Given the current obesity epidemic in tandem with the aging US population, it is imperative to identify methods for reducing cardiovascular disease (CVD) risk that will be efficacious for both sexes. Arterial stiffness (AS) is an independent risk factor for a first cardiovascular event that increases with advancing age and obesity. Previous studies have found that modest weight loss (WL) of 5 to 10 percent successfully reduces AS and other risk factors for CVD. However, it remains unclear whether WL via caloric restriction reduces AS similarly among sexes. We tested the hypothesis that WL via caloric restriction would reduce AS more in men than women because men accumulate more abdominal visceral fat (VF) and lose more with WL compared with women of similar age and adiposity. To test our hypothesis AS was assessed from measurements of pulse wave velocity and ultrasonography of the carotid artery (Ã -SI). Total body and VF were measured using dual energy x-ray absorptiometry and computed tomography scans, respectively. Subjects underwent a 12-week WL intervention. No baseline differences in AS were observed between sexes. However, men were heavier and demonstrated higher levels of VF while women were fatter and had higher levels of abdominal subcutaneous fat. Contrary to our hypothesis both sexes experienced similar decreases in AS with WL despite greater reductions in VF in men. Our findings suggest that VF loss is not the primary mechanism mediating reductions in AS with WL. Future studies are needed to determine the mechanisms of arterial destiffening with WL. / Master of Science

The thesis is concerned with the analysis of measuring pulse wave velocity in human body with the aid of whole-body multichannel bioimpedance which was developed at ISI AS CR, v.v.i.. The evaluation of pulse wave velocity can provide us with important information about the state of vessel compliance which is one of the basic parameters informing on their physiological state. The examination of the state of vascular system is a very important part of early diagnostics because its pathological states are the main contributor to the rise of cardiovascular diseases and disease mortality. The thesis is concerned with the theoretical analysis together with the available methods of valuation of the state of vascular system that use measuring of pulse wave velocity. The main part of the thesis deals with the analysis of the whole-body multichannel bioimpedance measurement. The proposed and programmed protocol that summarizes and visualizes all obtained information is a part of this thesis. This is currently used as an output of the experimental measurement by this method. Data file for statistical processing contains the values of the pulse wave velocity of 35 healthy volunteers and subsequently the properties of pulse wave are assessed at various excitations.

This study aims to develop a new method to monitor peripheral arterial pulse using a PVDF piezoelectric sensor. After comparing different locations of sensor placement, a specific sensor wrap for the finger was developed. Its composition, size, and location make it inexpensive and very convenient to use. In order to monitor the effectiveness of the sensor at producing a reliable pulse waveform, a monitoring system, including the PZT sensor, ECG, pulse-oximeter, respiratory sensor, and accelerometer was setup. Signal analysis from the system helped discover that the PZT waveform is relative to the 1st derivative of the artery pressure wave. Also, the system helped discover that the first, second, and third peaks in PZT waveform represent the pulse peak, inflection point, and dicrotic notch respectively. The relationship between PZT wave and respiration was also analyzed, and, consequently, an algorithm to derive respiratory rate directly from the PZT waveform was developed. This algorithm gave a 96% estimating accuracy. Another feature of the sensor is that by analyzing the relationship between pulse peak amplitude and blood pressure change, temporal artery blood pressure can be predicted during Valsalva maneuver. PZT pulse wave monitoring offers a new type of pulse waveform which is not yet fully understood. Future studies will lead to a more broadly applied use of PZT sensors in cardiac monitoring applications.

Arterial pulse pressure is critically important to a number of diseases such as isolated systolic hypertension, coronary artery disease and heart failure. Determining the cause of increased pulse pressure has been hampered for two reasons. First, pulse pressure results from contraction of the heart and the load formed by the complex arterial tree. Pressure pulses travel from the heart to the peripheral arteries. As they reach a bifurcation or change in arterial wall properties, some of the pulses get reflected and propagate retrograde towards the heart. Second, two different modeling approaches (0-D and 1-D) describe the arterial system. The Windkessel model ascribed changes in pulse pressure to changes in total arterial compliance (Ctot) and total arterial resistance, whereas the transmission model ascribed them to changes in the magnitude, timing and sites of reflection. Our investigation has addressed both these limitations by finding that a complex arterial system degenerates into a simple 2-element Windkessel model when wavelength of the propagated pulse increases. This theoretical development has yielded three practical results. First, isolated systolic hypertension can be viewed as a manifestation of a system that has degenerated into a Windkessel, and thus increased pulse pressure is due to decreased Ctot. Second, the well-discussed Augmentation Index does not truly describe augmentation of pulse pressure by pulse reflection. Third, the simple 2-element Windkessel can be used to characterize the interaction among heart, arterial system and axial-flow left ventricular assist device analytically. The fact that arterial systems degenerate into Windkessels explains why it becomes much easier to estimate total arterial compliance in hypertension?total arterial compliance is the dominant determinant of pulsatile pressure.

Arterial pulse pressure is critically important to a number of diseases such as isolated systolic hypertension, coronary artery disease and heart failure. Determining the cause of increased pulse pressure has been hampered for two reasons. First, pulse pressure results from contraction of the heart and the load formed by the complex arterial tree. Pressure pulses travel from the heart to the peripheral arteries. As they reach a bifurcation or change in arterial wall properties, some of the pulses get reflected and propagate retrograde towards the heart. Second, two different modeling approaches (0-D and 1-D) describe the arterial system. The Windkessel model ascribed changes in pulse pressure to changes in total arterial compliance (Ctot) and total arterial resistance, whereas the transmission model ascribed them to changes in the magnitude, timing and sites of reflection. Our investigation has addressed both these limitations by finding that a complex arterial system degenerates into a simple 2-element Windkessel model when wavelength of the propagated pulse increases. This theoretical development has yielded three practical results. First, isolated systolic hypertension can be viewed as a manifestation of a system that has degenerated into a Windkessel, and thus increased pulse pressure is due to decreased Ctot. Second, the well-discussed Augmentation Index does not truly describe augmentation of pulse pressure by pulse reflection. Third, the simple 2-element Windkessel can be used to characterize the interaction among heart, arterial system and axial-flow left ventricular assist device analytically. The fact that arterial systems degenerate into Windkessels explains why it becomes much easier to estimate total arterial compliance in hypertension?total arterial compliance is the dominant determinant of pulsatile pressure.

Hypertension guidelines recommend out of office blood pressure (BP) measurement especially 24- hour ambulatory measurement (ABPM), to diagnose and manage hypertension but this is not routinely performed in kidney transplant units. This study was to determine if 24-hour ABPM, compared with office BP in kidney transplant recipients, would be more informative regarding BP management, and if pulse wave analysis (PWA) would assist in risk stratification. This study included patients older than 18 years, with working graft kidney for >12 months, and without problems affecting BP measurement and interpretation. After performing office BP measurements, a 24-hour ABPM with additional capability of calculating pulse wave velocity (PWV),augmentation index and central BP was undertaken. Patients were assessed for controlled hypertension, uncontrolled hypertension, masked hypertension, nocturnal hypertension, white coat hypertension, and dipping BP status. Data were analysed using standard statistical tests. Of 30 patients, 15 were Black Africans and 15 were of Mixed Ancestry with a mean age of 48.9 years. Seventeen patients were males and 36.7% had controlled hypertension, 30% uncontrolled hypertension, 6.7% white coat hypertension and 33.3% masked hypertension, of whom 70% had isolated nocturnal hypertension. 70% had a non-dipping, 26.7% a reverse dipping and only 3.3% had a normal dipping BP pattern. The mean difference between brachia! systolic BP and central systolic BP was 10.4 mm Hg, whereas PWV and augmentation index were similar to healthy populations. CONCLUSION: In kidney transplant recipients, 24-hour ABPM was superior to office BP in defining hypertensive status that qualified for modification of therapy but PWA did not contribute to risk assessment.

No description available.

No description available.

No description available.

The inclusion of a new device in clinical practice requires an adequate validation. The original publication which introduced multichannel bioimpedance monitor MBM was focused on discribing its technical parameters and demonstration measurements. Further evaluation desires comparision with other standard measuring device. This thesis describes pulse wave measurement by MBM and by other medical devices used for establishing cardiovascular risk. It proposes the validation experiment with synchronized vascular ultrasonography as a reference method. The process of the experimental measurement, aquired data and following data analysis are described in detail. The outputs of the experiment are statistically evaluated. The MBM’s performance and design of the experiment are discussed.