Assessment of Vascular Haemodynamics Assessment of Vascular Haemodynamics Investigation of...

download Assessment of Vascular Haemodynamics Assessment of Vascular Haemodynamics Investigation of non-invasive

of 385

  • date post

    23-Sep-2020
  • Category

    Documents

  • view

    0
  • download

    0

Embed Size (px)

Transcript of Assessment of Vascular Haemodynamics Assessment of Vascular Haemodynamics Investigation of...

  • Ghent University

    Faculty of Applied Sciences

    Department of Civil Engineering

    Hydraulics Laboratory

    Assessment of Vascular Haemodynamics Investigation of non-invasive and minimally invasive

    methods for assessment of vascular function at rest and during cardiovascular challenge

    Koen S. Matthys, MSc EME

    Academic Year 2003-2004

    Thesis supervisors: Prof. P. R. Verdonck, PhD & Prof. P. Segers, PhD

    Thesis submitted to the Faculty of Applied Sciences

    in fulfilment of the requirements for

    the degree of Doctor in Applied Sciences

  • "From now on, I'm not doing anything I don't want to do! The world owes me happiness, fulfillment and success.... I'm just here to cash in."

    Homicidal Psycho Jungle Cat: A Calvin and Hobbes Collection p145 Copyright  by Bill Watterson

  • Ghent University

    Faculty of Applied Sciences

    Department of Civil Engineering

    Hydraulics Laboratory

    Assessment of Vascular Haemodynamics Investigation of non-invasive and minimally invasive

    methods for assessment of vascular function at rest and during cardiovascular challenge

    Koen S. Matthys, MSc EME

    Academic Year 2003-2004

    Thesis supervisors: Prof. P. R. Verdonck, PhD & Prof. P. Segers, PhD

    Thesis submitted to the Faculty of Applied Sciences

    in fulfilment of the requirements for

    the degree of Doctor in Applied Sciences

  • ISBN 9080885711

     Koen S. Matthys, 2004.

    Cover illustration shows a drawing by Marcel Anteunis of a supine bicycle.

    Contact author at: matthys_k@hotmail.com

    mailto:matthys_k@hotmail.com

  • Thesis supervisors: Prof. P. R. Verdonck, PhD & Prof. P. Segers, PhD

    Hydraulics Laboratory

    Department of Civil Engineering (TW15V)

    Faculty of Applied Sciences

    Ghent University (UG)

    St-Pietersnieuwstraat 41 B-9000 Ghent

    Members of the exam committee:

    Prof. Ronny Verhoeven, PhD (chairman, Faculty of Applied Sciences, UG)

    Yves D’Asseler, PhD (secretary, Faculty of Applied Sciences, UG)

    Prof. Alberto Avolio, PhD (Graduate School Biomedical Engineering, UNSW, Sydney)

    Stéphane Carlier, MD, PhD (Cardiovascular Research Foundation, New York)

    Stefaan De Mey, PhD (European Space Research and Technology Centre, Noordwijk)

    Prof. Patrick Segers, PhD (supervisor, Faculty of Applied Sciences, UG)

    Prof. Luc Van Bortel, MD, PhD (Faculty of Medicine, UG)

    Prof. Pascal Verdonck, PhD (supervisor, Faculty of Applied Sciences, UG)

    Prof. Henri Verhaaren, MD, PhD (Faculty of Medicine, UG)

    This research has been made possible by a specialization grant of the Institute for the

    Promotion of Innovation by Science and Technology in Flanders (IWT993175) and a

    practicum student scolarship of the University of New South Wales, Sydney, Australia.

  • Table of Contents

    Table of Contents 1 I Introduction 3

    1 The Heart and the Circulation ..........................................................................5 2 Rationale for this Thesis ................................................................................35

    II Methodology I: Biomechanics, Identification and Modelling 41

    1 Background: Vascular Biomechanics.............................................................43 2 Transfer Function Estimation Methods for the Aorta-Radial Path ..................93 3 An Arterial Network Model to Assess Pulse Pressure Reduction ................115

    III Methodology II: Measuring Devices and Signal Acquisition 127

    1 Background: Pressure and Flow..................................................................129 2 Development and modelling of arterial tonometry........................................155 3 Arterial tonometry as an alternative for long-term intra-arterial pressure

    monitoring ....................................................................................................171 4 An acquisition tool for synchronized monitoring of a Doppler

    spectrogram, an electrocardiogram and arterial tonometry..........................191 IV Vascular haemodynamics during physical exercise and drug-induced

    stress 203 1 Background: Exercise and Dobutamine.......................................................205 2 Haemodynamic assessment in adolescents during a standing and

    supine bicycle stress test .............................................................................215 3 Haemodynamic assessment in adults during dobutamine stress or a

    treadmill exercise test ..................................................................................229 V Vascular haemodynamics during coronary intervention 241

    1 Background: Stents, QCA, IVUS & FFR ......................................................243 2 Evaluation of the FFR Index for the Assessment of Stent Deployment .......261 3 A Corrected FFR Index to Account for the Myocardial Waterfall Effect........279

    General Discussion and Conclusion 297 Appendix 307 Nomenclature 317 References 335 Acknowledgements 371

    - 1 -

  • - 2 -

  • I Introduction

    In the first chapter, some basics concerning the anatomy and physiology of the heart and the

    circulatory system are explained. The second chapter clarifies the rationale and outline of this

    thesis. In these two chapters of this introductory part an attempt was made to avoid any

    reference to mathematical equations or models, as this will be dealt with in more detail in the

    following part elaborating on vascular biomechanics.

    - 3 -

  • - 4 -

  • CH1 THE HEART AND THE CIRCULATION

    1 The Heart and the Circulation

    - 5 -

  • PART I INTRODUCTION

    - 6 -

  • CH1 THE HEART AND THE CIRCULATION

    History

    The heart and the circulation, or the circulation and the heart, it is the story of the ball and

    chain: they are complementary in every way and to discuss one without mentioning the other

    is therefore pointless. Although this thesis will mainly focus on the arterial circulation -the

    vessel network that provides muscles and organs with the necessary elements to function in a

    healthy way- a brief description on the function and the working of the heart could not be

    omitted.

    The investigation of heart and vessels goes back to ancient times. The Egyptians, Chinese and

    Greeks independently described the importance of palpation of the pulse in their medical

    literature. A characteristic of those times is the mystique that surrounds them and the peculiar

    way in which physiological phenomena were described. For example, in the Chinese

    manuscript ‘Huang Ti Nei Ching Wen. The Yellow Emperor’s Classic of Internal Medicine’

    by the emperor Huang Ti, one can read that: ‘the pulse of a healthy heart should feel like

    continuous hammer blows…like the notes of a string instrument…like wood floating on water

    or like fish gliding through waves’! Huang Ti is thought to have lived c. 2697-2597 BC, but

    some believe that he was only a legendary figure and the book was actually written by a large

    number of people, composed to one manuscript by the 2nd century BC.(Naqvi and Blaufox

    1998)

    It was the ancient civilization of Greece that established the relationship of the heart with the

    blood vessels, when the pulse was recognized as a function of the heart. Gradually through

    time, the knowledge about the cardiovascular system improved, but this journey was also full

    of misconceptions. The fact that arteries contract and relax was known since the time of

    Aristotle. Following this, the Alexandrian Erasistratus (310-250BC), also called ‘the father of

    physiology’, believed that the arteries were filled with air, or ‘pneuma’, which was released as

    soon as the artery was severed, and that the blood from the neighbouring veins quickly filled

    in to take its place. Claudius Galenus, or Galen (131-199) wrote more on the subject of the

    pulse than anyone before or since. Interesting is his experimental approach where he used a

    hollow reed to simulate an artery. However, though his teachings prevailed for at least five

    centuries, a lot of mistakes were also passed on in this way. He wrongfully described the ebb

    and flow of blood in arteries and the passing of blood from the right side of the heart to the

    - 7 -

  • PART I INTRODUCTION

    left side through pores, thinking of the circulation as an open-circuit. Only much later, Galileo

    Galilei (1564-1642) countered these findings and considered the circulation of blood to be in

    a closed system.(Allbutt 1921; Dobson 1927)

    Despite the fact that the history of the investigation of heart and circulation dates back so far

    in time, the modern perception of the cardiovascular system is derived from the ideas

    stipulated only in 1616 by a contempora