(精选)Pulse analysis-stroke volume, vascular stiffening and cardiovascular disease教学课件.pptVIP

Pulse contour analysis We’ll skip the math and validation studies. Intuitively– the bigger the waveform and the longer it lasts, the bigger the stroke volume. Calibration (e.g. with lithium dilution) vs. age / weight / height algorithm to predict probable aortic compliance and then follow trends. Big stroke volume Small stroke volume P R E S S U R E WW Nichols Curr Opin Cardiol 2002, 17:543–551 As healthy individuals age, reflected wave arrives at ascending aorta earlier and increases augmentation index and central pulse pressure. Tom Archer, 58 yo, after work, seated comfortably. Aix = 11%. 67 y.o. obese female-- AIx 24% 77 y.o. man. Never smoked. Aix = 29%. 42 y.o. obese female, smoker. Aix = 36% 77 yo male, ESRD, AV fistula, CAD, HBP Takes atenolol, lisinopril, terazosin, finasteride. Aix = 39% When is Aix high– acutely? Arterial compression in legs (squatting) Cold body temperature. Nicotine ingestion Tom Archer, 58 y.o., while squatting. Aix = 21% Tom Archer, seated, very cold from being outside in winter. Aix = 27% David G. Edwards,1 Amie L. Gauthier,2 Melissa A. Hayman,2 Jesse T. Lang,2 and Robert W. Kenefick2J Appl Physiol 100: 1210–1214, 2006. Exposure of healthy young adults to cold air for 30 min increases augmentation index. Does cold weather increase MI rate due to increased AIx? Perioperative hypothermia increases cardiac event rate. Is this due to increased AIx with hypothermia? What makes AIx go down-- chronically? Exercise Weight loss Red wine Statins Control of blood pressure (ACEI and CCB) NTG Ted A, 30 yo, at rest, seated. Subject runs marathons. Aix = -14%. 64 yo obese male. HBP on lisinopril. Moderate ETOH consumption. Aix = 14%. What makes Aix go down-- acutely? Exercise Red wine Lowering blood pressure NTG Tom Archer, 58 yo, after exercise and wine. AIx = 1% S. C. MI