Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance

Anish N Bhuva; A D'Silva; C Torlasco; N Nadarajan; S Jones; R Boubertakh; J Van Zalen; P Scully; K Knott; G Benedetti; J B Augusto; Rachel Bastiaenen; G Lloyd; S Sharma; J C Moon; K H Parker; C H Manisty; Alun D Hughes

doi:10.1093/ehjci/jez227

Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance

Eur Heart J Cardiovasc Imaging. 2020 Jul 1;21(7):805-813. doi: 10.1093/ehjci/jez227.

Authors

Anish N Bhuva^{1

2}, A D'Silva³, C Torlasco⁴, N Nadarajan¹, S Jones¹, R Boubertakh², J Van Zalen², P Scully^{1

2}, K Knott^{1

2}, G Benedetti², J B Augusto^{1

2}, Rachel Bastiaenen³, G Lloyd², S Sharma³, J C Moon^{1

2}, K H Parker⁵, C H Manisty^{1

2}, Alun D Hughes^{1

6}

Affiliations

¹ Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.
² Barts Heart Centre, West Smithfield, London EC1A 7BE, UK.
³ Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK.
⁴ IRCCS, Istituto Auxologico Italiano, Via Ludovico Ariosto 13, 20145 Milan, Italy, Italy.
⁵ Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
⁶ MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK.

Abstract

Background: Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms.

Methods and results: Two hundred and six healthy volunteers (age range 21-73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, -6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (-8.6 and -20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001).

Conclusion: This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.

Keywords: CMR; aorta; haemodynamics; reflection index; ventriculo-arterial coupling; wave intensity analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aorta* / diagnostic imaging
Blood Flow Velocity
Blood Pressure
Female
Humans
Magnetic Resonance Spectroscopy
Male
Middle Aged
Predictive Value of Tests
Pulse Wave Analysis*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding