Noninvasive central hemodynamic monitoring in the primary care setting: improving prevention and management of cardiovascular diseases
Background: Although cardiovascular disease (CVD) has markedly declined since the early 1960s due to medical advances and better management, this condition persists as the most critical and preventable cause of death in the US. For that reason, the identification and application of more sensitive, specific, validated, and noninvasive biomarkers of cardiovascular functioning in the primary care setting for the early identification of CVD risk at the subclinical level are warranted.
Aim: The goal of the present review is twofold: first, to familiarize the primary care practitioner with noninvasive aortic hemodynamic parameters, including how these could be integrated into primary care services and patient management, and second, to propose a model for earlier detection of CVD based on the noninvasive hemodynamic parameters in the primary care setting.
Relevance for patients: Implementation of noninvasive hemodynamic monitoring in a primary care setting could help in the identification of heart disease risk at the early onset thus preventing the need for expensive treatment or death at later stages.
[1] Nasir K, Michos ED, Blumenthal RS, Raggi P. Detection of High-risk Young Adults and Women by Coronary Calcium and National Cholesterol Education Program Panel III Guidelines. J Am Coll Cardiol 2005;46:1931-6.
[2] Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, et al. From Vulnerable Plaque to Vulnerable Patient--Part III: Executive Summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. Am J Cardiol 2006;98:2h-15.
[3] McGill HC Jr., McMahan CA, Gidding SS. Preventing Heart Disease in the 21st Century: Implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study. Circulation 2008;117:1216-27.
[4] Liu H, Wang H. Early Detection System of Vascular Disease and Its Application Prospect. Biomed Res Int 2016;2016:1723485.
[5] Chi C, Yu X, Auckle R, Lu Y, Fan X, Yu S, et al. Hypertensive Target Organ Damage is Better Associated with Central than Brachial Blood Pressure: The Northern Shanghai Study. J Clin Hypertens (Greenwich) 2017;19:1269-75.
[6] Dalen JE, Alpert JS, Goldberg RJ, Weinstein RS. The Epidemic of the 20th Century: Coronary Heart Disease. Am J Med 2014;127:807-12.
[7] Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, et al. Assessment of Arterial Distensibility by Automatic Pulse Wave Velocity Measurement. Validation and Clinical Application Studies. Hypertension 1995;26:485-90.
[8] Harada S, Takeda K. Pulse Wave Velocity (PWV). Nippon Rinsho 2004;62:1136-42.
[9] Nichols WW. Clinical Measurement of Arterial Stiffness Obtained from Noninvasive Pressure Waveforms. Am J Hypertens 2005;18:3S-10.
[10] Nichols WW, Singh BM. Augmentation Index as a Measure of Peripheral Vascular Disease State. Curr Opin Cardiol 2002;17:543-51.
[11] Huang Y, Tang S, Chen JY, Huang C, Li J, Cai AP, et al. Central Aortic Systolic Blood Pressure Can Predict Prolonged QTc Duration better than Brachial Artery Systolic Blood Pressure in Rural Community Residents. Clin Exp Hypertens 2018;40:238-43.
[12] Sugawara J, Tanaka H. Arterial Path Length Measurements Required for the Pulse Wave Velocity. J Hypertens 2009;27:1102; author reply 1102-04.
[13] Lazar JM, Morris M, Qureshi G, Jean-Noel G, Nichols W, Qureshi MR, et al. The Effects of Head-Out-of-Water Immersion on Arterial Wave Reection in Healthy Adults. J Am Soc Hypertens 2008;2:455-61.
[14] Bunckberg GD, Fixler DE, Archie JP, Hoffman J. Experimental Subendocardial Ischemia in Dogs with Normal Coronary Arteries. Circ Res 1972;30:67-81.
[15] Gobel FL, Norstrom LA, Nelson RR, Jorgensen CR, Wang Y. The Rate-pressure Product as an Index of Myocardial Oxygen Consumption during Exercise in Patients with Angina Pectoris. Circulation 1978;57:549-56.
[16] Sanchez-Gonzalez MA, May RW, Brown PC, Koutnik AP, Fincham FD. Depressive Symptoms Contribute to Increased Wave Reection during Cold Pressor Test in Young Adult Men. Am J Hypertens 2013;26:778-83.
[17] Sanchez-Gonzalez MA, May RW, Koutnik AP, Fincham FD. Impact of Negative Affectivity and Trait Forgiveness on Aortic Blood Pressure and Coronary Circulation. Psychophysiology 2015;52:296-303.
[18] Sanchez-Gonzalez MA, Wong A, Vicil F, Gil R, Park SY, Figueroa A. Impact of Passive Vibration on Pressure Pulse Wave Characteristics. J Hum Hypertens 2012;26:610-5.
[19] Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, et al. Central Pressure more Strongly Relates to Vascular Disease and Outcome than does Brachial Pressure: The Strong Heart Study. Hypertension 2007;50:197-203.
[20] Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W, et al. High Central Pulse Pressure is Independently Associated with Adverse Cardiovascular Outcome the Strong Heart Study. J Am Coll Cardiol 2009;54:1730-4.
[21] Hashimoto J, Imai Y, O’Rourke MF. Indices of Pulse Wave Analysis are Better Predictors of Left Ventricular Mass Reduction than Cuff Pressure. Am J Hypertens 2007;20:378-84.
[22] Whelton PK, Carey RM. The 2017 Clinical Practice Guideline for High Blood Pressure. JAMA 2017;318:2073-4.
[23] Böcskei RM, Benczúr B, Müller V, Bikov A, Székely A, Kahan T, et al. Oscillometrically Measured Aortic Pulse Wave Velocity Reveals Asymptomatic Carotid Atherosclerosis in a Middle-Aged, Apparently Healthy Population. Biomed Res Int 2020;2020:8571062.
[24] Hidvégi EV, Jakab AE, Lenkey Z, Bereczki C, Cziráki A, Illyés M. Updated and Revised Normal Values of Aortic Pulse Wave Velocity in Children and Adolescents Aged 3-18 Years. J Hum Hypertens 2021;35:604-12.
[25] Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke: the Rotterdam Study. Circulation 2006;113:657-63.
[26] Redheuil A, Yu WC, Wu CO, Mousseaux E, de Cesare A, Yan R, et al. Reduced Ascending Aortic Strain and Distensibility: Earliest Manifestations of Vascular Aging in Humans. Hypertension 2010;55:319-26.
[27] Hashimoto J, Imai Y, O’Rourke MF. Monitoring of Antihypertensive Therapy for Reduction in Left Ventricular Mass. Am J Hypertens 2007;20:1229-33.
[28] O’Rourke MF, Hashimoto J. Arterial Stiffness: A Modifiable Cardiovascular Risk Factor? J Cardiopulm Rehabil Prev 2008;28:225-37.
[29] Sharma RK, Verma M, Tiwari RM, Joshi A, Trivedi CA, Chodankar DR. Prevalence and Real-World Assessment of Central Aortic Blood Pressure in Adult Patients with Essential Hypertension Uncontrolled on Single Anti-hypertensive Agents. Indian Heart J 2018;70(Suppl 3):S213-20.
[30] Ardern CI, Katzmarzyk PT, Janssen I, Church TS, Blair SN. Revised Adult Treatment Panel III Guidelines and Cardiovascular Disease Mortality in Men Attending a Preventive Medical Clinic. Circulation 2005;112:1478-85.
[31] Cheng AY, Leiter LA. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Curr Opin Cardiol 2006;21:400-4.
[32] Fox CS, Golden SH, Anderson C, Bray GA, Burke LE, de Boer IH, et al. Update on Prevention of Cardiovascular Disease in Adults with Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement from the American Heart Association and the American Diabetes Association. Diabetes Care 2015;38:1777-803.
[33] Toth PP. Subclinical Atherosclerosis: What It Is, What It Means and What We Can Do About It. Int J Clin Pract 2008;62:1246-54.
[34] Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr., Hayman LL, et al. Value of Primordial and Primary Prevention for Cardiovascular Disease: A Policy Statement from the American Heart Association. Circulation 2011;124:967-90.
[35] Hametner B, Wassertheurer S, Mayer CC, Danninger K, Binder RK, Weber T. Aortic Pulse Wave Velocity Predicts Cardiovascular Events and Mortality in Patients Undergoing Coronary Angiography: A Comparison of Invasive Measurements and Noninvasive Estimates. Hypertension 2021;77:571-81.
[36] Sequí-Domínguez I, Cavero-Redondo I, Álvarez-Bueno C, Pozuelo-Carrascosa DP, de Arenas-Arroyo SN, MartínezVizcaíno V. Accuracy of Pulse Wave Velocity Predicting Cardiovascular and All-Cause Mortality. A Systematic Review and Meta-Analysis. J Clin Med 2020;9:2080.
[37] Sari CI, Eikelis N, Head GA, Schlaich M, Meikle P, LambertG, et al. Android Fat Deposition and Its Association With Cardiovascular Risk Factors in Overweight Young Males. Front Physiol 2019;10:1162.
[38] Hotamisligil GS. Inammation and Metabolic Disorders. Nature 2006;444:860-7.
[39] Corrigan FE 3rd, Kelli HM, Dhindsa DS, Heinl RE, Al Mheid I, Hammadah M, et al. Changes in Truncal Obesity and Fat Distribution Predict Arterial Health. J Clin Lipidol 2017;11:1354-60.e1353.
[40] Lillie EO, Patay B, Diamant J, Issell B, Topol EJ, Schork NJ. The n-of-1 Clinical Trial: The Ultimate Strategy for Individualizing Medicine? Per Med 2011;8:161-73.