Systolic time intervals assessed from analysis of the carotid pressure waveform

Paolo Salvi, Andrea Grillo, Isabella Tan, Giulia Simon, Lucia Salvi, Lan Gao, Matteo Rovina, Mark Butlin, Ying Yang, Erika Meneghin, Lei Meng, Andrea Faini, Edward Barin, Alessandro Pini, Renzo Carretta, Yong Huo, Alberto Avolio, Gianfranco Parati

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: The timing of mechanical cardiac events is usually evaluated by conventional echocardiography as an index of cardiac systolic function and predictor of cardiovascular outcomes. We aimed to measure the systolic time intervals, namely the isovolumetric contraction time (ICT) and pre-ejection period (PEP), by arterial tonometry. Approach: Sixty-two healthy volunteers (age 47 ± 17 years) and 42 patients with heart failure and reduced ejection fraction were enrolled (age 66 ± 14 years). Pulse waves were recorded at the carotid artery by arterial tonometry together with simultaneous aortic transvalvular flow by Doppler-echocardiography, synchronized by electrocardiographic gating. The ICT was determined from the time delay between the electrical R wave and the carotid pressure waveform, after adjustment for the pulse transit time from the aortic valve to the carotid artery site, estimated by an algorithm based on the carotid-femoral pulse wave velocity. The PEP was evaluated by adding the electrical QR duration to the ICT. Main results: The ICT derived from carotid pulse wave analysis was closely related to that measured by echocardiography (r = 0.90, p <0.0001), with homogeneous distribution in Bland-Altman analysis (mean difference and 95% confidence interval = 0.2 from -14.2 to 14.5 ms). ICT and PEP were higher in cardiac patients than in healthy volunteers (p <0.0001). The ratio between PEP and left ventricular ejection time was related to the ejection fraction measured with echocardiography (r = 0.555, p <0.0001). Significance: The timing of electro-mechanical cardiac events can be reliably obtained from the carotid pulse waveform and carotid-femoral PWV, evaluated using arterial tonometry. Systolic time intervals assessed with this approach showed good agreement with measurements performed with conventional echocardiography and may represent a promising additional application of arterial tonometry.

LanguageEnglish
Article number084002
Pages1-12
Number of pages12
JournalPhysiological Measurement
Volume39
Issue number8
DOIs
Publication statusPublished - 20 Aug 2018

Keywords

  • arterial tonometry
  • ejection fraction
  • isometric contraction time
  • pre-ejection period
  • pulse wave velocity
  • systolic time intervals

Cite this

Salvi, P., Grillo, A., Tan, I., Simon, G., Salvi, L., Gao, L., ... Parati, G. (2018). Systolic time intervals assessed from analysis of the carotid pressure waveform. Physiological Measurement, 39(8), 1-12. [084002]. https://doi.org/10.1088/1361-6579/aad51b
Salvi, Paolo ; Grillo, Andrea ; Tan, Isabella ; Simon, Giulia ; Salvi, Lucia ; Gao, Lan ; Rovina, Matteo ; Butlin, Mark ; Yang, Ying ; Meneghin, Erika ; Meng, Lei ; Faini, Andrea ; Barin, Edward ; Pini, Alessandro ; Carretta, Renzo ; Huo, Yong ; Avolio, Alberto ; Parati, Gianfranco. / Systolic time intervals assessed from analysis of the carotid pressure waveform. In: Physiological Measurement. 2018 ; Vol. 39, No. 8. pp. 1-12.
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abstract = "Objective: The timing of mechanical cardiac events is usually evaluated by conventional echocardiography as an index of cardiac systolic function and predictor of cardiovascular outcomes. We aimed to measure the systolic time intervals, namely the isovolumetric contraction time (ICT) and pre-ejection period (PEP), by arterial tonometry. Approach: Sixty-two healthy volunteers (age 47 ± 17 years) and 42 patients with heart failure and reduced ejection fraction were enrolled (age 66 ± 14 years). Pulse waves were recorded at the carotid artery by arterial tonometry together with simultaneous aortic transvalvular flow by Doppler-echocardiography, synchronized by electrocardiographic gating. The ICT was determined from the time delay between the electrical R wave and the carotid pressure waveform, after adjustment for the pulse transit time from the aortic valve to the carotid artery site, estimated by an algorithm based on the carotid-femoral pulse wave velocity. The PEP was evaluated by adding the electrical QR duration to the ICT. Main results: The ICT derived from carotid pulse wave analysis was closely related to that measured by echocardiography (r = 0.90, p <0.0001), with homogeneous distribution in Bland-Altman analysis (mean difference and 95{\%} confidence interval = 0.2 from -14.2 to 14.5 ms). ICT and PEP were higher in cardiac patients than in healthy volunteers (p <0.0001). The ratio between PEP and left ventricular ejection time was related to the ejection fraction measured with echocardiography (r = 0.555, p <0.0001). Significance: The timing of electro-mechanical cardiac events can be reliably obtained from the carotid pulse waveform and carotid-femoral PWV, evaluated using arterial tonometry. Systolic time intervals assessed with this approach showed good agreement with measurements performed with conventional echocardiography and may represent a promising additional application of arterial tonometry.",
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author = "Paolo Salvi and Andrea Grillo and Isabella Tan and Giulia Simon and Lucia Salvi and Lan Gao and Matteo Rovina and Mark Butlin and Ying Yang and Erika Meneghin and Lei Meng and Andrea Faini and Edward Barin and Alessandro Pini and Renzo Carretta and Yong Huo and Alberto Avolio and Gianfranco Parati",
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Salvi, P, Grillo, A, Tan, I, Simon, G, Salvi, L, Gao, L, Rovina, M, Butlin, M, Yang, Y, Meneghin, E, Meng, L, Faini, A, Barin, E, Pini, A, Carretta, R, Huo, Y, Avolio, A & Parati, G 2018, 'Systolic time intervals assessed from analysis of the carotid pressure waveform', Physiological Measurement, vol. 39, no. 8, 084002, pp. 1-12. https://doi.org/10.1088/1361-6579/aad51b

Systolic time intervals assessed from analysis of the carotid pressure waveform. / Salvi, Paolo; Grillo, Andrea; Tan, Isabella; Simon, Giulia; Salvi, Lucia; Gao, Lan; Rovina, Matteo; Butlin, Mark; Yang, Ying; Meneghin, Erika; Meng, Lei; Faini, Andrea; Barin, Edward; Pini, Alessandro; Carretta, Renzo; Huo, Yong; Avolio, Alberto; Parati, Gianfranco.

In: Physiological Measurement, Vol. 39, No. 8, 084002, 20.08.2018, p. 1-12.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Systolic time intervals assessed from analysis of the carotid pressure waveform

AU - Salvi, Paolo

AU - Grillo, Andrea

AU - Tan, Isabella

AU - Simon, Giulia

AU - Salvi, Lucia

AU - Gao, Lan

AU - Rovina, Matteo

AU - Butlin, Mark

AU - Yang, Ying

AU - Meneghin, Erika

AU - Meng, Lei

AU - Faini, Andrea

AU - Barin, Edward

AU - Pini, Alessandro

AU - Carretta, Renzo

AU - Huo, Yong

AU - Avolio, Alberto

AU - Parati, Gianfranco

PY - 2018/8/20

Y1 - 2018/8/20

N2 - Objective: The timing of mechanical cardiac events is usually evaluated by conventional echocardiography as an index of cardiac systolic function and predictor of cardiovascular outcomes. We aimed to measure the systolic time intervals, namely the isovolumetric contraction time (ICT) and pre-ejection period (PEP), by arterial tonometry. Approach: Sixty-two healthy volunteers (age 47 ± 17 years) and 42 patients with heart failure and reduced ejection fraction were enrolled (age 66 ± 14 years). Pulse waves were recorded at the carotid artery by arterial tonometry together with simultaneous aortic transvalvular flow by Doppler-echocardiography, synchronized by electrocardiographic gating. The ICT was determined from the time delay between the electrical R wave and the carotid pressure waveform, after adjustment for the pulse transit time from the aortic valve to the carotid artery site, estimated by an algorithm based on the carotid-femoral pulse wave velocity. The PEP was evaluated by adding the electrical QR duration to the ICT. Main results: The ICT derived from carotid pulse wave analysis was closely related to that measured by echocardiography (r = 0.90, p <0.0001), with homogeneous distribution in Bland-Altman analysis (mean difference and 95% confidence interval = 0.2 from -14.2 to 14.5 ms). ICT and PEP were higher in cardiac patients than in healthy volunteers (p <0.0001). The ratio between PEP and left ventricular ejection time was related to the ejection fraction measured with echocardiography (r = 0.555, p <0.0001). Significance: The timing of electro-mechanical cardiac events can be reliably obtained from the carotid pulse waveform and carotid-femoral PWV, evaluated using arterial tonometry. Systolic time intervals assessed with this approach showed good agreement with measurements performed with conventional echocardiography and may represent a promising additional application of arterial tonometry.

AB - Objective: The timing of mechanical cardiac events is usually evaluated by conventional echocardiography as an index of cardiac systolic function and predictor of cardiovascular outcomes. We aimed to measure the systolic time intervals, namely the isovolumetric contraction time (ICT) and pre-ejection period (PEP), by arterial tonometry. Approach: Sixty-two healthy volunteers (age 47 ± 17 years) and 42 patients with heart failure and reduced ejection fraction were enrolled (age 66 ± 14 years). Pulse waves were recorded at the carotid artery by arterial tonometry together with simultaneous aortic transvalvular flow by Doppler-echocardiography, synchronized by electrocardiographic gating. The ICT was determined from the time delay between the electrical R wave and the carotid pressure waveform, after adjustment for the pulse transit time from the aortic valve to the carotid artery site, estimated by an algorithm based on the carotid-femoral pulse wave velocity. The PEP was evaluated by adding the electrical QR duration to the ICT. Main results: The ICT derived from carotid pulse wave analysis was closely related to that measured by echocardiography (r = 0.90, p <0.0001), with homogeneous distribution in Bland-Altman analysis (mean difference and 95% confidence interval = 0.2 from -14.2 to 14.5 ms). ICT and PEP were higher in cardiac patients than in healthy volunteers (p <0.0001). The ratio between PEP and left ventricular ejection time was related to the ejection fraction measured with echocardiography (r = 0.555, p <0.0001). Significance: The timing of electro-mechanical cardiac events can be reliably obtained from the carotid pulse waveform and carotid-femoral PWV, evaluated using arterial tonometry. Systolic time intervals assessed with this approach showed good agreement with measurements performed with conventional echocardiography and may represent a promising additional application of arterial tonometry.

KW - arterial tonometry

KW - ejection fraction

KW - isometric contraction time

KW - pre-ejection period

KW - pulse wave velocity

KW - systolic time intervals

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U2 - 10.1088/1361-6579/aad51b

DO - 10.1088/1361-6579/aad51b

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SP - 1

EP - 12

JO - Physiological Measurement

T2 - Physiological Measurement

JF - Physiological Measurement

SN - 0967-3334

IS - 8

M1 - 084002

ER -