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Aortic pressure-only wave separation analysis in adolescents: accuracy and associations with left ventricular mass index

Journal of Human Hypertension volume 37, pages 1119–1125 (2023)Cite this article

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Abstract

Early-life exposure to high blood pressure (BP) is associated with cardiovascular target organ damage but not all BP-related risk is attributable to systolic and diastolic BP alone. In adolescence, aortic wave separation (WS) parameters are associated with increased left ventricular mass index (LVMI) but this approach is limited by the requirement for aortic flow measurements. Several methods for estimating the aortic flow waveform from pressure waveforms have emerged, but their accuracy and associations with LVMI have never been tested in adolescents, which was the aim of our study. Carotid pressure waveforms were acquired by tonometry from 58 adolescents (age 16 ± 1.5 years, 59% female). Measured (aortic) flow and LVMI were acquired via 2D echocardiography. Three pressure-only approximations of aortic flow were synthesized, including triangular, excess, and individualized-physiologic flow. A 4th aortic flow (average flow) was approximated from the average of all 58 measured flow waveforms. Forward (Pf) and backward (Pb) pressure and reflection magnitude (Rm) were derived from WS analysis. The individualized-physiologic flow produced the best approximations of Pf (mean difference ± SD, −0.15 ± 2.38 mmHg), Pb (0.14 ± 0.25 mmHg), and Rm (0.01 ± 0.02 mmHg). Pf derived using measured, individualized-physiologic, and average flow, was similarly associated with LVMI adjusting for age, brachial systolic BP, cardiac output, and BMI (P ≤ 0.03 all). Pb derived using all flow waveforms was associated with LVMI and all associations yielded similar effect estimates. Of the estimated flow waveforms, individualized-physiologic flow yielded the best approximation of WS parameters and may provide important physiological and clinical insight among adolescents.

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Fig. 1: Representative example of the individualized physiologic flow waveform (light grey curve) estimated from the blood pressure waveform (white curve) morphology and compared with measured flow (dark grey curve).
Fig. 2: Examples of wave seperation performed using measured and estimated flow waveforms.
Fig. 3: Bland-Altman plots showing agreement between Pf and Pb derived via measured flow with Pf and Pb derived via estimated flow.

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Data are available upon reasonable request.

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Funding

This study was supported by Child Health Discovery Institute pilot grant (awarded to Dr. Pierce), Medical College of Georgia, Augusta University. GLP is supported by grants from NIH R01 AG063790 and the American Heart Association 19TPA34910016, and by the Russell B. Day and Florence D. Day Chair in Liberal Arts and Sciences at the University of Iowa. MKA is supported by a National Institutes of Health Iowa Training Program in Kidney and Hypertension Research Fellowship grant (T32DK007690). JAC is supported by NIH grants R01 HL121510, U01 TR003734, U01 TR00373401S1, UO1 HL160277, R33 HL146390, R01 HL153646, K24 AG070459, R01 AG058969, R01 HL104106, P01 HL094307, R03 HL146874, R56 HL136730, R01 HL157108, R01 HL155764, R01-HL155599, R01 HL157264, and 1R01 HL153646. He has recently consulted for Bayer, Sanifit, Fukuda-Denshi, Bristol-Myers Squibb, JNJ, Edwards Life Sciences, Merck, NGM Biopharmaceuticals and the Galway-Mayo Institute of Technology. He received University of Pennsylvania research grants from National Institutes of Health, Fukuda-Denshi, Bristol-Myers Squibb, Microsoft and Abbott. He is named as inventor in a University of Pennsylvania patent for the use of inorganic nitrates/nitrites for the treatment of Heart Failure and Preserved Ejection Fraction and for the use of biomarkers in heart failure with preserved ejection fraction. He has received payments for editorial roles from the American Heart Association, the American College of Cardiology and Wiley. He has received research device loans from Atcor Medical, Fukuda-Denshi, Unex, Uscom, NDD Medical Technologies, Microsoft and MicroVision Medical.

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Authors and Affiliations

  1. Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA

    Matthew K. Armstrong & Gary L. Pierce

  2. Department of Medicine, Perelman School of Medicine, University of Pennsylvania and Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Julio A. Chirinos

  3. Departments of Pediatrics and Medicine, Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Gaston K. Kapuku

  4. Department of Internal Medicine, University of Iowa, Iowa City, IA, USA

    Gary L. Pierce

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  1. Matthew K. Armstrong
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Contributions

MA—Conception, data interpretation and manuscript preparation and revision. JC—Data interpretation, and critical manuscript revision. GK—Data interpretation and critical manuscript revision. GP—Data interpretation and critical manuscript revision.

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Correspondence to Gary L. Pierce.

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Armstrong, M.K., Chirinos, J.A., Kapuku, G.K. et al. Aortic pressure-only wave separation analysis in adolescents: accuracy and associations with left ventricular mass index. J Hum Hypertens 37, 1119–1125 (2023). https://doi.org/10.1038/s41371-022-00757-y

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