Noninvasive Measurement of Central Vascular Pressures With Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform? Matthew R. Nelson, MD,

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Presentation transcript:

Noninvasive Measurement of Central Vascular Pressures With Arterial Tonometry: Clinical Revival of the Pulse Pressure Waveform? Matthew R. Nelson, MD, MS, Jan Stepanek, MD, MPH, Michael Cevette, PhD, Michael Covalciuc, MD, MPH, R. Todd Hurst, MD, A. Jamil Tajik, MD Mayo Clinic Proceedings Volume 85, Issue 5, Pages 460-472 (May 2010) DOI: 10.4065/mcp.2009.0336 Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Sphygmograph by Etienne Jules Marey in 1860. Mayo Clinic Proceedings 2010 85, 460-472DOI: (10.4065/mcp.2009.0336) Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Applanation tonometry is performed by placing a pressure sensor over the radial artery. Pictured is the SphygmoCor device (AtCor Medical, Sydney, Australia). Mayo Clinic Proceedings 2010 85, 460-472DOI: (10.4065/mcp.2009.0336) Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Radial artery applanation tonometry recording of a 41-yr-old man. The upper long panel shows the radial pressure waveform above the derived central pressure waveform. The bottom left panel demonstrates a magnified radial arterial waveform. Systolic and diastolic pressures are 117/85 mm Hg. The bottom right panel provides a magnified derived central pressure waveform. Central pressure is 105/85 mm Hg. Mayo Clinic Proceedings 2010 85, 460-472DOI: (10.4065/mcp.2009.0336) Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Reflection of the pulse wave during the systolic period leads to an increase in left ventricular workload (black upward arrows) and a decrease in the diastolic pressure (black downward arrows). Reflection of the pulse wave during the diastolic period leads to a decrease in ventricular workload and an increase in diastolic pressures. Mayo Clinic Proceedings 2010 85, 460-472DOI: (10.4065/mcp.2009.0336) Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Central pulse pressure waveform. Systolic and diastolic pressures are the peak and trough of the waveform. Augmentation pressure is the additional pressure added to the forward wave by the reflected wave. Augmentation index is the ratio between augmentation pressure and central pulse pressure. The dicrotic notch represents closure of the aortic valve and is used to calculate ejection duration. Time to wave reflection is calculated at the point of rise in the initial ejection wave to the onset of the reflected wave. The reflected wave in this central pressure waveform results in augmentation of systolic flow. Mayo Clinic Proceedings 2010 85, 460-472DOI: (10.4065/mcp.2009.0336) Copyright © 2010 Mayo Foundation for Medical Education and Research Terms and Conditions