Transfer‐function‐free technique for the noninvasive determination of the human arterial pressure waveform

Giudici, Alessandro; Palombo, Carlo; Morizzo, C.; Kozàkovà, M.; Cruickshank, J.; Wilkinson, Ian B.; Khir, Ashraf W.

doi:10.14814/phy2.15040

Cited by 4 publications

(3 citation statements)

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“…Although this phase of the cardiac cycle spanned between DBP and ∼65% of the PP, our results indicated that, on average, P c was determined for its 91.5% by DBP and only for its 8.5% by SBP (Figure 4). We obtained similar results when estimating cPWV via the lnDUloop method, a linear regression between blood velocity (U) and the natural logarithm of the diameter distension (lnD) in early systole (Giudici et al, 2021d). These findings suggest that, as regional PWV, loop methods provide nearly diastolic measures of PWV and that DBP should be regarded as the main driver of their BP-dependency.…”

Section: Discussionsupporting

confidence: 55%

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Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients

et al. 2022

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Pulse wave velocity (PWV) is a powerful predictor of cardiovascular events. However, its intrinsic blood pressure (BP)-dependency complicates distinguishing between acute and chronic effects of increased BP on arterial stiffness. Based on the assumption that arteries exhibit a nearly exponential pressure-area (P-A) relationship, this study proposes a method to assess intersubject differences in local PWV independently from BP. The method was then used to analyze differences in local carotid PWV (cPWV) between hypertensive and healthy normotensive people before and after BP-normalization. Pressure (P) and diameter (D) waveforms were simultaneously acquired via tonometer at the left and ultrasound scanning at right common carotid artery (CCA), respectively, in 22 patients with Grade 1 or 2 hypertension and 22 age- and sex-matched controls. cPWV was determined using the D2P-loop method. Then, the exponential modeling of the P-area (A = πD2/4) relationships allowed defining a mathematical formulation to compute subject-specific changes in cPWV associated with BP changes, thus enabling the normalization of cPWV against intersubject differences in BP at the time of measurement. Carotid systolic BP (SBP) and diastolic BP (DBP) were, on average, 17.7 (p < 0.001) and 8.9 mmHg (p < 0.01) higher in hypertensives than controls, respectively. cPWV was 5.56 ± 0.86 m/s in controls and 6.24 ± 1.22 m/s in hypertensives. BP alone accounted for 68% of the cPWV difference between the two groups: 5.80 ± 0.84 vs. 6.03 ± 1.07 m/s after BP-normalization (p = 0.47). The mechanistic normalization of cPWV was in agreement with that estimated by analysis of covariance (ANCOVA). In conclusion, the proposed method, which could be easily implemented in the clinical setting, allows to assess the intersubject differences in PWV independently of BP. Our results suggested that mild hypertension in middle-aged subjects without target organ damage does not significantly alter the stiffness of the CCA wall independently of acute differences in BP. The results warrant further clinical investigations to establish the potential clinical utility of the method.

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Section: Discussionsupporting

confidence: 55%

“…2 and rearranging using Eq. 1 leads to the following relationship between PWV and γ 0 , as previously demonstrated (Giudici et al, 2021d) (refer to Eqs A1-A7 in Appendix for the detailed calculations):…”

Section: Theoretical Backgroundmentioning

confidence: 63%

Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients

et al. 2022

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“…In summary, until the vagaries of estimating central BP based on inevitable current brachial BP calibration are eliminated -and these methods are emerging [2,3] to this commentator, central BP offers little of value over the hugely 'validated' brachial BP. Using arterial function measured as aortic pulse wave velocity is quite another and more valuable a matter -not available in UK Biobank.…”

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confidence: 99%

Age-dependent association of central blood pressure with cardiovascular outcomes: a cohort study involving 34 289 participants using the UK biobank

Cruickshank

2024

Journal of Hypertension

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Estimation of Blood Pressure by Image-Free, Wearable Ultrasound

Amado Rey

2024

Artery Res

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Abstract1.28 billion adults worldwide have high pressure, and only 21% of people have it under control. If high blood pressure (BP) is not diagnosed and treated properly, then there is a high risk for cardiovascular diseases, the main cause of mortality. Ultrasound has emerged as a potential medical imaging system to monitor cardiovascular health. It is comfortable, noninvasive, safe, and a very well-established and well-known technology. However, there are currently no commercial single ultrasound systems to directly quantify vascular parameters, without the need for complex imaging algorithms, additional software-based solutions, and high energy demands that limit portable and prolonged measurements. In this paper, we present the steps to design an image-free novel ultrasound device to continuously extract vital parameters, with a focus on BP. Moreover, as the BP waveforms are amplified toward the periphery (i.e., from the aorta to the radial artery), we applied mathematical models and algorithms, specific to the site of measurement, to accurately extract BP. We validated these algorithms in silico, in vitro, and ex vivo, where tissue and artery phantoms help emulate human physiology. In young subjects, an in silico pulse pressure (PP) correlation of 0.978 and a mean difference of (– 2.85 ± 2.57) mmHg at the radial artery were achieved. The ex vivo PP correlation was 0.986, with a mean difference of (1.72 ± 3.29) mmHg. Soon thereafter, in vivo measurements of BP and stiffness, and their correlation analysis will be performed to corroborate the accuracy of the developed proof-of-concept device.

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Transfer‐function‐free technique for the noninvasive determination of the human arterial pressure waveform

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 4 publications

References 53 publications

Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients

Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients

Age-dependent association of central blood pressure with cardiovascular outcomes: a cohort study involving 34 289 participants using the UK biobank

Estimation of Blood Pressure by Image-Free, Wearable Ultrasound

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