Applied arterial mechanics: from theory to clinical practice

Abstract

Cardiovascular disease remains to date the number one cause of death in the Western World. The early detection of subjects at increased cardiovascular risk and the first stages of cardiovascular disease thus remain a spearhead in clinical research. Increasingly this research integrates an engineering approach for the development of new diagnostic tools for use in clinical practice. This thesis therefore focuses on large artery mechanics. An abnormal thickening of the arterial wall of these vessels for instance, or an elevated stiffness of their walls could indicate the early onset of vascular disease and an increased total cardiovascular risk. This thesis contains a number of methodological studies investigating the most optimal way of measuring these and other vascular parameters and exploring how these parameters can best be leveraged to gain knowledge of the status of the cardiovascular system. The parameters and approaches presented are then used on clinical data obtained from a large population study, the Asklepios Study, in which clinical and stiffness parameters of over 2,500 subjects aged between 35 and 55 years old were included. From the results of these analyses we could for instance demonstrate that in the age range covered by the Asklepios Study the stiffness of large elastic arteries increases at a faster rate in women than in men. Next to a proper understanding of how to measure and interpret arterial stiffness parameters, efficient use of these parameters in clinical practice requires a set of reference values to which values measured in an individual can be compared. This thesis also presents the results of an European study in which a database was constructed containing the clinical and stiffness parameter data from over 25,000 subjects from 13 different centers. Based on these data reference values for the clinically most relevant stiffness parameter (carotid-femoral pulse wave velocity) are proposed