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Personalized physiologic flow waveforms improve wave reflection estimates compared to triangular flow waveforms in

Ninette Shenouda1, Joseph M Stock1, Jordan C Patik1

  • 1Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware.

American Journal of Physiology. Heart and Circulatory Physiology
|March 12, 2021
PubMed
Summary
This summary is machine-generated.

Personalized physiologic flow waveforms accurately estimate aortic wave reflection indices, unlike triangular waveforms which overestimate these measures, especially with higher pulse pressures. This finding supports using physiologic waveforms when direct flow measurement is not possible.

Keywords:
arterial stiffnesscentral blood pressurereflection magnitudevalidation studywave separation analysis

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Area of Science:

  • Cardiovascular Physiology
  • Biomedical Engineering
  • Hemodynamics

Background:

  • Central aortic pressure waveforms offer prognostic information beyond central systolic pressure.
  • Wave separation analysis decomposes pressure waveforms into forward (Pf) and backward (Pb) components.
  • Reflection magnitude (RM = Pb/Pf) predicts heart failure and mortality, but accurate estimation relies on precise aortic flow data.

Purpose of the Study:

  • To compare the accuracy of personalized synthetic physiologic flow waveforms against triangular and measured flow waveforms for estimating wave reflection indices.
  • To evaluate the impact of flow waveform estimation methods on wave reflection indices in young and older adults, including those with chronic kidney disease (CKD).

Main Methods:

  • Acquired central aortic pressure via radial tonometry and measured aortic flow via Doppler echocardiography in 49 young and 29 older adults.
  • Constructed triangular and personalized physiologic flow waveforms from measured aortic pressure waveforms.
  • Analyzed wave separation indices (Pf, Pb, RM) derived from measured, triangular, and physiologic flow waveforms.

Main Results:

  • The triangular waveform underestimated Pf in older adults and overestimated Pb and RM in both age groups compared to measured flow.
  • Personalized physiologic flow waveforms yielded estimates equivalent to measured flow for all wave reflection indices.
  • Physiologic waveforms showed smaller mean absolute biases than triangular waveforms across all comparisons (P < 0.05).
  • Higher central pulse pressure correlated with increased bias in triangular waveform estimates of Pb and RM, independent of age or arterial stiffness.

Conclusions:

  • Personalized physiologic flow waveforms are a robust and accurate alternative to measured flow for estimating wave reflection indices when direct measurement is not feasible.
  • Triangular flow waveforms overestimate wave reflection indices, particularly in individuals with higher central pulse pressures, limiting their clinical utility.
  • These findings support the adoption of personalized physiologic flow waveforms in clinical practice for improved cardiovascular risk assessment.