Health & Environment Department, AIT Austrian Institute of Technology, Vienna, Austria; International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, United Kingdom.
Health & Environment Department, AIT Austrian Institute of Technology, Vienna, Austria; Department of Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria.
Int J Cardiol. 2014 Jan 15;171(1):31-6. doi: 10.1016/j.ijcard.2013.11.039. Epub 2013 Nov 23.
Analysis of the arterial pressure curve plays an increasing role in cardiovascular risk stratification. Measures of wave reflection and aortic stiffness have been identified as independent predictors of risk. Their determination is usually based on wave propagation models of the circulation. Another modeling approach relies on modified Windkessel models, where pressure curves can be divided into reservoir and excess pressure. Little is known of their prognostic value.
The aim of this study is to evaluate the predictive value of parameters gained from reservoir theory applied to aortic pressure curves in a cohort of high-risk patients. Furthermore the relation of these parameters to those from wave separation analysis is investigated. Central pressure curves from 674 patients with preserved ejection fraction, measured by radial tonometry and a validated transfer function, were analyzed. A high correlation between the amplitudes of backward traveling pressure waves and reservoir pressures was found (R=0.97). Various parameters calculated from the reservoir and excess pressure waveforms predicted cardiovascular events in univariate Cox proportional hazards modeling. In a multivariate model including several other risk factors such as brachial blood pressure, the amplitude of reservoir pressure remained a significant predictor (HR=1.37 per SD, p=0.016).
Based on very different models, parameters from reservoir theory and wave separation analysis are closely related and can predict cardiovascular events to a similar extent. Although Windkessel models cannot describe all of the physiological properties of the arterial system, they can be useful to analyze its behavior and to predict cardiovascular events.
分析动脉压力曲线在心血管风险分层中的作用日益重要。反射波和主动脉僵硬度的测量被认为是风险的独立预测指标。它们的确定通常基于循环的波传播模型。另一种建模方法依赖于改良的 Windkessel 模型，其中压力曲线可以分为储层压力和超压。它们的预后价值知之甚少。
本研究旨在评估应用于主动脉压力曲线的储层理论参数在高危患者队列中的预测价值。此外，还研究了这些参数与波分离分析参数之间的关系。使用径向张力测量法和经过验证的传递函数测量了 674 例射血分数保留的患者的中心压力曲线。发现逆行压力波的幅度与储层压力之间存在高度相关性（R=0.97）。从储层和超压波形计算的各种参数在单变量 Cox 比例风险模型中预测心血管事件。在包括臂血压等几个其他风险因素的多变量模型中，储层压力的幅度仍然是一个显著的预测因子（HR=1.37/SD，p=0.016）。
基于非常不同的模型，储层理论和波分离分析的参数密切相关，可以在一定程度上预测心血管事件。尽管 Windkessel 模型不能描述动脉系统的所有生理特性，但它们可以用于分析其行为并预测心血管事件。
