doi: 10.1161/hy1201.098298
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2001;38:1433.)
© 2001 American Heart Association, Inc.
Fourth Workshop on Structure and Function of Large Arteries: Part III |
Pulsatile Hemodynamics in Congestive Heart Failure
From Cardiovascular Engineering Inc (G.F.M.), Holliston, Mass; Montreal Heart Institute (J.-C.T.), Montreal, Quebec, Canada; London Health Sciences Center (J.M.O.A., G.M.), London, Ontario, Canada; Ralph H. Johnson VA Medical Center (T.X.O.), Charleston, SC; Louis Stokes VA Medical Center (M.E.D.), Cleveland, Ohio; and Brigham and Women’s Hospital (M.A.P.), Boston, Mass.
Correspondence to Gary F. Mitchell, MD, Cardiovascular Engineering Inc, 327 Fiske St, Holliston, MA 01746. E-mail GaryFMitchell{at}mindspring.com
Abstract
Pulse pressure, an indirect measure of vascular stiffness and pulsatile load, predicts clinical events in congestive heart failure (CHF), suggesting that abnormal pulsatile load may contribute to CHF. This study was designed to assess more direct measures of central pulsatile load in CHF. Noninvasive hemodynamic evaluations were performed in 28 subjects with CHF and 40 controls using calibrated tonometry of the brachial, radial, femoral, and carotid arteries along with echocardiographic assessment of left ventricular outflow tract (LVOT) diameter and Doppler flow. Characteristic impedance (Zc) was calculated as the ratio of 
P (carotid) and Q (LVOT flow) in early systole. Carotid-radial (CR-PWV) and carotid-femoral (CF-PWV) pulse wave velocities were calculated from tonometry. Augmentation index was assessed from the carotid waveform. Total arterial compliance (TAC) was calculated using the area method. Brachial pulse pressure was elevated (62±16 versus 53±15 mm Hg, P=0.015) in CHF because of lower diastolic pressure (66±10 versus 73±9 mm Hg, P=0.003). CHF had higher Zc (225±76 versus 184±66 dyne · sec · cm-5, P=0.020). CF-PWV did not differ (9.7±2.7 versus 9.2±2.0, P=0.337), whereas CR-PWV was lower in CHF (8.6±1.4 versus 9.4±1.5, P=0.038). There was no difference in TAC (1.4±0.5 versus 1.4±0.6 mL/mmHg, P=0.685), and augmentation index was lower in CHF (8±17 versus 21±13%, P=0.001). CHF subjects have elevated central pulsatile load (Zc), which is not apparent in global measures such as augmentation index or TAC, possibly because of contrasting changes in central and peripheral conduit vessels. This increased pulsatile load represents an important therapeutic target in CHF.
Key Words: heart failure • hemodynamics • aorta • pulse pressure • vascular stiffness
This article has been cited by other articles:
 |
|
 |
|
  J. A. Chirinos, E. R. Rietzschel, M. L. De Buyzere, D. De Bacquer, T. C. Gillebert, A. K. Gupta, P. Segers, and on behalf of the Asklepios investigators Arterial Load and Ventricular-Arterial Coupling: Physiologic Relations With Body Size and Effect of Obesity Hypertension, September 1, 2009; 54(3): 558 - 566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Patrianakos, F. I. Parthenakis, D. Karakitsos, E. Nyktari, and P. E. Vardas Proximal aortic stiffness is related to left ventricular function and exercise capacity in patients with dilated cardiomyopathy Eur J Echocardiogr, May 1, 2009; 10(3): 425 - 432. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Olafiranye, G. Qureshi, L. Salciccioli, K. Vernon-Jones, C. Philip, J. Kassotis, and J. M. Lazar The Relationship Between Effective Arterial Capacitance and Pulse Wave Velocity Is Dependent on Left Ventricular Stroke Volume Angiology, February 1, 2009; 60(1): 82 - 86. [Abstract] [PDF]
|
|
|
|
 |
|
 P. Milliez, S. Messaoudi, J. Nehme, C. Rodriguez, J.-L. Samuel, and C. Delcayre Beneficial effects of delayed ivabradine treatment on cardiac anatomical and electrical remodeling in rat severe chronic heart failure Am J Physiol Heart Circ Physiol, February 1, 2009; 296(2): H435 - H441. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. F. Mitchell Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage J Appl Physiol, November 1, 2008; 105(5): 1652 - 1660. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, V. Gudnason, L. J. Launer, T. Aspelund, and T. B. Harris Hemodynamics of Increased Pulse Pressure in Older Women in the Community-Based Age, Gene/Environment Susceptibility-Reykjavik Study Hypertension, April 1, 2008; 51(4): 1123 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Shimizu and K. Kario Review: Role of the augmentation index in hypertension Therapeutic Advances in Cardiovascular Disease, February 1, 2008; 2(1): 25 - 35. [Abstract] [PDF]
|
|
|
|
|
|
S. M. Farasat, C. H. Morrell, A. Scuteri, C.-T. Ting, F. C.P. Yin, H. A. Spurgeon, C.-H. Chen, E. G. Lakatta, and S. S. Najjar Pulse Pressure Is Inversely Related to Aortic Root Diameter Implications for the Pathogenesis of Systolic Hypertension Hypertension, February 1, 2008; 51(2): 196 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, P. R. Conlin, M. E. Dunlap, Y. Lacourciere, J. M. O. Arnold, R. I. Ogilvie, J. Neutel, J. L. Izzo Jr, and M. A. Pfeffer Aortic Diameter, Wall Stiffness, and Wave Reflection in Systolic Hypertension Hypertension, January 1, 2008; 51(1): 105 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. K. Sweitzer, M. Shenoy, J. H. Stein, S. Keles, M. Palta, T. LeCaire, and G. F. Mitchell Increases in Central Aortic Impedance Precede Alterations in Arterial Stiffness Measures in Type 1 Diabetes Diabetes Care, November 1, 2007; 30(11): 2886 - 2891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Curtis, A. Zambanini, J. Mayet, S. A. McG Thom, R. Foale, K. H. Parker, and A. D. Hughes Reduced systolic wave generation and increased peripheral wave reflection in chronic heart failure Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H557 - H562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Segers, E. R. Rietzschel, M. L. De Buyzere, S. J. Vermeersch, D. De Bacquer, L. M. Van Bortel, G. De Backer, T. C. Gillebert, P. R. Verdonck, and on behalf of the Asklepios investigators Noninvasive (Input) Impedance, Pulse Wave Velocity, and Wave Reflection in Healthy Middle-Aged Men and Women Hypertension, June 1, 2007; 49(6): 1248 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell Impedance Progress: Aortic Diameter Rears Its Head Again? Hypertension, June 1, 2007; 49(6): 1207 - 1209. [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, M. E. Dunlap, W. Warnica, A. Ducharme, J. M. O. Arnold, J.-C. Tardif, S. D. Solomon, M. J. Domanski, K. A. Jablonski, M. M. Rice, et al. Long-Term Trandolapril Treatment Is Associated With Reduced Aortic Stiffness: The Prevention of Events With Angiotensin-Converting Enzyme Inhibition Hemodynamic Substudy Hypertension, June 1, 2007; 49(6): 1271 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Westerhof, I. Guelen, N. Westerhof, J. M. Karemaker, and A. Avolio Quantification of Wave Reflection in the Human Aorta From Pressure Alone: A Proof of Principle Hypertension, October 1, 2006; 48(4): 595 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. F. Mitchell, J. M. O. Arnold, M. E. Dunlap, T. X. O'Brien, G. Marchiori, E. Warner, C. B. Granger, S. S. Desai, and M. A. Pfeffer Pulsatile hemodynamic effects of candesartan in patients with chronic heart failure: The CHARM Program Eur J Heart Fail, March 1, 2006; 8(2): 191 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, Y. Lacourciere, J. M. O. Arnold, M. E. Dunlap, P. R. Conlin, and J. L. Izzo Jr Changes in Aortic Stiffness and Augmentation Index After Acute Converting Enzyme or Vasopeptidase Inhibition Hypertension, November 1, 2005; 46(5): 1111 - 1117. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Heitritter, C. G. Solomon, G. F. Mitchell, N. Skali-Ounis, and E. W. Seely Subclinical Inflammation and Vascular Dysfunction in Women with Previous Gestational Diabetes Mellitus J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 3983 - 3988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke and W. W. Nichols Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase With Age and Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 652 - 658. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Giannattasio, F. Achilli, M. Failla, A. Capra, A. Vincenzi, G. Gentile, D. Corsi, C. Zazzeron, L. Turolo, A. Morganti, et al. Arterial stiffness in heart failure patients: dependance on diastolic dysfunction and plasma aldosterone levels Eur. Heart J. Suppl., November 1, 2004; 6(suppl_F): F30 - F34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, H. Parise, J. A. Vita, M. G. Larson, E. Warner, J. F. Keaney Jr, M. J. Keyes, D. Levy, R. S. Vasan, and E. J. Benjamin Local Shear Stress and Brachial Artery Flow-Mediated Dilation: The Framingham Heart Study Hypertension, August 1, 2004; 44(2): 134 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. F. Mitchell, Y. Lacourciere, J.-P. Ouellet, J. L. Izzo Jr, J. Neutel, L. J. Kerwin, A. J. Block, and M. A. Pfeffer Determinants of Elevated Pulse Pressure in Middle-Aged and Older Subjects With Uncomplicated Systolic Hypertension: The Role of Proximal Aortic Diameter and the Aortic Pressure-Flow Relationship Circulation, September 30, 2003; 108(13): 1592 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Safar, B. I. Levy, and H. Struijker-Boudier Current Perspectives on Arterial Stiffness and Pulse Pressure in Hypertension and Cardiovascular Diseases Circulation, June 10, 2003; 107(22): 2864 - 2869. [Full Text] [PDF]
|
|
|
|
|
|
S. Bonapace, A. Rossi, M. Cicoira, L. Franceschini, G. Golia, L. Zanolla, P. Marino, and P. Zardini Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy Circulation, April 1, 2003; 107(12): 1603 - 1608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Zureik, J.-M. Bureau, M. Temmar, C. Adamopoulos, D. Courbon, K. Bean, P.-J. Touboul, A. Benetos, and P. Ducimetiere Echogenic Carotid Plaques Are Associated With Aortic Arterial Stiffness in Subjects With Subclinical Carotid Atherosclerosis Hypertension, March 1, 2003; 41(3): 519 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, J. L. Izzo Jr, Y. Lacourciere, J.-P. Ouellet, J. Neutel, C. Qian, L. J. Kerwin, A. J. Block, and M. A. Pfeffer Omapatrilat Reduces Pulse Pressure and Proximal Aortic Stiffness in Patients With Systolic Hypertension: Results of the Conduit Hemodynamics of Omapatrilat International Research Study Circulation, June 25, 2002; 105(25): 2955 - 2961. [Abstract] [Full Text] [PDF]
|
|