The effects of passive leg raising on arterial wave reflection in healthy adults

Abstract

Background: Passive leg raising (PLR) produces hemodynamic and physiological changes related to centralizing blood volume and baroreceptor activation.

Methods/results: To evaluate the effects of PLR on central hemodynamics, we prospectively studied 50 healthy participants (80% male, age 37 +/- 12 years). Central aortic blood pressures (CA-BPs) and reflected wave properties were evaluated using applanation tonometry at baseline and upon 1 min of PLR. Heart rate (HR) was unchanged. Brachial artery (BA)-systolic BP, BA-diastolic BP, and BA-pulse pressure (PP) all decreased from baseline to PLR. Changes in BA-PP were significantly greater than changes in CA-PP. Reflected wave augmentation pressure (P(s)-P(i)), HR corrected augmentation index (AIx@75), and augmentation index decreased significantly [(P(s)-P(i)): 5 +/- 6 vs. 4 +/-5, P < 0.001; AIx@75%: 10 +/- 13 vs. 7 +/- 12, P = 0.004; AI%: 14 +/- 12 vs. 12 +/- 12, P = 0.014, respectively]. HR corrected ejection duration (ED(c)), round trip travel time (deltat(p)), and reflected wave systolic duration (deltat(r)) all increased upon PLR [ED(c): 433 +/- 15 vs. 444 +/- 17, P < 0.001; deltat(p): 149 +/- 18 vs. 156 +/- 20, P = 0.003; deltat(r): 174 +/- 33 vs. 179 +/- 32, P = 0.046, respectively]. Indices of left ventricular (LV) workload including wasted LV energy and tension-time index decreased upon PLR.

Conclusion: PLR decreases the amplitude and delays the onset of the reflected aortic pressure wave. This decreases wasted LV pressure energy and workload.