PULSE WAVE VELOCITY IN VESSELS 38th Aniversary Panhellenic Congress 70 years of Cardiology, Hellenic Society of Cardiology PULSE WAVE VELOCITY IN VESSELS Theodore G. Papaioannou Associate Professor Biomedical Engineering Unit, First Department of Cardiology Medical School, National & Kapodistrian University of Athens

Term Stiffness Elasticity Compliance Distensibility Viscoelasticity Arterial Mechanical Properties Term Stiffness Elasticity Compliance Distensibility Viscoelasticity Strain http://www.webmd.com

Term Stiffness Elasticity Compliance Distensibility Viscoelasticity Arterial Mechanical Properties Term Stiffness Elasticity Compliance Distensibility Viscoelasticity Strain

Moens–Korteweg equation Adriaan Isebree Moens Dutch physician and physiologist (1846-1891) Diederik Johannes Korteweg Dutch mathematician (1848-1941)

Pulse wave velocity Estimation of regional arterial stiffness

Pulse wave velocity Estimation of regional arterial stiffness Estimation of local arterial stiffness

Pulse wave velocity Estimation of regional arterial stiffness Estimation of local arterial stiffness Estimation of total arterial stiffness

Arterial stiffness Total Methodological & Technological Advances Local Regional

Devices and techniques Complior PoPmetre CAVI SphygmoCor Xcel Vicorder MobiloGraph ABPM

Sensors / Devices for pulse recording Algorithms for signal processing Advancements Sensors / Devices for pulse recording Algorithms for signal processing

Asynchronous, non-simultaneous recordings Regional arterial stiffness Asynchronous, non-simultaneous recordings Pulse Transit Time (PTT)

Regional arterial stiffness Pulse Transit Time (PTT) Max 1st Derivative Max 2nd Derivative Minimum method Tangential method Characteristic Points

Chiu YC, et al. Am Heart J. 1991; 121: 1460–1470 Foot-to-foot methods for PTT estimation Chiu YC, et al. Am Heart J. 1991; 121: 1460–1470

Absolute difference in PWV (m/sec) Foot-to-foot methods for PTT estimation Reproducibility issues …   Absolute difference in PWV (m/sec) PWV ≤0.25 m/s 0.26-0.49 0.50 – 0.99 ≥1.0 1st – 2nd measure 21 (35%) 19 (31.7%) 9 (15%) 11 (18.3%) Papaioannou TG, Protogerou A, et al. J Hum Hypertens. 2012;26(10):594-602

Foot-to-foot methods for PTT estimation Tangential Method

Foot-to-foot methods for PTT estimation Validation of a novel and existing algorithms for the estimation of pulse transit time: advancing the accuracy in pulse wave velocity measurement. Vardoulis O, Papaioannou TG, Stergiopulos N. Am J Physiol Heart Circ Physiol. 2013; 304:H1558-67

Foot-to-foot methods for PTT estimation Validation of a novel and existing algorithms for the estimation of pulse transit time: advancing the accuracy in pulse wave velocity measurement. Vardoulis O, Papaioannou TG, Stergiopulos N. Am J Physiol Heart Circ Physiol. 2013; 304:H1558-67

Foot-to-foot methods for PTT estimation The “Diastole – Patching” method Vardoulis O, Papaioannou TG, Stergiopulos N. Am J Physiol Heart Circ Physiol. 2013; 304:H1558-67

Foot-to-foot methods for PTT estimation The “Diastole – Patching” method Vardoulis O, Papaioannou TG, Stergiopulos N. Am J Physiol Heart Circ Physiol. 2013; 304:H1558-67

Foot-to-foot methods for PTT estimation The “Diastole – Patching” method in-vivo Papaioannou TG, Vardoulis O, Protogerou A, et al. Physiol Meas. 2015;36:149-61

Foot-to-foot methods for PTT estimation Accuracy and Precision of PWV measurement Clinical value of PWV ???

“Heart rate variability” 21.837 papers “c reactive protein” 64.756 papers

Measurements issues - Consensus Documents Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Van Bortel L, et al. J Hypertens. 2012; 30(3):445-8. Expert consensus document on arterial stiffness: Methodological issues and clinical applications. Laurent S, et al. Eur. Heart J. 2006; 27:2588-2605.

Normal and Reference Values of PWV Eur Heart J. 2010 Oct;31(19):2338-50.

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PWV and cardiovascular risk Ben-Shlomo et al, JACC; 2014; 63: 636-46

The main finding of the current study is that aortic stiffness, assessed by measurement of aPWV, can predict future cardiovascular events and mortality, even after accounting for other established cardiovascular risk factors. The predictive value of aPWV was stronger in younger versus older subjects but was not modified by hypertension, smoking, sex, diabetes, or kidney disease. Addition of aPWV into risk prediction models also increased the number of participants who were correctly classified, particularly among younger individuals at intermediate risk, and it improved the overall 10-year classification by 13%. Ben-Shlomo et al, JACC; 2014; 63: 636-46

Guidelines

Thank you Étienne-Jules Marey (1863)