Noninvasive Wave Intensity Analysis Research Articles

Wave Intensity Analysis Combined With Machine Learning can Detect Impaired Stroke Volume in Simulations of Heart Failure.

Heart failure is treatable, but in the United Kingdom, the 1-, 5- and 10-year mortality rates are 24.1, 54.5 and 75.5%, respectively. The poor prognosis reflects, in part, the lack of specific, simple and affordable diagnostic techniques; the disease is often advanced by the time a diagnosis is made. Previous studies have demonstrated that certain metrics derived from pressure–velocity-based wave intensity analysis are significantly altered in the presence of impaired heart performance when averaged over groups, but to date, no study has examined the diagnostic potential of wave intensity on an individual basis, and, additionally, the pressure waveform can only be obtained accurately using invasive methods, which has inhibited clinical adoption. Here, we investigate whether a new form of wave intensity based on noninvasive measurements of arterial diameter and velocity can detect impaired heart performance in an individual. To do so, we have generated a virtual population of two-thousand elderly subjects, modelling half as healthy controls and half with an impaired stroke volume. All metrics derived from the diameter–velocity-based wave intensity waveforms in the carotid, brachial and radial arteries showed significant crossover between groups—no one metric in any artery could reliably indicate whether a subject’s stroke volume was normal or impaired. However, after applying machine learning to the metrics, we found that a support vector classifier could simultaneously achieve up to 99% recall and 95% precision. We conclude that noninvasive wave intensity analysis has significant potential to improve heart failure screening and diagnosis.

The composition of vulnerable plaque and its effect on arterial waveforms

Carotid plaque composition is a key factor of plaque stability and it carries significant prognostic information. The carotid unstable plaques are characterized by a thin fibrous cap (FC) ≤65μm with large lipid core (LC), while stable plaques have a thicker FC and less LC. Identifying the percentage of plaque compositions could help surgeons to make a precise decision for their patients’ treatment protocol. This study aims to distinguish between stable and unstable plaque by defining the relationship between plaque composition and arterial waveform non-invasively. An in-vitro arterial system, composed of a Harvard pulsatile flow pump and artificial circulation system, was used to investigate the effect of the plaque compositions on the pulsatile arterial waveforms. Five types of arterial plaques, composed of the LC, FC, Collagen (Col) and Calcium (Ca), were implemented into the artificial carotid artery to represent the diseased arterial system with 30% of blockage. The pulsatile pressure, velocity and arterial wall movement were measured simultaneously at the site proximal to the plaque. Non-invasive wave intensity analysis (Non-WIA) was used to separate the waves into forward and backward components. The correlation between the plaque compositions and the reflected waveforms was quantitatively analysed. The experimental results indicate that the reflected waveforms are strongly correlated with the plaque compositions, where the percentages of the Col are linearly correlated with the amplitude of the backward diameter (correlation coefficient, r = 0.74) and the lipid content has a strong negative correlation with the backward diameter (r = 0.82). A slight weak correlation exists between the reflected waveform and the percentage of Ca. The strong correlation between the compositions of the plaques with the backward waveforms observed in this study demonstrates that the components of the arterial plaques could be distinguished by the arterial waveforms. This finding might lead to a potential novel non-invasive clinical tool to determine the composition of the plaques and distinguish between stable and vulnerable arterial plaques at the early stage.

Noninvasive assessment of the common carotid artery hemodynamics with increasing exercise work rate using wave intensity analysis.

Noninvasively determined local wave speed (c) and wave intensity (WI) parameters provide insights into arterial stiffness and cardiac-vascular interactions in response to physiological perturbations. However, the effects of incremental exercise and subsequent recovery on c and WI have not been fully established. We examined the changes in c and WI parameters in the common carotid artery (CCA) during exercise and recovery in eight young, healthy male athletes. Ultrasound measurements of CCA diameter and blood flow velocity were acquired at rest, during five stages of incremental exercise (up to 70% maximum work rate), and throughout 1 h of recovery, and noninvasive WI analysis [diameter-velocity (DU) approach] was performed. During exercise, c increased (+136%), showing increased stiffness with work rate. All peak and area of forward compression, backward compression, and forward expansion waves increased during exercise (+452%, +700%, and +900%, respectively). However, WI reflection indexes and CCA resistance did not significantly change from rest to exercise. Furthermore, wave speed and the magnitude of all waves returned to baseline within 5 min of recovery, suggesting that the effects of exercise in the investigated parameters of young, healthy individuals were transient. In conclusion, incremental exercise was associated with an increase in local CCA stiffness and increases in all wave parameters, indicative of enhanced ventricular contractility and improved late-systolic blood flow deceleration.NEW & NOTEWORTHY We examined hemodynamics of the common carotid artery using noninvasive application of wave intensity analysis during exercise and recovery. The hemodynamic adjustments to exercise were associated with increases in local common carotid artery stiffness and all waves’ parameters, with the latter indicating enhanced ventricular contractility and improved late systolic blood flow deceleration.

Non-invasive wave intensity analysis in the aorta and internal carotid using phase-contrast MR angiography: The effect of hypertension

IntroductionHypertension is associated with stiffening of blood vessels, reduced arterial lumen and reduced cerebral blood flow; however, it is not known how lower cerebral blood flow relates to arterial structure or impacts on wave dynamics. We hypothesise increased backward wave energy and faster wave speed in the hypertensive internal carotid artery as an indication of increased resistance to flow.MethodsNormotensive, controlled and uncontrolled hypertensive participants were recruited (daytime ambulatory BP < 135/85 mmHg and >135/ 85 mmHg, respectively; n = 11 per group). Wave intensity analysis was performed on left internal carotid and ascending aorta phase-contrast magnetic resonance angiography.ResultsWhile ascending aortic wave speed increased significantly in the uncontrolled hypertensive compared to normotensive (p<0.001) and controlled hypertensive participants (p = 0.038), no significant difference was observed in the internal carotid. Carotid forward and backward wave intensity increased in uncontrolled hypertensives compared to normotensives (p = 0.036 and p = 0.033, respectively), and backward wave energy increased in the controlled hypertensives compared to normotensives (p = 0.041). There was no significant difference between uncontrolled and controlled hypertensives.Figure 1Analysis of the phase contrast MR angiography data. A) Magnitude imageB)Phaseimageoftheinternalcarotid arteriesC)Magnitude image and D) Phase image of the ascending aorta E) example of log(Area)-Velocity loop. Red line indicates the slope from which wave speed is calculated in early systole F) Exampleofthe wave Intensity components, where blueisthe forward wave energy, red is the backward wave energy and black is the net wave intensity.ConclusionWave intensity in the internal carotid artery is altered in uncontrolled hypertension. This is partly rescued when blood pressure is controlled by medication, although greater backward wave energy persists. This supports the hypothesis of increased resistance to flow in the cerebral circulation of the hypertensives. Whilst increased aortic wave speed confirmed an expected increase in stiffness, this was not observed in the internal carotid. This might suggest a protective mechanism in the cerebral circulation, in conjunction with the effect of vessel tortuosity.

Common Carotid Artery Diameter, Blood Flow Velocity and Wave Intensity Responses at Rest and during Exercise in Young Healthy Humans: A Reproducibility Study

The aim of this study was to assess the reproducibility of non-invasive, ultrasound-derived wave intensity (WI) in humans at the common carotid artery. Common carotid artery diameter and blood velocity of 12 healthy young participants were recorded at rest and during mild cycling, to assess peak diameter, change in diameter, peak velocity, change in velocity, time derivatives, non-invasive wave speed and WI. Diameter, velocity and WI parameters were fairly reproducible. Diameter variables exhibited higher reproducibility than corresponding velocity variables (intra-class correlation coefficient [ICC] = 0.79 vs. 0.73) and lower dispersion (coefficient of variation [CV] = 5% vs. 9%). Wave speed had fair reproducibility (ICC = 0.6, CV = 16%). WI energy variables exhibited higher reproducibility than corresponding peaks (ICC = 0.78 vs. 0.74) and lower dispersion (CV = 16% vs. 18%). The majority of variables had higher ICCs and lower CVs during exercise. We conclude that non-invasive WI analysis is reliable both at rest and during exercise.

Effects of Thoratec pulsatile ventricular assist device timing on the abdominal aortic wave intensity pattern.

Arterial waves are seen as possible independent mediators of cardiovascular risks, and the wave intensity analysis (WIA) has therefore been proposed as a method for patient selection for ventricular assist device (VAD) implantation. Interpreting measured wave intensity (WI) is challenging, and complexity is increased by the implantation of a VAD. The waves generated by the VAD interact with the waves generated by the native heart, and this interaction varies with changing VAD settings. Eight sheep were implanted with a pulsatile VAD (PVAD) through ventriculoaortic cannulation. The start of PVAD ejection was synchronized to the native R wave and delayed between 0 and 90% of the cardiac cycle in 10% steps or phase shifts (PS). Pressure and velocity signals were registered, with the use of a combined Doppler and pressure wire positioned in the abdominal aorta, and used to calculate the WI. Depending on the PS, different wave interference phenomena occurred. Maximum unloading of the left ventricle (LV) coincided with constructive interference and maximum blood flow pulsatility, and maximum loading of the LV coincided with destructive interference and minimum blood flow pulsatility. We believe that noninvasive WIA could potentially be used clinically to assess the mechanical load of the LV and to monitor the peripheral hemodynamics such as blood flow pulsatility and risk of intestinal bleeding.