Abstract
The optimal performance of the cardiovascular system, as well as the break-down of this performance with disease, both involve complex biomechanical interactions between the heart, conduit vascular networks and microvascular beds. ‘Wave analysis’ refers to a group of techniques that provide valuable insight into these interactions by scrutinizing the shape of blood pressure and flow/velocity waveforms. The aim of this review paper is to provide a comprehensive introduction to wave analysis, with a focus on key concepts and practical application rather than mathematical derivations. We begin with an overview of invasive and non-invasive measurement techniques that can be used to obtain the signals required for wave analysis. We then review the most widely used wave analysis techniques—pulse wave analysis, wave separation and wave intensity analysis—and associated methods for estimating local wave speed or characteristic impedance that are required for decomposing waveforms into forward and backward wave components. This is followed by a discussion of the biomechanical phenomena that generate waves and the processes that modulate wave amplitude, both of which are critical for interpreting measured wave patterns. Finally, we provide a brief update on several emerging techniques/concepts in the wave analysis field, namely wave potential and the reservoir-excess pressure approach.
Highlights
Cardiovascular disease has a profound impact on people around the world and across the human lifespan, accounting for 31% of all deaths globally (World Health Organization, 2013), as well as being the most common and costly category of birth defects (Centers for Disease Prevention and Control, 2019)
We start by briefly reviewing techniques for measuring blood pressure, flow, and velocity waveforms, cover the most well-established wave analysis techniques
Central aortic blood pressure is of particular interest in many studies, as it represents the direct pressure load faced by the ejecting left ventricle
Summary
Cardiovascular disease has a profound impact on people around the world and across the human lifespan, accounting for 31% of all deaths globally (World Health Organization, 2013), as well as being the most common and costly category of birth defects (Centers for Disease Prevention and Control, 2019). The major biomechanical properties of the heart and circulatory system, including cardiac contraction, ventriculo-vascular coupling, large artery stiffness, and microvasculature properties, all influence the pattern of pressure/flow waves that can be measured in blood vessels. A range of established and emerging wave analyses are available, including pulse wave analysis, wave separation, wave intensity (with several variations), and reservoir-excess pressure analysis. The aim of this review is to introduce key techniques and concepts relating to arterial wave analyses, whilst providing an update on recent developments and emerging techniques in the field. We start by briefly reviewing techniques for measuring blood pressure, flow, and velocity waveforms, cover the most well-established wave analysis techniques (pulse wave analysis, wave separation and wave intensity analysis). To appeal to a broad readership, this review will contain minimal mathematics and no derivations, but references will be provided where such details can be found
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