Investigation of Viscoelasticity in the Relationship Between Carotid Artery Blood Pressure and Distal Pulse Volume Waveforms

We investigated the relationship between carotid artery blood pressure (BP) and distal pulse volume waveforms (PVRs) via subject-specific mathematical modeling. We conceived three physical models to define the relationship: a tube-load model augmented with a gain (TLG), Voigt (TLV), and standard linear solid (TLS) models. We compared these models using PVRs measured via BP cuffs at an upper arm and an ankle as well as carotid artery tonometry waveform collected from 133 subjects. At both upper arm and ankle, PVR was related to carotid artery tonometry by TLV and TLS models better than by TLG model; when root-mean-squared over all the subjects, the systolic and diastolic BP errors between measured carotid artery tonometry waveform and the one estimated from distal PVR reduced from 4.3 mmHg and 4.6 mmHg (TLG) to 1.1 mmHg and 1.0 mmHg (TLS) for the upper arm (p <; 0.0167), and from 2.1 mmHg and 1.7 mmHg (TLG) to 2.1 mmHg and 1.5 mmHg (TLV) for the ankle. Further, TLV and TLS models exhibited superior Akaike's Information Criterion (AIC) in both locations than TLG model. However, the difference between TLG versus TLV and TLS models associated with the ankle was not large. Therefore, the relationship of central arterial BP to arm PVR arises from both wave reflection and viscoelasticity while the relationship to ankle PVR mainly arises from wave reflection. These findings may imply that an effective subject-specific transfer function for estimating accurate central arterial BP from an arm PVR should account for the impact of viscoelasticity.