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Individualization of transfer function in estimation of central aortic pressure from the peripheral pulse is not required in patients at rest

¹BMEYE, Amsterdam; ²Department of Physiology, Academic Medical Center, University of Amsterdam; ³AEGON, Groningen; ⁴Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein; ⁵Laboratory for Physiology and Department of Pulmonary Diseases, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam; ⁶Department of Internal Medicine, St. Antonius Ziekenhuis, Nieuwegein; ⁸Laboratory of Medical Physics, Academic Medical Center, University of Amsterdam, The Netherlands; and ⁷Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology, Lausanne, Switzerland

Submitted 5 August 2008 ; accepted in final form 30 September 2008

Central aortic pressure gives better insight into ventriculo-arterial coupling and better prognosis of cardiovascular complications than peripheral pressures. Therefore transfer functions (TF), reconstructing aortic pressure from peripheral pressures, are of great interest. Generalized TFs (GTF) give useful results, especially in larger study populations, but detailed information on aortic pressure might be improved by individualization of the TF. We found earlier that the time delay, representing the travel time of the pressure wave between measurement site and aorta is the main determinant of the TF. Therefore, we hypothesized that the TF might be individualized (ITF) using this time delay. In a group of 50 patients at rest, aged 28–66 yr (43 men), undergoing diagnostic angiography, ascending aortic pressure was 119 ± 20/70 ± 9 mmHg (systolic/diastolic). Brachial pressure, almost simultaneously measured using catheter pullback, was 131 ± 18/67 ± 9 mmHg. We obtained brachial-to-aorta ITFs using time delays optimized for the individual and a GTF using averaged delay. With the use of ITFs, reconstructed aortic pressure was 121 ± 19/69 ± 9 mmHg and the root mean square error (RMSE), as measure of difference in wave shape, was 4.1 ± 2.0 mmHg. With the use of the GTF, reconstructed pressure was 122 ± 19/69 ± 9 mmHg and RMSE 4.4 ± 2.0 mmHg. The augmentation index (AI) of the measured aortic pressure was 26 ± 13%, and with ITF and GTF the AIs were 28 ± 12% and 30 ± 11%, respectively. Details of the wave shape were reproduced slightly better with ITF but not significantly, thus individualization of pressure transfer is not effective in resting patients.

brachial pressure; augmentation index; travel time