Hypertension. 2001;37:e23
(Hypertension. 2001;37:e23.)
© 2001 American Heart Association, Inc.
Ray Kelly
Michael O’Rourke;
David A. Kass
 |
Introduction
|
|---|
Raymond
Kelly, who died at age 43, on October 5, 2000, was
one of a small group
of young cardiovascular researchers in
Sydney who have
made major contributions to their field over
the past 15 years.
Kelly’s work extended that of Stephen
MacMahon on
epidemiology of hypertension and complemented
that
of David Celermajer on arterial function, both working
in the
Olympic city.
Kelly’s major contributions related to the interpretation
of the arterial pulse in humans. As a doctoral student in a
department with strength in arterial
hemodynamics, he was presented with a new
tonometer that had been specially developed by Huntly Millar of
Houston. Kelly validated this instrument against invasive
recordings for clinical use in recording the radial and
carotid pressure waveforms.1
He then conducted a study in >1000 normal subjects to establish aging
changes in the arterial pulse at the 2 anatomic sites. He
showed there was a progressive rise with age in the second
systolic pressure peak caused by progressive medial
degeneration of the aorta and elastic arteries, and he emphasized that
changes in the radial pulse paralleled those in the carotid pulse
but followed several decades behind. He showed that increase in
amplitude of the second systolic pressure peak in central
arteries was due to early wave reflection, consequent on aortic
stiffening, and that this could be reduced by vasodilator drug
therapy.2 An important
corollary of this work, subsequently confirmed by colleagues Takazawa
(Japan),3 and Fitchett
(Canada),4 was that
beneficial effects of vasodilator drugs on left ventricular
load and central arterial pressures are underestimated by
conventional recordings of systolic brachial pressure.
All this work showed a consistency between pulse contour in
central and upper limb arteries, leading torecent development of
systems designed to generate aortic pressure from the radial
pulse.
Kelly’s next contribution in Baltimore and Montreal
was to confirm in animal studies how arterial stiffening
(as seen with aging in humans) compromises ventricular
function and energetics at rest and especially during simulated
exercise.5 Extending human
work on the arterial pulse, he showed how this could be
used with dimensional and flow ultrasound to characterize
ventricular/vascular interaction, as well as the hydraulic
properties of the systemic circulation (as systemic vascular
impedance).6
Returning home to Sydney in 1993, Kelly initiated further
clinical studies, including 1 in a large group of twins in order to
separate genetic and acquired contributions to arterial
stiffness as interpreted from the arterial pulse. He was
able to establish the different effects of body height, of
gender,7 of other genetic
influences, and of hypertension, atherosclerosis,
smoking, and drug therapy. Papers on these topics are still in press,
and 2 abstracts were presented at the AHA meeting 1 month after
his death by his pupil Chris Hayward.
Ray Kelly’s death took many by surprise. His
continuing scientific productivity was matched by a busy career in
cardiovascular medicine. He did not want his colleagues
or patients to know of his illness (renal cell carcinoma). He bore his
illness stoically, with optimism and strong faith in his creator. He
leaves his beloved wife, Louise, and 4 young sons: Thomas, Stephen,
Peter, and Matthew, ages 3 to 12. He was deeply committed to his family
and wished his life and his passing to be of some inspiration to them.
It was, and it is, to the larger family of medical scientists
throughout the world.
|
References
|
|---|
-
Kelly R,
Hayward C, Avolio A, O’Rourke M. Noninvasive determination of
age-related changes in the human arterial pulse.
Circulation.. 1989;80:1652–1659.[Abstract/Free Full Text]
-
Kelly RP, Gibbs HH,
O’Rourke MF, Daley JE, Mang K, Morgan JJ, Avolio AP. Nitroglycerin has
more favourable effects on left ventricle overload than apparent from
measurement of pressure in a peripheral artery.
Eur Heart J. 1990;11:138–144.[Abstract/Free Full Text]
-
Takazawa K, Tanaka
N, Takeda K, Kurosu F, Ibukiyama C. Underestimation of vasodilator
effects of nitroglycerin by upper limb blood pressure.
Hypertension. 1995;26:520–523.[Abstract/Free Full Text]
-
Fitchett DH, Simkus
GJ, Beaudry JP, Marpole DG. Reflected pressure waves in the ascending
aorta: effect of glycerol trinitrate.
Cardiovasc Res. 1988;22:494–500.[Medline]
[Order article via Infotrieve]
-
Kelly RP, Tunin R,
Kass DA. Effect of reduced aortic compliance on cardiac efficiency and
contractile function of in situ left ventricle.
Circ Res. 1992;71:490–502.[Abstract/Free Full Text]
-
Kelly R, Fitchett
D. Noninvasive determination of aortic input impedance and external
left ventricular power output: a validation and repeatability study of
a new technique. J Am Coll
Cardiol. 1992;20:952–963.[Abstract]
-
Hayward CS, Kelly
RP. Gender-related differences in the central arterial pressure
waveform. J Am Coll Cardiol. 1997;30:1863–1871. [Abstract]
Top
Introduction
References