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Estimation of coronary wave intensity analysis using noninvasive techniques and its application to exercise physiology

Broyd, CJ; Nijjer, S; Sen, S; Petraco, R; Jones, S; Al-Lamee, R; Foin, N; ... Davies, JE; + view all (2016) Estimation of coronary wave intensity analysis using noninvasive techniques and its application to exercise physiology. American Journal of Physiology: Heart and Circulatory Physiology , 310 (5) H619-H627. 10.1152/ajpheart.00575.2015. Green open access

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Abstract

Wave intensity analysis (WIA) has found particular applicability in the coronary circulation where it can quantify traveling waves that accelerate and decelerate blood flow. The most important wave for the regulation of flow is the backward-traveling decompression wave (BDW). Coronary WIA has hitherto always been calculated from invasive measures of pressure and flow. However, recently it has become feasible to obtain estimates of these waveforms noninvasively. In this study we set out to assess the agreement between invasive and noninvasive coronary WIA at rest and measure the effect of exercise. Twenty-two patients (mean age 60) with unobstructed coronaries underwent invasive WIA in the left anterior descending artery (LAD). Immediately afterwards, noninvasive LAD flow and pressure were recorded and WIA calculated from pulsed-wave Doppler coronary flow velocity and central blood pressure waveforms measured using a cuff-based technique. Nine of these patients underwent noninvasive coronary WIA assessment during exercise. A pattern of six waves were observed in both modalities. The BDW was similar between invasive and noninvasive measures [peak: 14.9 ± 7.8 vs. -13.8 ± 7.1 × 10(4) W·m(-2)·s(-2), concordance correlation coefficient (CCC): 0.73, P < 0.01; cumulative: -64.4 ± 32.8 vs. -59.4 ± 34.2 × 10(2) W·m(-2)·s(-1), CCC: 0.66, P < 0.01], but smaller waves were underestimated noninvasively. Increased left ventricular mass correlated with a decreased noninvasive BDW fraction (r = -0.48, P = 0.02). Exercise increased the BDW: at maximum exercise peak BDW was -47.0 ± 29.5 × 10(4) W·m(-2)·s(-2) (P < 0.01 vs. rest) and cumulative BDW -19.2 ± 12.6 × 10(3) W·m(-2)·s(-1) (P < 0.01 vs. rest). The BDW can be measured noninvasively with acceptable reliably potentially simplifying assessments and increasing the applicability of coronary WIA.

Type: Article
Title: Estimation of coronary wave intensity analysis using noninvasive techniques and its application to exercise physiology
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1152/ajpheart.00575.2015
Publisher version: http://dx.doi.org/10.1152/ajpheart.00575.2015
Language: English
Additional information: Copyright © 2016 the American Physiological Society. All rights reserved.
Keywords: Artery, blood flow, hypertrophy, microcirculation, physiology, Aged, Arterial Pressure, Blood Flow Velocity, Blood Pressure Determination, Brachial Artery, Cardiac Catheterization, Coronary Circulation, Coronary Vessels, Echocardiography, Doppler, Color, Echocardiography, Doppler, Pulsed, Exercise, Exercise Test, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Reproducibility of Results, Sphygmomanometers, Time Factors
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1493365
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