Constitutive interpretation of arterial stiffness in clinical studies: a methodological review

Koen D. Reesink*, Bart Spronck

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Citations (Web of Science)

Abstract

Clinical assessment of arterial stiffness relies on noninvasive measurements of regional pulse wave velocity or local distensibility. However, arterial stiffness measures do not discriminate underlying changes in arterial wall constituent properties (e.g., in collagen, elastin, or smooth muscle), which is highly relevant for development and monitoring of treatment. In ARTERIAL STIFFNESS IN RECENT CLINICAL-EPIDEMIOLOGICAL STUDIES, we systematically review clinical-epidemiological studies (2012-) that interpreted arterial stiffness changes in terms of changes in arterial wall constituent properties (63 studies included of 514 studies found). Most studies that did so were association studies (52 of 63 studies) providing limited causal evidence. Intervention studies (11 of 63 studies) addressed changes in arterial stiffness through the modulation of extracellular matrix integrity (5 of 11 studies) or smooth muscle tone (6 of 11 studies). A handful of studies (3 of 63 studies) used mathematical modeling to discriminate between extracellular matrix components. Overall, there exists a notable gap in the mechanistic interpretation of stiffness findings. In CONSTITUTIVE MODEL-BASED INTERPRETATION, we first introduce constitutive-based modeling and use it to illustrate the relationship between constituent properties and stiffness measurements ("forward" approach). We then review all literature on modeling approaches for the constitutive interpretation of clinical arterial stiffness data ("inverse" approach), which are aimed at estimation of constitutive properties from arterial stiffness measurements to benefit treatment development and monitoring. Importantly, any modeling approach requires a tradeoff between model complexity and measurable data. Therefore, the feasibility of changing in vivo the biaxial mechanics and/or vascular smooth muscle tone should be explored. The effectiveness of modeling approaches should be confirmed using uncertainty quantification and sensitivity analysis. Taken together, constitutive modeling can significantly improve clinical interpretation of arterial stiffness findings.

Original languageEnglish
Pages (from-to)H693-H709
Number of pages17
JournalAmerican Journal of Physiology-heart and Circulatory Physiology
Volume316
Issue number3
DOIs
Publication statusPublished - Mar 2019

Keywords

  • distensibility
  • extracellular matrix
  • pulse wave velocity
  • smooth muscle cell
  • vascular remodeling
  • PULSE-WAVE VELOCITY
  • ANKLE VASCULAR INDEX
  • MATRIX GLA-PROTEIN
  • INCREASED AORTIC STIFFNESS
  • EXPERT CONSENSUS DOCUMENT
  • SERUM 25-HYDROXYVITAMIN D
  • GLYCATION END-PRODUCTS
  • HUMAN ABDOMINAL-AORTA
  • BLOOD-PRESSURE
  • MECHANICAL-PROPERTIES

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