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Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff

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Abstract
Recently a new method has been proposed as a tool to measure arterial pulse wave velocity (PWV), a measure of the stiffness of the large arteries and an emerging parameter used as indicator of clinical cardiovascular risk. The method is based on measurement of brachial blood pressure during supra-systolic pressure inflation of a simple brachial cuff (the device is known as the Arteriograph (Tensiomed, Budapest, Hungary)). This occlusion yields pronounced first and secondary peaks in the pressure waveform, the latter ascribed to a reflection from the aortic bifurcation, and PWV is calculated as the ratio of twice the jugulum-symphysis distance and the time difference between the two peaks. To test the validity of this working principle we used a numerical model of the arterial tree to simulate pressures and flows in the normal configuration, and in a configuration with an occluded brachial artery. A pronounced secondary peak was indeed found in the brachial pressure signal of the occluded model, but its timing was only related to brachial stiffness and not to aortic stiffness. We also compared PWV’s calculated with 3 different methods: PWVATG (~ Arteriograph principle), PWVcar-fem (~ carotid-femoral PWV, the current clinical gold standard method) and PWVtheor (~ Bramwell-Hill equation). Both PWVATG (R²=0.94) and PWVcar-fem (R²=0.95) correlated well with PWVtheor, but their numerical values were lower (by 2.17 ± 0.42 and 1.08 ± 0.70 m/s for PWVATG and PWVcar-fem, respectively). In conclusion, our simulations question the working principle of the Arteriograph. Our data indicate that the method picks up wave reflection phenomena confined to the brachial artery, and derived values of PWV rather reflect the stiffness of the brachial arteries.
Keywords
wave propagation, pulse wave velocity, pressure waveforms, heart model, Wave reflections, arterial stiffness, arterial network model, wave intensity analysis

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Citation

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MLA
Trachet, Bram et al. “Numerical Validation of a New Method to Assess Aortic Pulse Wave Velocity from a Single Recording of a Brachial Artery Waveform with an Occluding Cuff.” ANNALS OF BIOMEDICAL ENGINEERING 38.3 (2010): 876–888. Print.
APA
Trachet, B., Reymond, P., Kips, J., Swillens, A., De Buyzere, M., Suys, B., Stergiopulos, N., et al. (2010). Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff. ANNALS OF BIOMEDICAL ENGINEERING, 38(3), 876–888.
Chicago author-date
Trachet, Bram, Philippe Reymond, Jan Kips, Abigaïl Swillens, Marc De Buyzere, Bert Suys, Nikos Stergiopulos, and Patrick Segers. 2010. “Numerical Validation of a New Method to Assess Aortic Pulse Wave Velocity from a Single Recording of a Brachial Artery Waveform with an Occluding Cuff.” Annals of Biomedical Engineering 38 (3): 876–888.
Chicago author-date (all authors)
Trachet, Bram, Philippe Reymond, Jan Kips, Abigaïl Swillens, Marc De Buyzere, Bert Suys, Nikos Stergiopulos, and Patrick Segers. 2010. “Numerical Validation of a New Method to Assess Aortic Pulse Wave Velocity from a Single Recording of a Brachial Artery Waveform with an Occluding Cuff.” Annals of Biomedical Engineering 38 (3): 876–888.
Vancouver
1.
Trachet B, Reymond P, Kips J, Swillens A, De Buyzere M, Suys B, et al. Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff. ANNALS OF BIOMEDICAL ENGINEERING. 2010;38(3):876–88.
IEEE
[1]
B. Trachet et al., “Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff,” ANNALS OF BIOMEDICAL ENGINEERING, vol. 38, no. 3, pp. 876–888, 2010.
@article{885529,
  abstract     = {Recently a new method has been proposed as a tool to measure arterial pulse wave velocity (PWV), a measure of the stiffness of the large arteries and an emerging parameter used as indicator of clinical cardiovascular risk. The method is based on measurement of brachial blood pressure during supra-systolic pressure inflation of a simple brachial cuff (the device is known as the Arteriograph (Tensiomed, Budapest, Hungary)). This occlusion yields pronounced first and secondary peaks in the pressure waveform, the latter ascribed to a reflection from the aortic bifurcation, and PWV is calculated as the ratio of  twice the jugulum-symphysis distance and the time difference between the two peaks. To test the validity of this working principle we used a numerical model of the arterial tree to simulate pressures and flows in the normal configuration, and in a configuration with an occluded brachial artery. A pronounced secondary peak was indeed found in the brachial pressure signal of the occluded model, but its timing was only related to brachial stiffness and not to aortic stiffness. We  also compared PWV’s calculated with 3 different methods: PWVATG (~ Arteriograph principle), PWVcar-fem (~ carotid-femoral PWV, the current clinical gold standard method) and PWVtheor (~ Bramwell-Hill equation). Both PWVATG (R²=0.94) and PWVcar-fem (R²=0.95) correlated well with PWVtheor, but their numerical values were lower (by 2.17 ± 0.42  and 1.08 ± 0.70 m/s for PWVATG and PWVcar-fem, respectively). In conclusion, our simulations question the working principle of the Arteriograph. Our data indicate that the method picks up wave reflection phenomena confined to the brachial artery, and derived values of PWV rather reflect the stiffness of the brachial arteries.},
  author       = {Trachet, Bram and Reymond, Philippe and Kips, Jan and Swillens, Abigaïl and De Buyzere, Marc and Suys, Bert  and Stergiopulos, Nikos and Segers, Patrick},
  issn         = {0090-6964},
  journal      = {ANNALS OF BIOMEDICAL ENGINEERING},
  keywords     = {wave propagation,pulse wave velocity,pressure waveforms,heart model,Wave reflections,arterial stiffness,arterial network model,wave intensity analysis},
  language     = {eng},
  number       = {3},
  pages        = {876--888},
  title        = {Numerical validation of a new method to assess aortic pulse wave velocity from a single recording of a brachial artery waveform with an occluding cuff},
  url          = {http://dx.doi.org/10.1007/s10439-010-9945-1},
  volume       = {38},
  year         = {2010},
}

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