Key result
Changes in hydrostatic pressure due to arm position changes significantly affected peripheral arterial stiffness, establishing peripheral autoregulation limits between 56 and 112 mmHg based on pulse wave velocity.
Why the study?
Does changing hydrostatic pressure by altering arm position allow for the estimation of peripheral autoregulation limits based on pulse wave velocity in healthy volunteers?
Observational (n=18)
No
Does changing hydrostatic pressure by altering arm position allow for the estimation of peripheral autoregulation limits based on pulse wave velocity in healthy volunteers?
Changes in hydrostatic pressure due to arm position alterations can be used to estimate peripheral autoregulation limits based on pulse wave velocity.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for arm-position PWV assessment of peripheral autoregulation; prospective validation required before clinical use.
Background: Constant blood flow despite changes in blood pressure, a phenomenon called autoregulation, has been demonstrated for various organ systems. We hypothesized that by changing hydrostatic pressures in peripheral arteries, we can establish these limits of autoregulation in peripheral arteries based on local pulse wave velocity (PWV). Methods: Electrocardiogram and plethysmograph waveforms were recorded at the left and right index fingers in 18 healthy volunteers. Each subject changed their left arm position, keeping the right arm stationary. Pulse arrival times (PAT) at both fingers were measured and used to calculate PWV. We calculated ΔPAT (ΔPWV), the differences between the left and right PATs (PWVs), and compared them to the respective calculated blood pressure at the left index fingertip to derive the limits of autoregulation. Results: ΔPAT decreased and ΔPWV increased exponentially at low blood pressures in the fingertip up to a blood pressure of 70 mmHg, after which changes in ΔPAT and ΔPWV were minimal. The empirically chosen 20 mmHg window (75-95 mmHg) was confirmed to be within the autoregulatory limit (slope=0.097, p=0.56). ΔPAT and ΔPWV within a 20 mmHg moving window were not significantly different from the respective data points within the control 75-95 mmHg window when the pressure at the fingertip was between 56 mmHg and 110 mmHg for ΔPAT and between 57 mmHg and 112 mmHg for ΔPWV. Conclusions: Changes in hydrostatic pressure due to changes in arm position significantly affect peripheral arterial stiffness as assessed by ΔPAT and ΔPWV, allowing us to estimate peripheral autoregulation limits based on PWV.
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Tripathi et al. (2017) conducted an observational in Healthy (n=18). Hydrostatic pressure changes via arm position vs. Stationary arm at heart level was evaluated on Limits of autoregulation based on local pulse wave velocity (PWV) and pulse arrival time (PAT). Changes in hydrostatic pressure due to arm position changes significantly affected peripheral arterial stiffness, establishing peripheral autoregulation limits between 56 and 112 mmHg based on pulse wave velocity.
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