticity (vascular compliance) it is the other way around [30,31].…”

The modified arterial reservoir: an update with consideration of asymptotic pressure (P∞) and zero-flow pressure (Pzf)

“…The existence of wave travel in arteries is undisputed. (13) A number of studies have envisaged the arterial system as a single or a T-tube; however this approach to arterial hemodynamics is too simplistic and a more sophisticated model of wave propagation in arteries is necessary. (15) More realistic 1-dimensional models show that the branching pattern of the arterial circulation gives rise to myriad reflected waves, which are themselves re-reflected and re-re-reflected before returning to the aortic root.…”