Lower limb hyperthermia augments functional hyperaemia during small muscle mass exercise similarly in trained elderly and young humans

Heat and exercise therapies are recommended to improve vascular health across the lifespan. However, the haemodynamic effects of hyperthermia, exercise and their combination are inconsistent in young and elderly people. Here we investigated the acute effects of local-limb hyperthermia and exercise on limb haemodynamics in nine healthy, trained elderly (69 ± 5 years) and 10 young (26 ± 7 years) adults, hypothesising that the combination of local hyperthermia and exercise interact to increase leg perfusion, albeit to a lesser extent in the elderly. Participants underwent 90 min of single whole-leg heating, with the contralateral leg remaining as control, followed by 10 min of low-intensity incremental single-leg knee-extensor exercise with both the heated and control legs. Temperature profiles and leg haemodynamics at the femoral and popliteal arteries were measured. In both groups, heating increased whole-leg skin temperature and blood flow by 9.5 ± 1.2°C and 0.7 ± 0.2 L min−1 (>3-fold), respectively (P < 0.0001). Blood flow in the heated leg remained 0.7 ± 0.6 and 1.0 ± 0.8 L min−1 higher during exercise at 6 and 12 W, respectively (P < 0.0001). However, there were no differences in limb haemodynamics between cohorts, other than the elderly group exhibiting a 16 ± 6% larger arterial diameter and a 51 ± 6% lower blood velocity following heating (P < 0.0001). In conclusion, local hyperthermia-induced limb hyperperfusion and/or small muscle mass exercise hyperaemia are preserved in trained older people despite evident age-related structural and functional alterations in their leg conduit arteries

How much of the intraaortic balloon volume is displaced toward the coronary circulation?

This is a post-print version of the published article. Copyright @ 2010 The American Association for Thoracic Surgery.This article has been made available through the Brunel Open Access Publishing Fund.Objective: During intraaortic balloon inflation, blood volume is displaced toward the heart (Vtip), traveling retrograde in the descending aorta, passing by the arch vessels, reaching the aortic root (Vroot), and eventually perfusing the coronary circulation (Vcor). Vcor leads to coronary flow augmentation, one of the main benefits of the intraaortic balloon pump. The aim of this study was to assess Vroot and Vcor in vivo and in vitro, respectively. Methods: During intraaortic balloon inflation, Vroot was obtained by integrating over time the aortic root flow signals measured in 10 patients with intraaortic balloon assistance frequencies of 1:1 and 1:2. In a mock circulation system, flow measurements were recorded simultaneously upstream of the intraaortic balloon tip and at each of the arch and coronary branches of a silicone aorta during 1:1 and 1:2 intraaortic balloon support. Integration over time of the flow signals during inflation yielded Vcor and the distribution of Vtip. Results: In patients, Vroot was 6.4% ± 4.8% of the intraaortic balloon volume during 1:1 assistance and 10.0% ± 5.0% during 1:2 assistance. In vitro and with an artificial heart simulating the native heart, Vcor was smaller, 3.7% and 3.8%, respectively. The distribution of Vtip in vitro varied, with less volume displaced toward the arch and coronary branches and more volume stored in the compliant aortic wall when the artificial heart was not operating. Conclusion: The blood volume displaced toward the coronary circulation as the result of intraaortic balloon inflation is a small percentage of the nominal intraaortic balloon volume. Although small, this percentage is still a significant fraction of baseline coronary flow.This article is available through the Open Access Publishing Fund

Arterial pulse wave modelling and analysis for vascular age studies: a review from VascAgeNet

Arterial pulse waves (PWs) such as blood pressure and photoplethysmogram (PPG) signals contain a wealth of information on the cardiovascular (CV) system that can be exploited to assess vascular age and identify individuals at elevated CV risk. We review the possibilities, limitations, complementarity, and differences of reduced-order, biophysical models of arterial PW propagation, as well as theoretical and empirical methods for analyzing PW signals and extracting clinically relevant information for vascular age assessment. We provide detailed mathematical derivations of these models and theoretical methods, showing how they are related to each other. Finally, we outline directions for future research to realize the potential of modeling and analysis of PW signals for accurate assessment of vascular age in both the clinic and in daily life

Wave intensity analysis in the ventricles, carotid and coronary arteries – What has been learnt during the last 25 years?: Part 2

Wave intensity analysis (WIA) was introduced 25 years ago for the study of arterial wave travel and has since been established as a powerful tool for the investigation of cardio-vascular interaction. Despite the complex mathematical derivation of the method, the implementation is simple. As a time-domain technique, WIA enables the direct association between waves and events during the cardiac cycle. Furthermore, it enables the separation of the pressure (or diameter), velocity and wave intensity waveforms into their forward and backward components, and provides a means for the determination of the timing and magnitude of waves of different origins. Hemodynamic questions at several locations along the vascular tree have been investigated with WIA. Part 2 of this review will focus on the physiological and clinical findings to which WIA has contributed, through clinical and in vivo studies in the ventricles and in the coronary and carotid arteries

Wave intensity analysis in the great arteries — What has been learnt during the last 25 years? Part 1

Wave intensity analysis (WIA) was introduced 25 years ago for the study of arterial wave propagation. The mathematical derivation of the method is complex, but the results are simple to use and WIA has since been established as a valuable technique for investigating the cardio-arterial interaction. WIA has several advantages; the most important of them is that it is a time-domain technique, which enables the direct association between waves and events during the cardiac cycle. Further, WIA allows for the separation of the measured pressure and velocity waveforms, and derived wave intensity, into their forward and backward directions, and also provides a means for the determination of the arrival time of reflected waves to the measurement site. This powerful technique has been used in several locations in the vascular system for investigating a wide range of physiological and clinical questions, but this review will focus on the clinical application of WIA, as demonstrated from in vivo and clinical studies in the aorta, pulmonary arteries and pulmonary veins

The contribution of upper and lower body arterial vessels to the aortic root reflections: A one-dimensional computational study

Background and Objectives Reflections measured at the aortic root are of physiological and clinical interest and thought to be composed of the superimposed reflections arriving from the upper and lower parts of the circulatory system. However, the specific contribution of each region to the overall reflection measurement has not been thoroughly examined. This study aims to elucidate the relative contribution of reflected waves arising from the upper and lower human body vasculature to those observed at the aortic root. Methods We utilised a one-dimensional (1D) computational model of wave propagation to study reflections in an arterial model that included 37 largest arteries. A narrow Gaussian-shaped pulse was introduced to the arterial model from five distal locations: carotid, brachial, radial, renal, and anterior tibial. The propagation of each pulse towards the ascending aorta was computationally tracked. We calculated the reflected pressure and wave intensity at the ascending aorta in each case. The results are presented as a ratio of the initial pulse. Results The findings of this study indicates that pressure pulses originated at the lower body can hardly be observed, while those originated from the upper body account for the largest portion of reflected waves seen at the ascending aorta. Conclusions Our study validates the findings of earlier studies, which demonstrated that human arterial bifurcations have a significantly lower reflection coefficient in the forward direction as compared to the backward direction. The results of this study underscore the need for further in-vivo investigations to provide a deeper understanding of the nature and characteristics of reflections observed in the ascending aorta, which can inform the development of effective strategies for the management of arterial diseases

The speed, reflection and intensity of waves propagating in flexible tubes with aneurysm and stenosis: Experimental investigation

A localized stenosis or aneurysm is a discontinuity that presents the pulse wave produced by the contracting heart with a reflection site. However, neither wave speed (c) in these discontinuities nor the size of reflection in relation to the size of the discontinuity has been adequately studied before. Therefore, the aim of this work is to study the propagation of waves traversing flexible tubes in the presence of aneurysm and stenosis in vitro. We manufactured different sized four stenosis and four aneurysm silicone sections, connected one at a time to a flexible ‘mother’ tube, at the inlet of which a single semi-sinusoidal wave was generated. Pressure and velocity were measured simultaneously 25 cm downstream the inlet of the respective mother tube. The wave speed was measured using the PU-loop method in the mother tube and within each discontinuity using the foot-to-foot technique. The stenosis and aneurysm dimensions and c were used to determine the reflection coefficient (R) at each discontinuity. Wave intensity analysis was used to determine the size of the reflected wave. The reflection coefficient increased with the increase and decrease in the size of the aneurysm and stenosis, respectively. c increased and decreased within stenosis and aneurysms, respectively, compared to that of the mother tube. Stenosis and aneurysm induced backward compression and expansion waves, respectively; the size of which was related to the size of the reflection coefficient at each discontinuity, increases with smaller stenosis and larger aneurysms. Wave speed is inversely proportional to the size of the discontinuity, exponentially increases with smaller stenosis and aneurysms and always higher in the stenosis. The size of the compression and expansion reflected wave depends on the size of R, increases with larger aneurysms and smaller stenosis