pulse wave velocity 측정의 역사 및 최신지견 · 2015-07-07 · the velocity of...
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Pulse Wave Velocity 측정의 역사
및 최신지견
Jin Oh Na, MD, PhD
Cardiovascular Center
Department of Internal Medicine
Korea University Guro Hospital
Korea University College of Medicine
2013 혈관연구회 춘천집담회
Pulse Wave Velocity (PWV)
• To evaluate arterial wall distensibility and
stiffness.
• Simple, accurate, noninvasive and reproducible
method
• Can be applied in large therapeutic and
epidemiological studies.
2013 혈관연구회 춘천집담회
Histological Overview of
Pulse Wave
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
• Egyptians Pulse wave is the ‘word’ of the
heart to the vessels
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
• Chinese analyze quality of pulse (진맥)
• 강하고 두드러지는 맥은 활력과 건강의 상징으로 여겨짐
개구리 점프 물고기 꼬리 떨어지는 물방울
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
Hippocrates (460 BC – 370 BC)
Aristotle (384 BC – 322 BC)
Arteries
communicate
with trachea.
Thus, contain
air
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
Galen (131 – 200 AD)
First to note a relationship between
heart and arteries
Arteries contain blood and not air
Arterial pulse was dependent on and
synchronous with the heart
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
• 1540년 Struthius, first attempted to study
pulse wave by placing a leaf on the artery
• 1553년 Miguel Serveto, described pulmonary
circulation
• 1628년 William Harvey, pulse wave as
manifestation of cardiac systole, which
correspond to the arterial diastole.
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
1731년
Reverend Stephen Hales,
recorded the first invasive
arterial pressure
measurement.
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
1863년
E.J. Marey, first to
accurately record the
human arterial pulse using
a sphygmography
2013 혈관연구회 춘천집담회
Beginning of the Arterial Hemodynamics
Dudgeon’s Sphygmograph
Frey’s Sphygmograph Pond’s Sphygmograph
2013 혈관연구회 춘천집담회
Histological Overview of Pulse Wave
• 1896년: Riva Rocci brachial cuff and
sphygmomanometer
• 1905년: description of Korotkoff sounds
Enable blood pressure measurement
Decrease use of the sphygmograph and pulse
wave analysis
• 1922년: Bramwell and Hill,
The velocity of transmission of the pulse is clinical
index of arterial elasticity.
2013 혈관연구회 춘천집담회
2013 혈관연구회 춘천집담회
Pulse Wave Velocity: Invasive method
Kim EJ, et al. J Hypertens. 2004; 22: S334
Applantation Tonometry
• 2 devices widely used in South Korea
SphygmoCor (AtCor Medical) GAON 21A (Hanbyul Meditech)
2013 혈관연구회 춘천집담회
Applantation tonometry
• Locate probe on radial artery
• Acquire radial artery waveform
• Using generalized transfer function
• Estimate central artery waveform
Aix
Aix@HR75
ED
SEVR
Central SBP
Central DBP
Central PP
waveform analysis Augmentation index
Ejection duration
Subendocardial viability ratio
2013 혈관연구회 춘천집담회
Augmentation index
Ejection duration
Subendocardial viability ratio
areaSystolic
areaDiastolic
Time
ED
PP
AP Arterial stiffness
Duration of systole
Coronary artery perfusion
Below 50%, subendocardial
ischemia occurs
Augmentation index at a heart rate 75 beats/min
2013 혈관연구회 춘천집담회
2013 혈관연구회 춘천집담회
Pulse Wave Velocity: Non-invasive method
Speed of the wave is related to the
stiffness of the artery it is traveling in
The stiffer the artery;
The higher the wave speed
Wave speed is proportional to the square root of
arterial stiffness
2013 혈관연구회 춘천집담회
Clinical impacts of
Pulse Wave Velocity
2013 혈관연구회 춘천집담회
Age and PWV (Aortic Stiffness)
Correlation between Age and PWV
AGE
9080706050403020
PW
V
50
40
30
20
10
0
Correlation between Age & PWV
Age
PW
V
Kim EJ, et al. J Hypertens. 2004; 22: S334
R=0.429 P<0.001
2013 혈관연구회 춘천집담회
Blood pressure and Aortic Stiffness (PWV)
Kim EJ, et al. J Human Hypertens 2007; 21: 141-8
R=0.330 P<0.001
R=0.363 P<0.001
2013 혈관연구회 춘천집담회
Insulin Sensitivity and Aortic Stiffness (PWV)
Sengstock, D. M. et al. J Clin Endocrinol Metab 2005;90:2823-7
2013 혈관연구회 춘천집담회
Metabolic Components and Aortic PWV in HTN patients
Schillaci, G. et al. Hypertension 2005;45:1078-82
2013 혈관연구회 춘천집담회
LVH and Aortic Stiffness (PWV)
Park CG, et al. J Hypertens 2002;20:S484
PW
V
2013 혈관연구회 춘천집담회
PWV and Vascular Endothelial Function
Hashimoto M, et al. Hypertens Res. 2000;23:233-8
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PWV and Microalbuminuria
Mule G, et al. J Intern Med. 2004;256:22-9
2013 혈관연구회 춘천집담회
PWV and NonDM-ESRD
Shoji T, et al. J Am Soc Nephrol 1998;9: 1277-84
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baPWV and Total CV events
Vlachopoulos C, et al. Hypertension. 2012;60:556-62.
2013 혈관연구회 춘천집담회
baPWV and Total CV Mortality
Vlachopoulos C, et al. Hypertension. 2012;60:556-62.
2013 혈관연구회 춘천집담회
baPWV and Total All-cause Mortality
Vlachopoulos C, et al. Hypertension. 2012;60:556-62.
2013 혈관연구회 춘천집담회