Noninvasive pressure pulse waveform analysis of flow-mediated vasodilation evoked by post-occlusive reactive hyperemia maneuver

Post-occlusive reactive hyperemia (PORH) assesses flow-mediated vasodilation at microvascular level due to bioactivity of endothelial-derived factors. Ordinary augmentation index that quantifies endothelial response is based on an ensemble-averaged waveform that limits its short-time application. This study proposes a mathematical model and two corresponding indices to evaluate arterial pressure response after blood flow restoration. Radial pressure pulse waveforms were acquired by a 12 bits acquisition board at a sampling rate of 1.0 kHz using a piezoelectric transducer. Signals were stored during 30 s at baseline condition and 60 s after 5-min occlusion using an arm-cuff placed over the brachial artery. In both conditions, the pressure pulse waveform presents systolic and diastolic phases with progressive and regressive pulse waveforms, respectively. Changes in pulse wave morphology were also observed and comprised attenuation of the pulse pressure amplitude (markedly first and second systolic peaks). This characteristic of the pulse pressure was described by the time-domain summation of two pairs of Gaussian-like waveforms (representing independent progressive and regressive components) with parameters related to amplitude, time lag, and duration for each component. A steepest descent optimization routine was used to fit the model parameters to experimental data of normotensive and subjects with hypertension. The optimized parameters were used to calculate two indices, RIx_1,2 (second-to-first systolic peak ratio) and RIx_1,3 (first diastolic-to-first systolic ratio). The observed responses between groups suggest that RIx_1,2 is related to an endothelial response to the ischemic process and could be used as a clinical tool to assess endothelial function in hypertension.