Wolos Kamil, Pstras Leszek, Debowska Malgorzata, Poleszczuk Jan
Laboratory of Mathematical Modeling of Physiological Processes, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
Front Physiol. 2025 Aug 15;16:1642645. doi: 10.3389/fphys.2025.1642645. eCollection 2025.
Multi-limb oscillometric cuff measurements can be used for estimating various vascular parameters and evaluating side differences in arterial pulse waveforms. In this study, we conduct an investigation to evaluate the potential impact of such measurements on hemodynamics.
We employed a 0-1D model of pulse wave propagation to examine the relationship between different levels of oscillometric cuff pressure applied simultaneously at multiple sites (right above the wrists and/or ankles) and the resulting changes in blood pressure and flow at selected sites in the vascular system, assuming the absence of cardiovascular regulatory mechanisms. The simulations included various combinations of cuff placements, including four cuffs applied simultaneously on all limbs. In addition, we conducted both global and local sensitivity analysis to evaluate the impact of selected cardiovascular parameters on the simulation results.
In the case of cuffs placed on all four limbs and inflated to suprasystolic pressure - effectively occluding the vessels beneath the cuffs - our simulations indicated an increase in mean arterial pressure (MAP) of approximately 10% in the ascending aorta, left common carotid artery, and abdominal aorta. Additionally, the mean carotid artery blood flow increased by approximately 11% compared to baseline value. In contrast, for the case with a cuff placed only on one wrist, we observed a significantly smaller MAP increase of only 2.5%, with a 3% rise in mean carotid artery flow. Our sensitivity analysis revealed that these changes can be mitigated by relatively small adjustments in specific cardiovascular parameters, suggesting that properly functioning physiological regulatory mechanisms should easily compensate for the cuff induced hemodynamic alterations. Furthermore, global sensitivity analysis demonstrated that relatively similar increases in MAP and mean carotid blood flow are expected for different combinations of cardiovascular parameters values, indicating the robustness of our findings.
This study suggests that multi-limb cuff-based measurements may induce measurable central hemodynamic alterations if not counteracted by cardiovascular regulatory mechanisms. This suggests that such measurements may not be innocuous to individuals with some deficiencies in cardiovascular regulation. Further investigation is warranted to verify this and, if necessary, establish appropriate safety protocols.
多肢体示波法袖带测量可用于估计各种血管参数并评估动脉脉搏波形的侧别差异。在本研究中，我们进行了一项调查，以评估此类测量对血流动力学的潜在影响。
我们采用脉搏波传播的0-1D模型，在假设不存在心血管调节机制的情况下，研究在多个部位（手腕和/或脚踝上方）同时施加不同水平的示波法袖带压力与血管系统中选定部位血压和血流变化之间的关系。模拟包括袖带放置的各种组合，包括在所有肢体上同时施加四个袖带。此外，我们进行了全局和局部敏感性分析，以评估选定心血管参数对模拟结果的影响。
在所有四个肢体上放置袖带并充气至收缩压以上（有效地阻塞袖带下方的血管）的情况下，我们的模拟表明升主动脉、左颈总动脉和腹主动脉的平均动脉压（MAP）升高约10%。此外，与基线值相比，颈总动脉平均血流量增加了约11%。相比之下，对于仅在一只手腕上放置袖带的情况，我们观察到MAP仅显著升高2.5%，颈总动脉平均血流量增加3%。我们的敏感性分析表明，通过对特定心血管参数进行相对较小的调整，可以减轻这些变化，这表明正常运作的生理调节机制应该很容易补偿袖带引起的血流动力学改变。此外，全局敏感性分析表明，对于心血管参数值的不同组合，预计MAP和颈总动脉平均血流量会有相对相似的增加，这表明我们的研究结果具有稳健性。
本研究表明，如果没有心血管调节机制的抵消作用，基于多肢体袖带的测量可能会引起可测量的中心血流动力学改变。这表明此类测量对于心血管调节存在某些缺陷的个体可能并非无害。有必要进行进一步调查以验证这一点，并在必要时制定适当的安全协议。
