Download - Pulse wave analysis
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Jafar Al-Said, M.B. ChB. MD. FASN. FACP.Chair of Internal Medicine.
Nephrology and Internal Medicine Consultant.Bahrain Specialist Hospital
PULSE WAVE ANALYSIS, PULSE WAVE VELOCITY AND CENTRAL
BLOOD PRESSURE
EUROPEAN HYPERTENSION EXELLENCE CENTER
BAHRAIN SPECIALIST HOSPITAL
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Scheme• Sphygmomanometer.• Pulse wave hemodynamics.• Incident wave & Reflected wave.• Augmentation pressure. • Central Pressure. • Pulse wave analysis.• Pulse wave Velocity.• How to check the Central pressure.• Evidenced based clinical significance. • PWA and Central BP research data from BSH European HTN
excellence center data. • Conclusion.
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Measurement of the BPKorotkoff sounds of BP measurement.
Discovered By Nocolas Korotkoff 1905.
BP CUFF PICTURE.
en.wikipedia.org/wiki/Korotkoff_souWikipedia
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Transportation in 1900
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Telecommunication and Mail 1900
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CARDIAC CYCLE AND PRESSURE ALTERATION
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Affect of Atherosclerosis on blood flow
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Aorta and Central Arteries
INCIDENT WAVE
REFLECTIVE WAVE
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• Arterial system is a closed system
• Primary wave (blue) travels along the arteries generating reflected waves from bifurcations
• These small reflected waves return to the heart, summing to create a reflected pressure wave as shown in grey, starting even before the end of systole
Figure 2
Physiology - Pressure Wave Reflection at the Heart
19• Central pressure waveform) is the sum of the outgoing and reflected wave (the green wave at
left)
Figure 3
Pressure Wave Reflection at the Heart
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S P
AP
PP
DP
Systolic pressure (SP)
Diastolic pressure (DP)
Central Pulse Pressure (PP)
Augmented pressure (AP)
“measure of the energy “wasted” by the heart due to the reflected wave”
AIx (= AP/PP)
“composite measure of the magnitude of wave reflection and arterial stiffness”
Key Central pressure parameters.
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• With stiffer arteries, the reflected wave arrives back at the heart sooner, adding to (i.e. augmenting) the outgoing wave
• Now there is a very different Central Pressure Waveform (the green wave)
• These features in the waveform can be measured, and have predictive value.Figure 5
Pressure Wave Reflection at the Heart
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Faster reflected time.
Added to systole
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Schematic representation of pulse pressure amplification.
Oliver J J , and Webb D J Arterioscler Thromb Vasc Biol. 2003;23:554-566Copyright © American Heart Association, Inc. All rights reserved.
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Aging and changes in the pulse wave
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ESH guidelines 2013
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In the CAFE study of over 2,000 patients, brachial blood pressure was controlled in both study arms
But the ACE/ CCB arm had up lower central BP and 30% less CV events than the beta blocker arm.
Augmented Pressure was reduced by the ACE/ CCB but not by the beta blocker.
Brachial pressure does not measure arterial stiffness
Central Pressure shows the effects of Drug therapy masked by Brachial Pressure
Williams B et al., Circulation 2006; 113: 1213-25
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PWV
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Final analysis Report
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Patient with CKD IV
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BSH study on PWA and Central BP
Aim:1-Is their a significant difference between the Brachial and Central:
• Systolic.• Dialysis.• Pulse Pressure.• MAP.
2-Independent variables affecting the Augmentation pressure and the Augmentation Pressure Index.
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N = 216
Mean Age (SE): 42 (1).
BMI (SE): 28.8 (0.47).
Gender Male%: 46.8%
BSH study on PWA and Central BP
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Pressure Brachial (SE)
Central (SE)
p
Systolic 136 (1.2) 121.8(1.10 <0.0001Diastolic 83(0.8) 84(0.8) < 0.0001MAP 100.9 (0.8) 100(0.9) < 0.0001Pulse pressure
52.7(1) 37.2(0.8) <0.0001
BSH study on PWA and Central BP
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Regression of the Augmentation Pressure RR 0.42
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Univariate correlation for the Augmentation Pressure
Variables Corr. Coeff. PAge 0.89 0.0001Gender 0.166 0.015BMI 0.327 0.0001Brachial syst. 0.46 0.0001Brachial diast. -0.058 0.39Brachial Pulse Pres. 0.633 0.0001Brachial MAP 0.18 0006Pulse Rate -0.2 0.002Central syst. 0.55 0.0001Central diast. -0.043 0.5Central Pulse Pres. 0.79 0.0001Central MAP 0.216 0.001
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Mulitvariate Regression of the Augmentation Pressure. RR 0.92
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Regression correlation for the Augmentation pressure Index. RR 0.81
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Conclusion• There is a significant difference between Central and Peripheral BP.
• Central BP is different from the peripheral BP.
• It is highly related with CV mortality and morbidity.
• Pulse wave analysis, Pulse wave velocity and Central pressure are additive factors for CV risk assessment.
• Measurement is easy and can be done in our hospital.
• It adds to the cardiovascular risk factor stratification and HTN management.