Central-to-peripheral stiffness gradients determine diastolic pressure and flow fluctuation waveforms: time domain analysis of femoral artery pulse
Central-to-peripheral stiffness gradients determine diastolic pressure and flow fluctuation waveforms: time domain analysis of femoral artery pulse
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中枢到外周的硬度梯度决定舒张压和流量波动波形：股动脉搏动的时域分析
DOI：
10.1097/hjh.0000000000003014
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发表时间：
2022
期刊：
影响因子：
4.9
通讯作者：
Ito S
中科院分区：
文献类型：
--
作者：
Hashimoto J;Tagawa K;Westerhof BE;Ito S
目的：舒张期血压波动产生重搏波，但其机制起源仍知之甚少。我们试图研究舒张压和流量波动的特征和决定因素，重点关注中央主动脉和外周动脉之间的硬度梯度。方法：使用压平张力测量法和双功能超声，记录 592 名患者（年龄：55±14 岁）的股动脉脉搏波形，以将舒张压波动估计为单指数衰减的残余波，并将舒张期流量波动估计为单指数衰减的残差波。双向（正向和反向）速度波。还记录桡动脉、颈动脉和足背压力，以测量外周/主动脉脉压（PP）和脉搏波速度（PWV）比率。结果：股动脉压力和流量波动波形之间非常相似。压力和流量波动在相对幅度上相互关联，以总脉冲高度为索引（r = 0.63），并且前者在时间上跟随后者。在多变量调整模型中，较高的外周/主动脉 PP 和 PWV 比率与较高的压力和流量波动指数独立相关（P < 0.001）。中介分析显示，PP 和 PWV 比率与压力波动指数的关联很大程度上是由流量波动指数介导的[间接/总效应比：分别为 57 (95% CI 42–80)% 和 54 (30–100)%]。结论：这些结果表明，中枢到外周脉搏放大和刚度梯度有助于三相流量波动和重搏压力波。主动脉硬化引起的硬度梯度减小或倒置可能因此减少舒张期径流，导致缺血性器官损伤。
Objective:Blood pressure fluctuates during diastole to create a dicrotic wave but the mechanistic origin remains poorly understood. We sought to investigate the characteristics and determinants of diastolic pressure and flow fluctuations with a focus on stiffness gradients between the central aorta and peripheral arteries.Methods:Using applanation tonometry and duplex ultrasound, pulse waveforms were recorded on the femoral artery in 592 patients (age: 55±14 years) to estimate the diastolic pressure fluctuation as a residual wave against the mono-exponential decay and the diastolic flow fluctuation as a bidirectional (forward and reverse) velocity wave. The radial, carotid, and dorsalis pedis pressures were also recorded to measure the peripheral/aortic pulse pressure (PP) and pulse wave velocity (PWV) ratios.Results:There were close resemblances between the femoral pressure and flow fluctuation waveforms. The pressure and flow fluctuations were mutually correlated in relative amplitude as indexed to the total pulse height (r= 0.63), and the former temporally followed the latter. In multivariate-adjusted models, higher peripheral/aortic PP and PWV ratios were independently associated with greater pressure and flow fluctuation indices (P< 0.001). Mediation analysis revealed that the associations of PP and PWV ratios with the pressure fluctuation index were largely mediated by the flow fluctuation index [indirect/total effect ratio: 57 (95% CI 42–80)% and 54 (30–100)%, respectively].Conclusion:These results suggest that central-to-peripheral pulse amplification and stiffness gradients contribute to triphasic flow fluctuations and dicrotic pressure waves. Diminished or inverted stiffness gradients caused by aortic stiffening may thus reduce diastolic runoff leading to ischemic organ damage.