Circulation, Vol 89, 2688-2699, Copyright © 1994 by American Heart Association
RH Marcus, C Korcarz, G McCray, A Neumann, M Murphy, K Borow, L Weinert, J Bednarz, DD Gretler and KT Spencer
BACKGROUND: The Poiseuillian model of the arterial system currently applied
in clinical physiology does not explain how arterial pressure is maintained
during diastole after cessation of pulsatile aortic inflow. Arterial
pressure-flow relations can be more accurately described by models that
incorporate arterial viscoelastic properties such as arterial compliance.
Continuous pressure and flow measurements are needed to evaluate these
properties. Since the techniques used to date to acquire such data have
been invasive, physiological models of the circulation that incorporate
these properties have not been widely applied in the clinical setting. The
purpose of this study was (1) to validate noninvasive methods for
continuous measurement of central arterial pressure and flow and (2) to
determine normal reference values for arterial compliance using
physiological models of the circulation applied to the noninvasively
acquired pressure and flow data. METHODS AND RESULTS: Simultaneously
acquired invasive and noninvasive aortic pressures (30 patients), flows (8
patients), and arterial mechanical properties (8 patients) were compared.
Pressure was measured by high- fidelity catheter aortic micromanometer
(invasive) and calibrated subclavian pulse tracing (noninvasive). Aortic
inflow was determined from thermodilution-calibrated electromagnetic flow
velocity data (invasive) and echo-Doppler data (noninvasive). Arterial
compliance was determined for two- and three-element windkessel models of
the circulation using the area method and an iterative procedure,
respectively. Once validated, the noninvasive methodology was used to
determine normal compliance values for a reference population of 70
subjects (age range, 20 to 81 years) with normal 24-hour ambulatory blood
pressures and without Doppler-echocardiographic evidence for structural
heart disease. The limits of agreement between invasive and noninvasive
pressure data, compared at 10% intervals during ejection and nonejection,
were narrow over a wide range of pressures, with no significant differences
between methods. Invasive and noninvasive instantaneous aortic inflow
values differed slightly but significantly at the start of ejection (P <
.05), but during the latter 90% of ejection, values for the two methods
were similar, with narrow limits of agreement. Total vascular resistance
and arterial compliance values derived from invasive and noninvasive data
were similar. Arterial compliance values for the normal population using
the two-element model (C2E) ranged from 0.74 to 2.44 cm3/mm Hg (mean, 1.57
+/- 0.38 cm3/mm Hg), with a beat-to-beat variability of 5.2 +/- 3.9%. C2E
decreased with increasing age (r = -.73, P < .001) and tended to be
higher in men (1.67 +/- 0.41 cm3/mm Hg) than in women (1.51 +/- 0.35 cm3/mm
Hg, P = .07). Compliance values for the three-element model (C3E) were
predictably smaller than for the two-element model (mean, 1.23 +/- 0.30;
range, 0.59 to 2.16 cm3/mm Hg, P < .001 versus C2E) but correlated with
C2E values (r = .81, P < .001) and were also inversely related to age (r
= -.56, P < .001). Ridge regression and principal component analyses
both showed the compliance value to be a composite function whose variation
could be best predicted by consideration of simultaneous values for five
major hemodynamic determinants: heart rate, mean flow, mean aortic
pressure, minimal diastolic pressure, and end-systolic pressure.
Multivariate analysis revealed age and sex to be independent predictors of
compliance (P < .01 for both). There were no differences in compliance
between black and white subjects. CONCLUSIONS: Noninvasive methods can be
used to acquire the hemodynamic data necessary for clinical application of
physiological models of the circulation that incorporate arterial
viscoelastic properties such as arterial compliance. The strong inverse
linear relation between model- based compliance estimates and age mandates
incorporation of this demographic parameter in
ARTICLES
Noninvasive method for determination of arterial compliance using Doppler echocardiography and subclavian pulse tracings. Validation and clinical application of a physiological model of the circulation
Department of Medicine, University of Chicago Medical Center, IL 60637.
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