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Published on: May 3, 2018
Pressure-Corrected Carotid Stiffness and Young's Modulus: Evaluation in an Outpatient Clinic Setting
Myrthe van der Bruggen1, Bart Spronck1,2,3, Siske Bos1
1Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Insights
New carotid stiffness measures are pressure-independent, ideal for individual patient risk assessment. These novel metrics avoid statistical correction, unlike conventional methods that are affected by blood pressure changes.
Area of Science:
- Cardiovascular physiology
- Biomedical engineering
- Arterial biomechanics
Background:
- Conventional arterial stiffness assessments are pressure-dependent, limiting individual patient evaluation.
- Statistical pressure adjustment in populations cannot differentiate acute pressure effects from long-term hypertension-induced arterial remodeling.
- Existing methods struggle to isolate intrinsic arterial properties from blood pressure influences.
Purpose of the Study:
- To derive and validate theoretically pressure-independent carotid stiffness measures for individual patient assessment.
- To introduce novel metrics: stiffness index β0, pressure-corrected carotid pulse wave velocity (cPWVcorr), and pressure-corrected Young's modulus (Ecorr).
- To evaluate the performance of these new measures against conventional stiffness indices in a longitudinal study.
Main Methods:
- Development of three pressure-independent carotid stiffness measures based on a single-exponential pressure-diameter relationship.
- Utilized linear regression analysis in the CATOD study cohort to assess changes in mean arterial pressure (ΔMAP) and stiffness measures over time.
- Compared changes in novel measures (Δβ0, ΔcPWVcorr, ΔEcorr) with conventional measures (ΔcPWV, ΔE).
Main Results:
- No significant association was found between changes in mean arterial pressure (ΔMAP) and the novel pressure-independent stiffness measures (Δβ0, ΔcPWVcorr, ΔEcorr).
- A significant association was observed between ΔMAP and conventional stiffness measures (ΔcPWV, ΔE).
- These associations remained consistent after adjustments for biomechanical confounders and traditional risk factors.
Conclusions:
- The newly developed pressure-independent carotid stiffness measures (β0, cPWVcorr, Ecorr) eliminate the need for statistical pressure correction.
- These novel metrics are suitable for clinical application in patient-specific risk stratification.
- They enable the investigation of blood pressure's remodeling effects on intrinsic arterial stiffness, distinguishing it from acute pressure dependency.
Background:
Conventional measures for assessing arterial stiffness are inherently pressure dependent. Whereas statistical pressure adjustment is feasible in (larger) populations, it is unsuited for the evaluation of an individual patient. Moreover, statistical "correction" for blood pressure may actually correct for: (i) the acute dependence of arterial stiffness on blood pressure at the time of measurement; and/or (ii) the remodeling effect that blood pressure (hypertension) may have on arterial stiffness, but it cannot distinguish between these processes.
Methods:
We derived-assuming a single-exponential pressure-diameter relationship-3 theoretically pressure-independent carotid stiffness measures suited for individual patient evaluation: (i) stiffness index β0, (ii) pressure-corrected carotid pulse wave velocity (cPWVcorr), and (iii) pressure-corrected Young's modulus (Ecorr). Using linear regression analysis, we evaluated in a sample of the CATOD study cohort changes in mean arterial pressure (ΔMAP) and comparatively the changes in the novel (Δβ0, ΔcPWVcorr, and ΔEcorr) as well as conventional (ΔcPWV and ΔE) stiffness measures after a 2.9 ± 1.0-year follow-up.
Results:
We found no association between ΔMAP and Δβ0, ΔcPWVcorr, or ΔEcorr. In contrast, we did find a significant association between ΔMAP and conventional measures ΔcPWV and ΔE. Additional adjustments for biomechanical confounders and traditional risk factors did neither materially change these associations nor the lack thereof.
Conclusions:
Our newly proposed pressure-independent carotid stiffness measures avoid the need for statistical correction. Hence, these measures (β0, cPWVcorr, and Ecorr) can be used in a clinical setting for (i) patient-specific risk assessment and (ii) investigation of potential remodeling effects of (changes in) blood pressure on intrinsic arterial stiffness.
Related Concept Videos
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:10Pre-Procedural Guidelines for Assessing Blood Pressure