Arterial functions: how to interpret the complex physiology

Arterial pressure is a cyclic phenomenon characterized by a pressure wave oscillating around the mean blood pressure, from diastolic to systolic blood pressure, defining the pulse pressure. Aortic input impedance is a measure of the opposition of the circulation to an oscillatory flow input (stroke volume generated by heart work). Aortic input impedance integrates factors opposing LV ejection, such as peripheral resistance, viscoelastic properties and dimensions of the large central arteries, and the intensity and timing of the pressure wave reflections, associated with the opposition to LV ejection influenced by inertial forces. The two most frequently used methods of arterial stiffness are measurement of PWV and central (aortic or common carotid artery) pulse wave analysis, recorded directly at the carotid artery or indirectly in the ascending aorta from radial artery pressure curve. The arterial system is heterogenous and characterized by the existence of a stiffness gradient with progressive stiffness increase (PWV) from ascending aorta and large elastic proximal arteries to the peripheral muscular conduit arteries. Analysis of aortic or carotid pressure waveform and amplitude concerns the effect of reflected waves on pressure shape and amplitude, estimated in absolute terms, augmented pressure in millimetre of mercury, or, in relative terms, 'augmentation index' (Aix in percentage of pulse pressure). Finally, if the aortic PWV has the highest predictive value for prognosis, the aortic or central artery pressure waveform should be recorded and analysed in parallel with the measure of PWV to allow a deeper analysis of arterial haemodynamics.