(Circulation. 1997;95:1827-1836.)
© 1997 American Heart Association, Inc.
Articles |
Estimation of Central Aortic Pressure Waveform by Mathematical Transformation of Radial Tonometry Pressure
Validation of Generalized Transfer Function
From the Division of Cardiology, Department of Internal Medicine, Johns Hopkins University Medical Institutions, Baltimore, Md.
Correspondence to David A. Kass, MD, Halsted 500, Division of Cardiology, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail dkass{at}welchlink.welch.jhu.edu
Background Central aortic pressures and waveform convey important information about cardiovascular status, but direct measurements are invasive. Peripheral pressures can be measured noninvasively, and although they often differ substantially from central pressures, they may be mathematically transformed to approximate the latter. We tested this approach, examining intersubject and intrasubject variability and the validity of using a single averaged transformation, which would enhance its applicability.
Methods and Results Invasive central aortic pressure by
micromanometer and radial pressure by automated tonometry were measured
in 20 patients at steady state and during hemodynamic transients
(Valsalva maneuver, abdominal compression, nitroglycerin, or vena caval
obstruction). For each patient, transfer functions (TFs) between aortic
and radial pressures were calculated by parametric model and results
averaged to yield individual TFs. A generalized TF was the average of
individual functions. TFs varied among patients, with coefficients of
variation for peak amplitude and frequency at peak amplitude of 24.9%
and 16.9%, respectively. Intrapatient TF variance with altered loading
(>20% variation in peak amplitude) was observed in 28.5% of
patients. Despite this, the generalized TF estimated central arterial
pressures to 
0.2±3.8 mm Hg error, arterial compliance to
6±7% accuracy, and augmentation index to within -7% points
(30±45% accuracy). Individual TFs were only marginally superior to
the generalized TF for reconstructing central pressures.
Conclusions Central aortic pressures can be accurately estimated from radial tonometry with the use of a generalized TF. The reconstructed waveform can provide arterial compliance estimates but may underestimate the augmentation index because the latter requires greater fidelity reproduction of the wave contour.
Key Words: blood pressure • diagnosis • aorta
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B. A. Mullan, C. N. Ennis, H. J. P. Fee, I. S. Young, and D. R. McCance Protective effects of ascorbic acid on arterial hemodynamics during acute hyperglycemia Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1262 - H1268. [Abstract] [Full Text] [PDF]
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P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]
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 A. L. Pauca, N. D. Kon, and M. F. O'Rourke The second peak of the radial artery pressure wave represents aortic systolic pressure in hypertensive and elderly patients Br. J. Anaesth., May 1, 2004; 92(5): 651 - 657. [Abstract] [Full Text] [PDF]
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 H.-Y. Hsu, Y.-T. Chen, H.-H. Hu, R. Aaslid, and D. W. Newell Limitations in Estimating Critical Closing Pressure by Noninvasive Blood Pressure Measurements * Response: Limitations in Estimating Critical Closing Pressure by Noninvasive Blood Pressure Measurements Stroke, May 1, 2004; 35(5): e91 - e92. [Full Text] [PDF]
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I. Ikonomidis, J. Lekakis, K. Stamatelopoulos, N. Markomihelakis, P. G. Kaklamanis, and M. Mavrikakis Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet's disease J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1075 - 1081. [Abstract] [Full Text] [PDF]
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S. A. Hope, D. B. Tay, I. T. Meredith, and J. D. Cameron Use of Arterial Transfer Functions for the Derivation of Central Aortic Waveform Characteristics in Subjects With Type 2 Diabetes and Cardiovascular Disease Diabetes Care, March 1, 2004; 27(3): 746 - 751. [Abstract] [Full Text] [PDF]
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G J Nollen, B E Westerhof, M Groenink, A Osnabrugge, E E van der Wall, and B J M Mulder Aortic pressure-area relation in Marfan patients with and without {beta} blocking agents: a new non-invasive approach Heart, March 1, 2004; 90(3): 314 - 318. [Abstract] [Full Text] [PDF]
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T. Weber, J. Auer, M. F. O'Rourke, E. Kvas, E. Lassnig, R. Berent, and B. Eber Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease Circulation, January 20, 2004; 109(2): 184 - 189. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, K. Hirata, and M. F O'Rourke Effect of sildenafil on arterial stiffness and wave reflection Vascular Medicine, November 1, 2003; 8(4): 243 - 248. [Abstract] [PDF]
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M. F. O'Rourke, A. Avolio, A. Qasem, S. C. Millasseau, J. M. Ritter, and P. J. Chowienczyk Clinical Assessment of Wave Reflection * Response: Augmentation Index and the Radial-to-Aortic Transfer Function Hypertension, November 1, 2003; 42 (5): e15 - e16. [Full Text] [PDF]
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S. A. Hope, I. T. Meredith, J. D. Cameron, S. C. Millasseau, J. M. Ritter, and P. J. Chowienczyk Is There Any Advantage to Using an Arterial Transfer Function? * Response: Aortic Augmentation Index and Radial-to-Aortic Transfer Function Hypertension, September 1, 2003; e7(3): . [Full Text] [PDF]
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H. Smulyan, D. S. Siddiqui, R. J. Carlson, G. M. London, and M. E. Safar Clinical Utility of Aortic Pulses and Pressures Calculated From Applanated Radial-Artery Pulses Hypertension, August 1, 2003; 42(2): 150 - 155. [Abstract] [Full Text] [PDF]
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 R Klocke, J R Cockcroft, G J Taylor, I R Hall, and D R Blake Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis Ann Rheum Dis, May 1, 2003; 62(5): 414 - 418. [Abstract] [Full Text] [PDF]
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G. E. McVeigh Pulse Waveform Analysis and Arterial Wall Properties Hypertension, May 1, 2003; 41(5): 1010 - 1011. [Full Text] [PDF]
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S. C. Millasseau, S. J. Patel, S. R. Redwood, J. M. Ritter, and P. J. Chowienczyk Pressure Wave Reflection Assessed From the Peripheral Pulse: Is a Transfer Function Necessary? Hypertension, May 1, 2003; 41(5): 1016 - 1020. [Abstract] [Full Text] [PDF]
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R. M.A. Henry, P. J. Kostense, A. M.W. Spijkerman, J. M. Dekker, G. Nijpels, R. J. Heine, O. Kamp, N. Westerhof, L. M. Bouter, and C. D.A. Stehouwer Arterial Stiffness Increases With Deteriorating Glucose Tolerance Status: The Hoorn Study Circulation, April 29, 2003; 107(16): 2089 - 2095. [Abstract] [Full Text] [PDF]
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 C L Turner, N Mendoza, R D Illingworth, and P J Kirkpatrick Measurement of pulse pressure profiles in patients with trigeminal neuralgia J. Neurol. Neurosurg. Psychiatry, April 1, 2003; 74(4): 533 - 535. [Abstract] [Full Text] [PDF]
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J. J. Oliver and D. J. Webb Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events Arterioscler Thromb Vasc Biol, April 1, 2003; 23(4): 554 - 566. [Abstract] [Full Text] [PDF]
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E. Lurbe, M. I. Torro, E. Carvajal, V. Alvarez, and J. Redon Birth Weight Impacts on Wave Reflections in Children and Adolescents Hypertension, March 1, 2003; 41(3): 646 - 650. [Abstract] [Full Text] [PDF]
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M. Tamminen, J. Westerbacka, S. Vehkavaara, and H. Yki-Jarvinen Insulin-Induced Decreases in Aortic Wave Reflection and Central Systolic Pressure Are Impaired in Type 2 Diabetes Diabetes Care, December 1, 2002; 25(12): 2314 - 2319. [Abstract] [Full Text] [PDF]
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