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Contribution of the Arterial System and the Heart to Blood Pressure during Normal Aging: A Simulation Study
KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Inst, Sweden.ORCID iD: 0000-0002-9654-447X
KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging. Karolinska Inst, Sweden.ORCID iD: 0000-0002-8987-9909
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, e0157493Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

During aging, systolic blood pressure continuously increases over time, whereas diastolic pressure first increases and then slightly decreases after middle age. These pressure changes are usually explained by changes of the arterial system alone (increase in arterial stiffness and vascular resistance). However, we hypothesise that the heart contributes to the age-related blood pressure progression as well. In the present study we quantified the blood pressure changes in normal aging by using a Windkessel model for the arterial system and the time-varying elastance model for the heart, and compared the simulation results with data from the Framingham Heart Study. Parameters representing arterial changes (resistance and stiffness) during aging were based on literature values, whereas parameters representing cardiac changes were computed through physiological rules (compensated hypertrophy and preservation of end-diastolic volume). When taking into account arterial changes only, the systolic and diastolic pressure did not agree well with the population data. Between 20 and 80 years, systolic pressure increased from 100 to 122 mmHg, and diastolic pressure decreased from 76 to 55 mmHg. When taking cardiac adaptations into account as well, systolic and diastolic pressure increased from 100 to 151 mmHg and decreased from 76 to 69 mmHg, respectively. Our results show that not only the arterial system, but also the heart, contributes to the changes in blood pressure during aging. The changes in arterial properties initiate a systolic pressure increase, which in turn initiates a cardiac remodelling process that further augments systolic pressure and mitigates the decrease in diastolic pressure.

Place, publisher, year, edition, pages
2016. Vol. 11, no 6, e0157493
National Category
Medical Image Processing
Identifiers
URN: urn:nbn:se:kth:diva-189802DOI: 10.1371/journal.pone.0157493ISI: 000378393600007PubMedID: 27341106Scopus ID: 2-s2.0-84976491042OAI: oai:DiVA.org:kth-189802DiVA: diva2:949523
Funder
Swedish Research Council, 2012-2800
Note

QC 20160720

Available from: 2016-07-20 Created: 2016-07-15 Last updated: 2016-11-15Bibliographically approved
In thesis
1. Imaging and modeling the cardiovascular system
Open this publication in new window or tab >>Imaging and modeling the cardiovascular system
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Understanding cardiac pumping function is crucial to guiding diagnosis, predicting outcomes of interventions, and designing medical devices that interact with the cardiovascular system.  Computer simulations of hemodynamics can show how the complex cardiovascular system is influenced by changes in single or multiple parameters and can be used to test clinical hypotheses. In addition, methods for the quantification of important markers such as elevated arterial stiffness would help reduce the morbidity and mortality related to cardiovascular disease.

The general aim of this thesis work was to improve understanding of cardiovascular physiology and develop new methods for assisting clinicians during diagnosis and follow-up of treatment in cardiovascular disease. Both computer simulations and medical imaging were used to reach this goal.

In the first study, a cardiac model based on piston-like motions of the atrioventricular plane was developed. In the second study, the presence of the anatomical basis needed to generate hydraulic forces during diastole was assessed in heathy volunteers. In the third study, a previously validated lumped-parameter model was used to quantify the contribution of arterial and cardiac changes to blood pressure during aging. In the fourth study, in-house software that measures arterial stiffness by ultrasound shear wave elastography (SWE) was developed and validated against mechanical testing.

The studies showed that longitudinal movements of the atrioventricular plane can well explain cardiac pumping and that the macroscopic geometry of the heart enables the generation of hydraulic forces that aid ventricular filling. Additionally, simulations showed that structural changes in both the heart and the arterial system contribute to the progression of blood pressure with age. Finally, the SWE technique was validated to accurately measure stiffness in arterial phantoms.

Place, publisher, year, edition, pages
KTH Royal Institute of Technology, 2016. 96 p.
Series
TRITA-STH, 2016:9
Keyword
Cardiac pumping, diastolic function, hemodynamics, modeling, simulation, arterial stiffness, ultrasound, shear wave elastography.
National Category
Other Medical Engineering
Research subject
Medical Technology
Identifiers
urn:nbn:se:kth:diva-196538 (URN)978-91-7729-192-3 (ISBN)
Public defence
2016-12-09, T2, Hälsovägen 11C, Huddinge, 10:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2012-2800, 2012-2795VINNOVA, 2011-01365
Note

QC 20161115

Available from: 2016-11-15 Created: 2016-11-15 Last updated: 2016-11-15Bibliographically approved

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