Estimating central pulse pressure from blood flow by identifying the main physical determinants of pulse pressure amplification

Joaquín Flores; Eugenia Corvera Poiré; Philip Chowienczyk; Jordi Alastruey

doi:10.3389/fphys.2021.608098

Estimating central pulse pressure from blood flow by identifying the main physical determinants of pulse pressure amplification

Joaquín Flores, Eugenia Corvera Poiré, Philip Chowienczyk, Jordi Alastruey

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Abstract

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.

Original language	English
Article number	608098
Journal	Frontiers in Physiology
Volume	12
DOIs	https://doi.org/10.3389/fphys.2021.608098
Publication status	Published - 23 Feb 2021

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title = "Estimating central pulse pressure from blood flow by identifying the main physical determinants of pulse pressure amplification",

abstract = "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.",

author = "Joaqu{\'i}n Flores and {Corvera Poir{\'e}}, Eugenia and Philip Chowienczyk and Jordi Alastruey",

note = "Funding Information: The authors thank Drs. Ye Li (King's College London), Jorge Aramburu (Navarra University), and Peter Charlton (King's College London) for data and programming support. Funding. JFG acknowledges support of a postdoctoral fellowship from CONACyT [CVU:288182]. ECP and JA acknowledge the UK-Mexico Visiting Chair for a mobility grant. ECP acknowledges funding from the Centre for Mexican Studies UNAM-UK, for financing a short stay; CONACyT (Mexico), through project no. 219584 and agreement no. 2018-000007- 01EXTV-00183; the Faculty of Chemistry UNAM, through PAIP 5000-9011; and DGAPA, UNAM, through a PASPA programme, during a sabbatical leave. PC and JA were partially funded by the British Heart Foundation (BHF) [PG/15/104/31913 and PG/17/50/32903]. The authors also acknowledge financial support from the Wellcome EPSRC Centre for Medical Engineering at King's College London [WT 203148/Z/16/Z], Department of Health through the National Institute for Health Research (NIHR) Cardiovascular MedTech Co-operative at Guy's and St Thomas' NHS Foundation Trust (GSTT) and the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Centers Digital biodesign and personalized healthcare [075-15-2020-926]. The views expressed are those of the authors and not necessarily those of the UNAM, CONACyT, AMEXCID, EPSRC, BHF, Wellcome Trust, NIHR, GSTT or Ministry of Science. Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Flores Ger{\'o}nimo, Corvera Poir{\'e}, Chowienczyk and Alastruey. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

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doi = "10.3389/fphys.2021.608098",

language = "English",

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N1 - Funding Information: The authors thank Drs. Ye Li (King's College London), Jorge Aramburu (Navarra University), and Peter Charlton (King's College London) for data and programming support. Funding. JFG acknowledges support of a postdoctoral fellowship from CONACyT [CVU:288182]. ECP and JA acknowledge the UK-Mexico Visiting Chair for a mobility grant. ECP acknowledges funding from the Centre for Mexican Studies UNAM-UK, for financing a short stay; CONACyT (Mexico), through project no. 219584 and agreement no. 2018-000007- 01EXTV-00183; the Faculty of Chemistry UNAM, through PAIP 5000-9011; and DGAPA, UNAM, through a PASPA programme, during a sabbatical leave. PC and JA were partially funded by the British Heart Foundation (BHF) [PG/15/104/31913 and PG/17/50/32903]. The authors also acknowledge financial support from the Wellcome EPSRC Centre for Medical Engineering at King's College London [WT 203148/Z/16/Z], Department of Health through the National Institute for Health Research (NIHR) Cardiovascular MedTech Co-operative at Guy's and St Thomas' NHS Foundation Trust (GSTT) and the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Centers Digital biodesign and personalized healthcare [075-15-2020-926]. The views expressed are those of the authors and not necessarily those of the UNAM, CONACyT, AMEXCID, EPSRC, BHF, Wellcome Trust, NIHR, GSTT or Ministry of Science. Publisher Copyright: © Copyright © 2021 Flores Gerónimo, Corvera Poiré, Chowienczyk and Alastruey. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2/23

Y1 - 2021/2/23

N2 - 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.

AB - 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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DO - 10.3389/fphys.2021.608098

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JO - Frontiers in Physiology

JF - Frontiers in Physiology

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ER -

Estimating central pulse pressure from blood flow by identifying the main physical determinants of pulse pressure amplification

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