Toward a noninvasive subject-specific estimation of abdominal aortic pressure.

A method for estimation of central arterial pressure based on linear one-dimensional wave propagation theory is presented in this paper. The equations are applied to a distributed model of the arterial tree, truncated by three-element windkessels. To reflect individual differences in the properties of the arterial trees, we pose a minimization problem from which individual parameters are identified. The idea is to take a measured waveform in a peripheral artery and use it as input to the model. The model subsequently predicts the corresponding waveform in another peripheral artery in which a measurement has also been made, and the arterial tree model is then calibrated in such a way that the computed waveform matches its measured counterpart. For the purpose of validation, invasively recorded abdominal aortic, brachial, and femoral pressures in nine healthy subjects are used. The results show that the proposed method estimates the abdominal aortic pressure wave with good accuracy. The root mean square error (RMSE) of the estimated waveforms was 1.61 +/- 0.73 mmHg, whereas the errors in systolic and pulse pressure were 2.32 +/- 1.74 and 3.73 +/- 2.04 mmHg, respectively. These results are compared with another recently proposed method based on a signal processing technique, and it is shown that our method yields a significantly (P < 0.01) lower RMSE. With more extensive validation, the method may eventually be used in clinical practice to provide detailed, almost individual, specific information as a valuable basis for decision making.

[1]  D. Webb,et al.  Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. , 2003, Arteriosclerosis, thrombosis, and vascular biology.

[2]  J Stålhand,et al.  Aorta in vivo parameter identification using an axial force constraint , 2005, Biomechanics and modeling in mechanobiology.

[3]  Stephen J. Wright,et al.  Numerical Optimization , 2018, Fundamental Statistical Inference.

[4]  K. Takazawa Augmentation index in heart disease. , 2005, American journal of hypertension.

[5]  J. Blacher,et al.  Central Pulse Pressure and Mortality in End-Stage Renal Disease , 2002, Hypertension.

[6]  V. Rideout,et al.  Difference-differential equations for fluid flow in distensible tubes. , 1967, IEEE transactions on bio-medical engineering.

[7]  Mette S. Olufsen,et al.  Modeling the arterial system with reference to an anesthesia simulator , 1998 .

[8]  R. Mukkamala,et al.  Blind identification of the aortic pressure waveform from multiple peripheral artery pressure waveforms. , 2007, American journal of physiology. Heart and circulatory physiology.

[9]  A. Klarbring,et al.  Towards in vivo aorta material identification and stress estimation , 2004, Biomechanics and modeling in mechanobiology.

[10]  W. Nichols,et al.  McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles , 1998 .

[11]  E H WOOD,et al.  Comparison of Simultaneously Recorded Central and Peripheral Arterial Pressure Pulses During Rest, Exercise and Tilted Position in Man , 1955, Circulation research.

[12]  C. Quick,et al.  Epidemiology and potential for prevention of abdominal aortic aneurysm , 1998, The British journal of surgery.

[13]  Alun D. Hughes,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006 .

[14]  B. Sonesson,et al.  Dynamic behaviour of the common femoral artery: age and gender of minor importance. , 2001, Ultrasound in medicine & biology.

[15]  M. Zamir,et al.  The Physics of Pulsatile Flow , 2000, Biological Physics Series.

[16]  David A. Vorp,et al.  Potential influence of intraluminal thrombus on abdominal aortic aneurysm as assessed by a new non-invasive method. , 1996, Cardiovascular surgery.

[17]  M. Zamir,et al.  Viscous damping in one‐dimensional wave transmission , 1992 .

[18]  A. P. Avó Multi-branched model of the human arterial system , 2006 .

[19]  J. Womersley,et al.  An Elastic Tube Theory of Pulse Transmission and Oscillatory Flow in Mammalian Arteries , 1957 .

[20]  Alice Stanton,et al.  Differential Impact of Blood Pressure–Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study , 2006, Circulation.

[21]  D. F. Young,et al.  Computer simulation of arterial flow with applications to arterial and aortic stenoses. , 1992, Journal of biomechanics.

[22]  N. Kon,et al.  Does radial artery pressure accurately reflect aortic pressure? , 1992, Chest.

[23]  N. Stergiopulos,et al.  Assessment of distributed arterial network models , 1997, Medical and Biological Engineering and Computing.

[24]  A. Avolio,et al.  A neural network for estimation of aortic pressure from the radial artery pressure pulse , 2001, 2001 Conference Proceedings of the 23rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[25]  G A Holzapfel,et al.  Determination of constitutive equations for human arteries from clinical data. , 2003, Journal of biomechanics.

[26]  K. Parker,et al.  Wave propagation in a model of the arterial circulation. , 2004, Journal of biomechanics.

[27]  A Noordergraaf,et al.  Estimation of total systemic arterial compliance in humans. , 1990, Journal of applied physiology.

[28]  P. Abbrecht,et al.  Digital computer simulation of human systemic arterial pulse wave transmission: a nonlinear model. , 1972, Journal of biomechanics.

[29]  A P Avolio,et al.  Pressure wave propagation in a multibranched model of the human upper limb. , 1995, The American journal of physiology.

[30]  D. Kass,et al.  Parametric model derivation of transfer function for noninvasive estimation of aortic pressure by radial tonometry , 1999, IEEE Transactions on Biomedical Engineering.

[31]  B. Sonesson,et al.  Sex difference in the mechanical properties of the abdominal aorta in human beings. , 1994, Journal of vascular surgery.

[32]  J. De Sutter,et al.  Individualizing the aorto-radial pressure transfer function: feasibility of a model-based approach. , 2000, American journal of physiology. Heart and circulatory physiology.

[33]  T Länne,et al.  Compliance and diameter in the human abdominal aorta--the influence of age and sex. , 1993, European journal of vascular surgery.

[34]  M. G. Taylor,et al.  The input impedance of an assembly of randomly branching elastic tubes. , 1966, Biophysical journal.

[35]  C. H. Chen,et al.  Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. , 1997, Circulation.

[36]  S. Julius,et al.  Hemodynamic Studies in Patients with Borderline Blood Pressure Elevation , 1968, Circulation.

[37]  M. G. Taylor,et al.  Alterations with Age in the Viscoelastic Properties of Human Arterial Walls , 1966, Circulation research.

[38]  M. Karamanoglu,et al.  Derivation of the ascending aortic-carotid pressure transfer function with an arterial model. , 1996, The American journal of physiology.

[39]  Amir Lerman,et al.  Endothelial Dysfunction: A Marker of Atherosclerotic Risk , 2003, Arteriosclerosis, thrombosis, and vascular biology.