pulse wave velocity 측정의 역사 및 최신지견 · 2015-07-07 · the velocity of...

Pulse Wave Velocity 측정의 역사

및 최신지견

Jin Oh Na, MD, PhD

Cardiovascular Center

Department of Internal Medicine

Korea University Guro Hospital

Korea University College of Medicine

2013 혈관연구회 춘천집담회

Pulse Wave Velocity (PWV)

• To evaluate arterial wall distensibility and

stiffness.

• Simple, accurate, noninvasive and reproducible

method

• Can be applied in large therapeutic and

epidemiological studies.


Histological Overview of

Pulse Wave


Histological Overview of Pulse Wave

• Egyptians Pulse wave is the ‘word’ of the

heart to the vessels



• Chinese analyze quality of pulse (진맥)

• 강하고 두드러지는 맥은 활력과 건강의 상징으로 여겨짐

개구리 점프 물고기 꼬리 떨어지는 물방울



Hippocrates (460 BC – 370 BC)

Aristotle (384 BC – 322 BC)

Arteries

communicate

with trachea.

Thus, contain

air



Galen (131 – 200 AD)

First to note a relationship between

heart and arteries

Arteries contain blood and not air

Arterial pulse was dependent on and

synchronous with the heart



• 1540년 Struthius, first attempted to study

pulse wave by placing a leaf on the artery

• 1553년 Miguel Serveto, described pulmonary

circulation

• 1628년 William Harvey, pulse wave as

manifestation of cardiac systole, which

correspond to the arterial diastole.



1731년

Reverend Stephen Hales,

recorded the first invasive

arterial pressure

measurement.



1863년

E.J. Marey, first to

accurately record the

human arterial pulse using

a sphygmography


Beginning of the Arterial Hemodynamics

Dudgeon’s Sphygmograph

Frey’s Sphygmograph Pond’s Sphygmograph



• 1896년: Riva Rocci brachial cuff and

sphygmomanometer

• 1905년: description of Korotkoff sounds

Enable blood pressure measurement

Decrease use of the sphygmograph and pulse

wave analysis

• 1922년: Bramwell and Hill,

The velocity of transmission of the pulse is clinical

index of arterial elasticity.



Pulse Wave Velocity: Invasive method

Kim EJ, et al. J Hypertens. 2004; 22: S334

Applantation Tonometry

• 2 devices widely used in South Korea

SphygmoCor (AtCor Medical) GAON 21A (Hanbyul Meditech)


Applantation tonometry

• Locate probe on radial artery

• Acquire radial artery waveform

• Using generalized transfer function

• Estimate central artery waveform

Aix

Aix@HR75

ED

SEVR

Central SBP

Central DBP

Central PP

waveform analysis Augmentation index

Ejection duration

Subendocardial viability ratio


Augmentation index

Ejection duration

Subendocardial viability ratio

areaSystolic

areaDiastolic

Time

ED

PP

AP Arterial stiffness

Duration of systole

Coronary artery perfusion

Below 50%, subendocardial

ischemia occurs

Augmentation index at a heart rate 75 beats/min



Pulse Wave Velocity: Non-invasive method

Speed of the wave is related to the

stiffness of the artery it is traveling in

The stiffer the artery;

The higher the wave speed

Wave speed is proportional to the square root of

arterial stiffness


Clinical impacts of

Pulse Wave Velocity


Age and PWV (Aortic Stiffness)

Correlation between Age and PWV

AGE

9080706050403020

PW

V

50

40

30

20

10

0

Correlation between Age & PWV

Age

PW

V

Kim EJ, et al. J Hypertens. 2004; 22: S334

R=0.429 P<0.001


Blood pressure and Aortic Stiffness (PWV)

Kim EJ, et al. J Human Hypertens 2007; 21: 141-8

R=0.330 P<0.001

R=0.363 P<0.001


Insulin Sensitivity and Aortic Stiffness (PWV)

Sengstock, D. M. et al. J Clin Endocrinol Metab 2005;90:2823-7


Metabolic Components and Aortic PWV in HTN patients

Schillaci, G. et al. Hypertension 2005;45:1078-82


LVH and Aortic Stiffness (PWV)

Park CG, et al. J Hypertens 2002;20:S484

PW

V


PWV and Vascular Endothelial Function

Hashimoto M, et al. Hypertens Res. 2000;23:233-8


PWV and Microalbuminuria

Mule G, et al. J Intern Med. 2004;256:22-9


PWV and NonDM-ESRD

Shoji T, et al. J Am Soc Nephrol 1998;9: 1277-84


baPWV and Total CV events

Vlachopoulos C, et al. Hypertension. 2012;60:556-62.


baPWV and Total CV Mortality



baPWV and Total All-cause Mortality



pulse wave velocity 측정의 역사 및 최신지견 · 2015-07-07 · the velocity of...

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