Cardiac Contractility is a Key Factor in Determining Pulse Pressure and Its Peripheral Amplification

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Jul 10

PMID 37424904

Authors

Francesco Piccioli

Ye Li

Alessandro Valiani

Valerio Caleffi

Phil Chowienczyk

Jordi Alastruey

Affiliations

Soon will be listed here.

Abstract

Background: Arterial stiffening and peripheral wave reflections have been considered the major determinants of raised pulse pressure (PP) and isolated systolic hypertension, but the importance of cardiac contractility and ventricular ejection dynamics is also recognised.

Methods: We examined the contributions of arterial compliance and ventricular contractility to variations in aortic flow and increased central (cPP) and peripheral (pPP) pulse pressure, and PP amplification (PPa) in normotensive subjects during pharmacological modulation of physiology, in hypertensive subjects, and using a cardiovascular model accounting for ventricular-aortic coupling. Reflections at the aortic root and from downstream vessels were quantified using emission and reflection coefficients, respectively.

Results: cPP was strongly associated with contractility and compliance, whereas pPP and PPa were strongly associated with contractility. Increased contractility by inotropic stimulation increased peak aortic flow (323.9 ± 52.8 vs. 389.1 ± 65.1 ml/s), and the rate of increase (3193.6 ± 793.0 vs. 4848.3 ± 450.4 ml/s) in aortic flow, leading to larger cPP (36.1 ± 8.8 vs. 59.0 ± 10.8 mmHg), pPP (56.9 ± 13.1 vs. 93.0 ± 17.0 mmHg) and PPa (20.8 ± 4.8 vs. 34.0 ± 7.3 mmHg). Increased compliance by vasodilation decreased cPP (62.2 ± 20.2 vs. 45.2 ± 17.8 mmHg) without altering , pPP or PPa. The emission coefficient changed with increasing cPP, but the reflection coefficient did not. These results agreed with data obtained by independently changing contractility/compliance over the range observed .

Conclusions: Ventricular contractility plays a key role in raising and amplifying PP, by altering aortic flow wave morphology.

Citing Articles

Effect of Acute Resistance Exercise and Resistance Exercise Training on Central Pulsatile Hemodynamics and Large Artery Stiffness: Part I.

Wakeham D, Pierce G, Heffernan K Pulse (Basel). 2025; 13(1):31-44.

PMID: 39991443 PMC: 11842066. DOI: 10.1159/000543313.

Editorial: Advanced invasive hemodynamics: pressure-volume maneuvers to obtain load-independent indices.

Konecny F, Kelle S, Alogna A Front Cardiovasc Med. 2024; 11:1468811.

PMID: 39188321 PMC: 11345272. DOI: 10.3389/fcvm.2024.1468811.

References

Kondiboyina A, Harrington H, Smolich J, Cheung M, Mynard J . Optimized design of an arterial network model reproduces characteristic central and peripheral haemodynamic waveform features of young adults. J Physiol. 2022; 600(16):3725-3747. PMC: 9544402. DOI: 10.1113/JP282942. View

ORourke M, Nichols W . Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension. 2005; 45(4):652-8. DOI: 10.1161/01.HYP.0000153793.84859.b8. View

Quinones M, Gaasch W, Alexander J . Influence of acute changes in preload, afterload, contractile state and heart rate on ejection and isovolumic indices of myocardial contractility in man. Circulation. 1976; 53(2):293-302. DOI: 10.1161/01.cir.53.2.293. View

Sharman J, Davies J, Jenkins C, Marwick T . Augmentation index, left ventricular contractility, and wave reflection. Hypertension. 2009; 54(5):1099-105. DOI: 10.1161/HYPERTENSIONAHA.109.133066. View

Torjesen A, Wang N, Larson M, Hamburg N, Vita J, Levy D . Forward and backward wave morphology and central pressure augmentation in men and women in the Framingham Heart Study. Hypertension. 2014; 64(2):259-65. PMC: 4184952. DOI: 10.1161/HYPERTENSIONAHA.114.03371. View

Chen C, Ting C, Nussbacher A, Nevo E, Kass D, Pak P . Validation of carotid artery tonometry as a means of estimating augmentation index of ascending aortic pressure. Hypertension. 1996; 27(2):168-75. DOI: 10.1161/01.hyp.27.2.168. View

Parker K . An introduction to wave intensity analysis. Med Biol Eng Comput. 2009; 47(2):175-88. DOI: 10.1007/s11517-009-0439-y. View

Hashimoto J, Ito S . Pulse pressure amplification, arterial stiffness, and peripheral wave reflection determine pulsatile flow waveform of the femoral artery. Hypertension. 2010; 56(5):926-33. DOI: 10.1161/HYPERTENSIONAHA.110.159368. View

Lim S, Vos T, Flaxman A, Danaei G, Shibuya K, Adair-Rohani H . A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2224-60. PMC: 4156511. DOI: 10.1016/S0140-6736(12)61766-8. View

10.

Charlton P, Mariscal Harana J, Vennin S, Li Y, Chowienczyk P, Alastruey J . Modeling arterial pulse waves in healthy aging: a database for in silico evaluation of hemodynamics and pulse wave indexes. Am J Physiol Heart Circ Physiol. 2019; 317(5):H1062-H1085. PMC: 6879924. DOI: 10.1152/ajpheart.00218.2019. View

11.

Chirinos J, Segers P, Gupta A, Swillens A, Rietzschel E, De Buyzere M . Time-varying myocardial stress and systolic pressure-stress relationship: role in myocardial-arterial coupling in hypertension. Circulation. 2009; 119(21):2798-807. DOI: 10.1161/CIRCULATIONAHA.108.829366. View

12.

Reymond P, Westerhof N, Stergiopulos N . Systolic hypertension mechanisms: effect of global and local proximal aorta stiffening on pulse pressure. Ann Biomed Eng. 2011; 40(3):742-9. DOI: 10.1007/s10439-011-0443-x. View

13.

Pauca A, Wallenhaupt S, Kon N, Tucker W . Does radial artery pressure accurately reflect aortic pressure?. Chest. 1992; 102(4):1193-8. DOI: 10.1378/chest.102.4.1193. View

14.

Millasseau S, Guigui F, Kelly R, Prasad K, Cockcroft J, Ritter J . Noninvasive assessment of the digital volume pulse. Comparison with the peripheral pressure pulse. Hypertension. 2000; 36(6):952-6. DOI: 10.1161/01.hyp.36.6.952. View

15.

Franklin S, Gustin 4th W, Wong N, Larson M, Weber M, Kannel W . Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997; 96(1):308-15. DOI: 10.1161/01.cir.96.1.308. View

16.

ORourke M, Hashimoto J . Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol. 2007; 50(1):1-13. DOI: 10.1016/j.jacc.2006.12.050. View

17.

Fok H, Guilcher A, Li Y, Brett S, Shah A, Clapp B . Augmentation pressure is influenced by ventricular contractility/relaxation dynamics: novel mechanism of reduction of pulse pressure by nitrates. Hypertension. 2014; 63(5):1050-5. DOI: 10.1161/HYPERTENSIONAHA.113.02955. View

18.

Mceniery C, Yasmin , Hall I, Qasem A, Wilkinson I, Cockcroft J . Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005; 46(9):1753-60. DOI: 10.1016/j.jacc.2005.07.037. View

19.

Parker K, Jones C . Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng. 1990; 112(3):322-6. DOI: 10.1115/1.2891191. View

20.

Chengode S . Left ventricular global systolic function assessment by echocardiography. Ann Card Anaesth. 2016; 19(Supplement):S26-S34. PMC: 5100240. DOI: 10.4103/0971-9784.192617. View