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词条 Pulse wave velocity
释义

  1. Relationship between arterial stiffness and pulse wave velocity

      The Frank / Bramwell-Hill equation    The Moens–Korteweg equation  

  2. Variation in pulse wave velocity in the circulatory system

  3. Dependence of pulse wave velocity on blood pressure

  4. Experimental approaches used to measure pulse wave velocity

      Using two simultaneously measured pressure waveforms    Using pressure and volume, or pressure and diameter    Using pressure-flow velocity, pressure-volumetric flow relationships or characteristic impedance    Using diameter-flow velocity relationships  

  5. Clinical measurement of pulse wave velocity

      Clinical methods    Interpretation  

  6. See also

  7. References

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}}Pulse wave velocity (PWV) is the velocity at which the blood pressure pulse propagates through the circulatory system, usually an artery or a combined length of arteries. PWV is used clinically as a measure of arterial stiffness and can be readily measured non-invasively in humans, with measurement of carotid to femoral PWV (cfPWV) being the recommended method.[1][2][3] cfPWV is highly reproducible,[4] and predicts future cardiovascular events and all-cause mortality independent of conventional cardiovascular risk factors.[5][6] It has been recognized by the European Society of Hypertension as an indicator of target organ damage and a useful additional test in the investigation of hypertension.[7]

Relationship between arterial stiffness and pulse wave velocity

The theory of the velocity of the transmission of the pulse through the circulation dates back to 1808 with the work of Thomas Young.[8] The relationship between pulse wave velocity (PWV) and arterial wall stiffness can be derived from Newton's second law of motion () applied to a small fluid element, where the force on the element equals the product of density (the mass per unit volume; ) and the acceleration.[9] The approach for calculating PWV is similar to the calculation of the speed of sound, , in a compressible fluid (e.g. air):

,

where is the bulk modulus and is the density of the fluid.

The Frank / Bramwell-Hill equation

For an incompressible fluid (blood) in a compressible (elastic) tube (e.g. an artery):[10]

,

where is volume per unit length and is pressure. This is the equation derived by Otto Frank,[10] and John Crighton Bramwell and Archibald Hill.[11]

Alternative forms of this equation are:

, or ,

where is the radius of the tube and is distensibility.

The Moens–Korteweg equation

This equation:

,

characterises PWV in terms of the incremental elastic modulus of the vessel wall, the wall thickness, and the radius. It was derived independently by Adriaan Isebree Moens and Diederik Korteweg and is equivalent to the Frank / Bramwell Hill equation:[10]{{rp|64}}

These equations assume that:

  1. there is little or no change in vessel area.
  2. there is little or no change in wall thickness.
  3. there is little or no change in density (i.e. blood is assumed incompressible).
  4. is negligible.

Variation in pulse wave velocity in the circulatory system

Since the wall thickness, radius and incremental elastic modulus vary from blood vessel to blood vessel, PWV will also vary between vessels.[12] Most measurements of PWV represent an average velocity over several vessels (e.g. from the carotid to the femoral artery).

Dependence of pulse wave velocity on blood pressure

PWV intrinsically varies with blood pressure.[13] PWV increases with pressure for two reasons:

  1. Arterial compliance () decreases with increasing pressure due to the curvilinear relationship between arterial pressure and volume.
  2. Volume () increases with increasing pressure (the artery dilates), directly increasing PWV.

Experimental approaches used to measure pulse wave velocity

A range of invasive or non-invasive methods can be used to measure PWV. Some general approaches are:

Using two simultaneously measured pressure waveforms

PWV, by definition, is the distance traveled () by the pulse wave divided by the time () for the wave to travel that distance:

,

in practice this approach is complicated by the existence of reflected waves.[12] It is widely assumed that reflections are minimal during late diastole and early systole.[12] With this assumption, PWV can be measured using the `foot' of the pressure waveform as a fiducial marker from invasive or non-invasive measurements; the transit time corresponds to the delay in arrival of the foot between two locations a known distance apart. Locating the foot of the pressure waveform can be problematic.[14] The advantage of the foot-to-foot PWV measurement is the simplicity of measurement, requiring only two pressure wave forms recorded with invasive catheters, or non-invasively using pulse detection devices applied to the skin at two measurement sites, and a tape measure.[15]

Using pressure and volume, or pressure and diameter

This is based on the method described by Bramwell & Hill[16] who proposed modifications to the Moens-Kortweg equation. Quoting directly, these modifications were:

"A small rise in pressure may be shown to cause a small increase, , in the radius of the artery, or a small increase, , in its own volume per unit length. Hence "

where represents the wall thickness (defined as above), the elastic modulus, and the vessel radius (defined as above). This permits calculation of local PWV in terms of , or , as detailed above, and provides an alternative method of measuring PWV, if pressure and arterial dimensions are measured, for example by ultrasound [17][18] or magnetic resonance imaging (MRI).[19]

Using pressure-flow velocity, pressure-volumetric flow relationships or characteristic impedance

The Water hammer equation expressed either in terms of pressure and flow velocity,[20] pressure and volumetric flow, or characteristic impedance[21] can be used to calculate local PWV:

,

where is velocity, is volumetric flow, is characteristic impedance and is the cross-sectional area of the vessel. This approach is only valid when wave reflections are absent or minimal, this is assumed to be the case in early systole.[22]

Using diameter-flow velocity relationships

A related method to the pressure-flow velocity method uses vessel diameter and flow velocity to determine local PWV.[23] It is also based on the Water hammer equation:

,

and since

,

where is diameter; then:

,

or using the incremental hoop strain, ,

PWV can be expressed in terms of and

,

therefore plotting against gives a 'lnDU-loop', and the linear portion during early systole, when reflected waves are assumed to be minimal, can be used to calculate PWV.

Clinical measurement of pulse wave velocity

Clinical methods

Clinically, PWV can be measured in several ways and in different locations. The 'gold standard' for arterial stiffness assessment in clinical practice is cfPWV,[2][3] and validation guidelines have been proposed.[24] Other measures such as brachial-ankle PWV and cardio-ankle vascular index (CAVI) are also popular.[25] For cfPWV, it is recommended that the arrival time of the pulse wave measured simultaneously at both locations, and the distance travelled by the pulse wave calculated as 80% of the direct distance between the common carotid artery in the neck and the femoral artery in the groin.[2] Numerous devices exist to measure cfPWV;[26][27] some techniques include:

  • use of a transducer to record the time of arrival of the pulse wave at the carotid and femoral arteries.
  • use of cuffs placed around the limbs and neck to record the time of arrival of the pulse wave oscillometrically.
  • use of Doppler ultrasound or magnetic resonance imaging to record the time of arrival of the pulse wave based on the flow velocity waveform.

Newer devices that employ an arm cuff,[28] fingertip sensors[29] or special weighing scales[30] have been described, but their clinical utility remains to be fully established.

Interpretation

Current guidelines by the European Society of Hypertension state that a measured PWV larger than 10 m/s can be considered an independent marker of end-organ damage.[7] However, the use of a fixed PWV threshold value is debated, as PWV is dependent on blood pressure .[13] A high pulse wave velocity (PWV) has also been associated with poor lung function.[31]

See also

  • Arterial stiffness
  • Blood pressure
  • Compliance (physiology)

References

1. ^{{cite journal | vauthors = Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H | display-authors = 6 | title = Expert consensus document on arterial stiffness: methodological issues and clinical applications | journal = European Heart Journal | volume = 27 | issue = 21 | pages = 2588–605 | date = November 2006 | pmid = 17000623 | doi = 10.1093/eurheartj/ehl254 }}
2. ^1 2 {{cite journal | vauthors = Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, Filipovsky J, Huybrechts S, Mattace-Raso FU, Protogerou AD, Schillaci G, Segers P, Vermeersch S, Weber T | display-authors = 6 | title = Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity | journal = Journal of Hypertension | volume = 30 | issue = 3 | pages = 445–8 | date = March 2012 | pmid = 22278144 | doi = 10.1097/HJH.0b013e32834fa8b0 | url = http://repub.eur.nl/pub/73145 }}
3. ^1 {{cite journal | vauthors = Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T | display-authors = 6 | title = Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association | journal = Hypertension | volume = 66 | issue = 3 | pages = 698–722 | date = September 2015 | pmid = 26160955 | pmc = 4587661 | doi = 10.1161/HYP.0000000000000033 }}
4. ^{{cite journal | vauthors = Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR, Webb DJ | title = Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis | journal = Journal of Hypertension | volume = 16 | issue = 12 Pt 2 | pages = 2079–84 | date = December 1998 | pmid = 9886900 | doi = 10.1097/00004872-199816121-00033 }}
5. ^{{cite journal | vauthors = Vlachopoulos C, Aznaouridis K, Stefanadis C | title = Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis | journal = Journal of the American College of Cardiology | volume = 55 | issue = 13 | pages = 1318–27 | date = March 2010 | pmid = 20338492 | doi = 10.1016/j.jacc.2009.10.061 }}
6. ^{{cite journal | vauthors = Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB | display-authors = 6 | title = Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects | journal = Journal of the American College of Cardiology | volume = 63 | issue = 7 | pages = 636–646 | date = February 2014 | pmid = 24239664 | pmc = 4401072 | doi = 10.1016/j.jacc.2013.09.063 }}
7. ^1 {{cite journal | vauthors = Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F | display-authors = 6 | title = 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) | journal = Journal of Hypertension | volume = 31 | issue = 7 | pages = 1281–357 | date = July 2013 | pmid = 23817082 | doi = 10.1097/01.hjh.0000431740.32696.cc }}
8. ^{{cite journal| vauthors = Young T |year=1809|title=The Croonian Lecture: On the functions of the heart and arteries|url=http://rstl.royalsocietypublishing.org/content/99/1.2.full.pdf+html|journal=Philosophical Transactions of the Royal Society of London|volume=99|pages=1–31|doi=10.1098/rstl.1809.0001}}
9. ^{{Cite book|title=Waves in fluids|last=Sir.|first=Lighthill, M. J.|date=1978|publisher=Cambridge University Press|isbn=978-0521216890|location=Cambridge [England]|oclc=2966533}}
10. ^{{Cite journal|last=Frank|first=Otto|date=1920|title=Die Elastizitat der Blutegefasse|url=|journal=Zeitschrift für Biologie|volume=71|pages=255–272|via=}}
11. ^{{cite journal|vauthors=Bramwell JC, Hill AV|year=1922|title=Velocity transmission of the pulse wave and elasticity of arteries|journal=Lancet|volume=199|issue=5149|pages=891–2|doi=10.1016/S0140-6736(00)95580-6}}
12. ^1 2 3 4 {{cite book | last1 = McDonald | first1 = Donald A. | last2 = Nichols | first2 = Wilmer W. | last3 = O'Rourke | first3 = Michael J. | last4 = Hartley | first4 = Craig | name-list-format = vanc |title=McDonald's Blood Flow in Arteries, Theoretical, experimental and clinical principles |publisher=Arnold |location=London |year=1998 |isbn=978-0-340-64614-4 |edition=4th}}
13. ^1 {{cite journal | vauthors = Spronck B, Heusinkveld MH, Vanmolkot FH, Roodt JO, Hermeling E, Delhaas T, Kroon AA, Reesink KD | display-authors = 6 | title = Pressure-dependence of arterial stiffness: potential clinical implications | journal = Journal of Hypertension | volume = 33 | issue = 2 | pages = 330–8 | date = February 2015 | pmid = 25380150 | doi = 10.1097/HJH.0000000000000407 }}
14. ^{{cite book|title=Hemodynamics|last = Milnor | first = William R. | name-list-format = vanc |publisher=Williams & Wilkins|year=1982|isbn=978-0-683-06050-8|location=Baltimore}}
15. ^{{cite journal|vauthors=Boutouyrie P, Briet M, Collin C, Vermeersch S, Pannier B|date=February 2009|title=Assessment of pulse wave velocity|journal=Artery Research|volume=3|issue=1|pages=3–8|doi=10.1016/j.artres.2008.11.002}}
16. ^{{cite journal|vauthors=Bramwell JC, Hill AV|year=1922|title=The velocity of the pulse wave in man|journal=Proceedings of the Royal Society of London. Series B|volume=93|issue=652|pages=298–306|doi=10.1098/rspb.1922.0022|jstor=81045}}
17. ^{{cite journal | vauthors = Meinders JM, Kornet L, Brands PJ, Hoeks AP | title = Assessment of local pulse wave velocity in arteries using 2D distension waveforms | journal = Ultrasonic Imaging | volume = 23 | issue = 4 | pages = 199–215 | date = October 2001 | pmid = 12051275 | doi = 10.1177/016173460102300401 }}
18. ^{{cite journal | vauthors = Rabben SI, Stergiopulos N, Hellevik LR, Smiseth OA, Slørdahl S, Urheim S, Angelsen B | display-authors = 6 | title = An ultrasound-based method for determining pulse wave velocity in superficial arteries | journal = Journal of Biomechanics | volume = 37 | issue = 10 | pages = 1615–22 | date = October 2004 | pmid = 15336937 | doi = 10.1016/j.jbiomech.2003.12.031 }}
19. ^{{cite journal | vauthors = Westenberg JJ, van Poelgeest EP, Steendijk P, Grotenhuis HB, Jukema JW, de Roos A | title = Bramwell-Hill modeling for local aortic pulse wave velocity estimation: a validation study with velocity-encoded cardiovascular magnetic resonance and invasive pressure assessment | language = En | journal = Journal of Cardiovascular Magnetic Resonance | volume = 14 | issue = 1 | pages = 2 | date = January 2012 | pmid = 22230116 | pmc = 3312851 | doi = 10.1186/1532-429x-14-2 }}
20. ^{{cite journal | vauthors = Khir AW, O'Brien A, Gibbs JS, Parker KH | title = Determination of wave speed and wave separation in the arteries | journal = Journal of Biomechanics | volume = 34 | issue = 9 | pages = 1145–55 | date = September 2001 | pmid = 11506785 | doi = 10.1016/S0021-9290(01)00076-8 }}
21. ^{{cite journal | vauthors = Murgo JP, Westerhof N, Giolma JP, Altobelli SA | title = Aortic input impedance in normal man: relationship to pressure wave forms | journal = Circulation | volume = 62 | issue = 1 | pages = 105–16 | date = July 1980 | pmid = 7379273 | doi = 10.1161/01.CIR.62.1.105 }}
22. ^{{cite journal | vauthors = Hughes AD, Parker KH | title = Forward and backward waves in the arterial system: impedance or wave intensity analysis? | journal = Medical & Biological Engineering & Computing | volume = 47 | issue = 2 | pages = 207–10 | date = February 2009 | pmid = 19198913 | doi = 10.1007/s11517-009-0444-1 }}
23. ^{{cite journal | vauthors = Feng J, Khir AW | title = Determination of wave speed and wave separation in the arteries using diameter and velocity | journal = Journal of Biomechanics | volume = 43 | issue = 3 | pages = 455–62 | date = February 2010 | pmid = 19892359 | doi = 10.1016/j.jbiomech.2009.09.046 }}
24. ^{{Cite journal|last=Wilkinson|first=Ian B.|last2=McEniery|first2=Carmel M.|last3=Schillaci|first3=Giuseppe|last4=Boutouyrie|first4=Pierre|last5=Segers|first5=Patrick|last6=Donald|first6=Anne|last7=Chowienczyk|first7=Philip J. | name-list-format = vanc |date=2010|title=ARTERY Society guidelines for validation of non-invasive haemodynamic measurement devices: Part 1, arterial pulse wave velocity |journal=Artery Research|volume=4|issue=2|pages=34–40|doi=10.1016/j.artres.2010.03.001|issn=1872-9312}}
25. ^{{cite journal | vauthors = Park JB, Kario K | title = New Epoch for Arterial Stiffness Measurement in the Clinic | language = English | journal = Pulse | volume = 4 | issue = Suppl 1 | pages = 1–2 | date = January 2017 | pmid = 28275587 | pmc = 5319595 | doi = 10.1159/000448497 }}
26. ^{{cite journal | vauthors = Davies JM, Bailey MA, Griffin KJ, Scott DJ | title = Pulse wave velocity and the non-invasive methods used to assess it: Complior, SphygmoCor, Arteriograph and Vicorder | journal = Vascular | volume = 20 | issue = 6 | pages = 342–9 | date = December 2012 | pmid = 22962046 | doi = 10.1258/vasc.2011.ra0054 }}
27. ^{{cite journal | vauthors = Pereira T, Correia C, Cardoso J | title = Novel Methods for Pulse Wave Velocity Measurement | journal = Journal of Medical and Biological Engineering | volume = 35 | issue = 5 | pages = 555–565 | date = 2015 | pmid = 26500469 | pmc = 4609308 | doi = 10.1007/s40846-015-0086-8 }}
28. ^{{cite journal | vauthors = Horváth IG, Németh A, Lenkey Z, Alessandri N, Tufano F, Kis P, Gaszner B, Cziráki A | title = Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity | journal = Journal of Hypertension | volume = 28 | issue = 10 | pages = 2068–75 | date = October 2010 | pmid = 20651604 | doi = 10.1097/HJH.0b013e32833c8a1a }}
29. ^{{cite journal | vauthors = Nabeel PM, Jayaraj J, Mohanasankar S | title = Single-source PPG-based local pulse wave velocity measurement: a potential cuffless blood pressure estimation technique | journal = Physiological Measurement | volume = 38 | issue = 12 | pages = 2122–2140 | date = November 2017 | pmid = 29058686 | doi = 10.1088/1361-6579/aa9550 }}
30. ^{{cite journal | vauthors = Campo D, Khettab H, Yu R, Genain N, Edouard P, Buard N, Boutouyrie P | title = Measurement of Aortic Pulse Wave Velocity With a Connected Bathroom Scale | journal = American Journal of Hypertension | volume = 30 | issue = 9 | pages = 876–883 | date = September 2017 | pmid = 28520843 | pmc = 5861589 | doi = 10.1093/ajh/hpx059 }}
31. ^{{cite journal | vauthors = Amaral AF, Patel J, Gnatiuc L, Jones M, Burney PG | title = Association of pulse wave velocity with total lung capacity: A cross-sectional analysis of the BOLD London study | journal = Respiratory Medicine | volume = 109 | issue = 12 | pages = 1569–75 | date = December 2015 | pmid = 26553156 | pmc = 4687496 | doi = 10.1016/j.rmed.2015.10.016 }}

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