Analysis of local hemodynamics in central and peripheral arteries

Abstract

To understand the function of the cardiovascular system, the propagation of waves in arteries has to be investigated, since they carry information which can be used for the prevention and diagnosis of cardiovascular diseases. The main goal of this thesis is to improve the understanding of wave propagation in central and peripheral arteries studying the local hemodynamics of the ascending aorta, the carotid artery and the femoral artery by analysing human, animal and in vitro data. Also, another aim is to introduce a technique for non-invasive determination of the local arterial distensibility, the wave speed, and wave intensities. Arterial hemodynamics is here studied using wave intensity analysis, a time domain technique based on pressure and velocity measurements that is derived from the 1D theory of wave propagation in elastic tubes. Also, variations of this technique were used, such as (i) the non-invasive wave intensity analysis that relies on diameter and velocity measurements and (ii) the reservoir-wave approach in which pressure is considered the sum of a pressure due to the elastic properties of the arteries and a pressure due to the travelling wave. To identify the correct analysis to describe the wave propagation in the ascending aorta using pressure and velocity measurements, the hemodynamics of the canine ascending aorta was studied invasively using the traditional wave intensity (or waveonly) analysis and the reservoir-wave approach in both control condition and during total aorta occlusions in order to provide clear reflection sites. The models produced a remarkably similar wave intensity curves, although the intensity magnitudes were different. The reservoir-wave model always yielded lower values for all hemodynamic parameters studied. Both models led to the conclusion that distal occlusions have little or no effect on hemodynamics in the ascending aorta. Since the ascending aorta is not an accessible vessel its examination in clinical routine is challenging. More superficial arteries, such as carotid, radial, brachial and femoral arteries, might be easier to examine, in particular using ultrasound equipment that is normally available in the clinic. These considerations led to the second study of this thesis that is the introduction of a new technique for the non-invasive determination of arterial distensibility, local wave speed and wave intensities to study arterial hemodynamics in humans. The technique relies only on diameter and velocity measurements that can be obtained using ultrasound. In particular, the technique was used for the first time to study the hemodynamic of the carotid and femoral arteries in a large population of healthy humans to investigate the changes with age and gender. The carotid artery was more affected by the aging process than the femoral artery, even in healthy subjects. Local wave speed, distensibility and hemodynamic wave intensity parameters (except the reflection index) had strong correlations with age at the carotid artery. The mechanical properties and hemodynamic parameters of the femoral artery were not significantly age-dependent, but local wave speed, distensibility and forward wave intensity were significantly gender-dependent. The findings of the first and second studies contributed to the design of the third study. The carotid artery is an elastic artery relatively close to the heart and thus the hemodynamics of this vessel is related to left ventricular function. For this reason, the carotid hemodynamics of the same healthy population was investigated for the first time using the reservoir-wave approach. Pressure and velocity measurements were separated into their reservoir and excess components and the effects of age and gender on these parameters were studied. It was found that in the carotid artery reservoir and excess components are strongly affected by the ageing process. From the above studies some questions about the hemodynamics of central arteries remained unsolved. For this reason it was decided to carry out in vitro experiments in a mock circulatory system to investigate the effects of variation of compliance and stroke volume on the reservoir and excess pressure components of the ascending aorta. This allows for the study of different physiological and pathological conditions, such as age, hypertension, atherosclerosis and ventricular dysfunction in relation to vascular compliance and stroke volume. The reservoir and excess components of the measured pressure wave were both significantly related to aortic compliance and stroke volume, but the reservoir pressure had a stronger relationship with aortic compliance compared with the excess pressure and its magnitude increased more significantly when the aorta became stiffer. Wave speeds, calculated using measured and excess pressures, followed the same pattern, but the one calculated using excess pressure was smaller than the other. Wave speed was strongly related to aortic compliance, but not to the change of stroke volume. In conclusion, the use of the wave-only and the reservoir-wave models led to different values of wave speed and intensities that can be explained considering the anatomy of the arterial system. Notably, elastic and muscular arteries are differently affected by age and gender. The hemodynamics of the carotid artery are strongly related to age also in healthy subjects. Pressure and flow velocity in the carotid artery can be separated into their reservoir and excess components. The new non-invasive technique based on diameter and velocity measurements could be relevant in clinical practice as a screening tool.