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Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Arterial wave reflection decreases gradually from supine to upright
Bas van den Bogaard1, Berend E Westerhof, Hendrik Best
1Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, the Netherlands. b.vandenbogaard@amc.nl
Arterial wave reflection, measured by augmentation index (AIx) and reflection magnitude (RM), gradually decreases during head-up tilt (HUT) even as total peripheral resistance (TPR) increases. This finding challenges typical cardiovascular responses to rising resistance.
Area of Science:
- Cardiovascular Physiology
- Hemodynamics
- Biomedical Engineering
Background:
- Increased total peripheral resistance (TPR) typically elevates arterial wave reflection.
- However, during passive head-up tilt (HUT), arterial wave reflection paradoxically decreases as TPR rises.
- This study investigated the progressive changes in arterial wave reflection during HUT.
Purpose of the Study:
- To determine if arterial wave reflection gradually decreases during passive head-up tilt.
- To analyze the relationship between increasing total peripheral resistance and arterial wave reflection during postural changes.
Main Methods:
- Ten healthy volunteers underwent passive head-up tilt (0°, 30°, 70°) and active standing (90°).
- Finger arterial pressures were recorded, and aortic pressure was reconstructed.
- Hemodynamics, including augmentation index (AIx) and reflection magnitude (RM), were calculated.
Main Results:
- Heart rate increased, while stroke volume and cardiac output decreased with HUT.
- Total peripheral resistance (TPR) significantly increased from supine to upright positions.
- Arterial wave reflection, quantified by AIx and RM, progressively decreased during HUT.
Conclusions:
- Arterial wave reflection, represented by AIx and RM, gradually decreases from supine to upright posture.
- This decrease occurs despite a concurrent increase in total peripheral resistance (TPR).
- The findings highlight a complex interplay between posture, TPR, and arterial wave dynamics.
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