Compliance (physiology)

Compliance is a measure of the tendency of a hollow organ to resist recoil toward its original dimensions upon removal of a distending or compressing force. It is the reciprocal of "elastance".

Blood vessels

The terms elastance and compliance are of particular significance in cardiovascular physiology and respiratory physiology. An increase in blood volume occurs in a vessel when the pressure in that vessel is increased. The tendency of the arteries and veins to stretch in response to pressure has a large effect on perfusion and blood pressure.^[1] Venous compliance is 20-24 times larger than arterial compliance. Compliance is calculated using the following equation, where ΔV is the change in volume, and ΔP is the change in pressure:^[2]

Physiologic compliance is generally in agreement with the above and adds dP/dt as a common academic physiologic measurement of both pulmonary and cardiac tissues. Mathematical adaptation of utility formulas once best applied to rubber and latex now allow measurement of complex and dynamic physiologic states, specifically addressed here in pulmonary and cardiac tissue compliance.

Vulcanization of natural rubber occurs when elements such as sulfur are introduced to the media. In industry, sulfur or similar additions are titrated to the desired compliance performance definition of the media. The Myocardium is decidedly not made of rubber but certainly shares many characteristics regarding infiltration by other agents. Introduction of Calcium within myocardial mass is a similar process that detracts from compliance and heralds Diastolic Dysfunction.

Current proponents of restoration of Ventricular Dyssynchrony purport that cardiac dP/dt curves can be reversed, thus demonstrating clinical improvement. One could then assume that inexpensive echocardiographically defined reversal of derived E:A time intervals of flow across the mitral valve would follow these curves in support of the theory espoused.

Veins have a much higher compliance than arteries (largely due to their thinner walls.) Veins which are abnormally compliant can be associated with edema. Pressure stockings are sometimes used to externally reduce compliance, and thus keep blood from pooling in the legs.

Arterial compliance

The classic definition by Spencer and Denison of compliance (C) is the change in arterial blood volume (ΔV) due to a given change in arterial blood pressure (ΔP). So, C = ΔV/ΔP.^[3]

Arterial compliance, an index of the elasticity of large arteries such as the thoracic aorta. Arterial compliance is an important cardiovascular risk factor. Compliance diminishes with age and menopause. Arterial compliance is measured by ultrasound as a pressure (carotid artery) and volume (outflow into aorta) relationship.^[4]

Arterial compliance in simple words is the action in which artery yields to pressure or force without disruption. It is used as an indication of arterial stiffening. An increase in the age and also in the systolic blood pressure (SBP) is accompanied with decrease on arterial compliance.^[5]

Endothelial dysfunction results in reduced compliance (increased arterial stiffness), especially in the smaller arteries. This is characteristic of patients with hypertension. However, it may be seen in normotensive patients (with normal blood pressure) before the appearance of clinical hypertension. Reduced arterial compliance is also seen in patients with diabetes and also in smokers. It is actually a part of a vicious cycle that further elevates blood pressure, aggravates atherosclerosis (hardening of the arteries), and leads to increased cardiovascular risk. Arterial compliance can be measured by several techniques. Most of them are invasive and are not clinically appropriate. Pulse contour analysis is a non-invasive method that allows easy measurement of arterial elasticity to identify patients at risk for cardiovascular events.^[6]

A study concluded that arterial compliance, which diminishes with menopause, was significantly improved with red clover isoflavones.^[7]

See also

• Pulmonary compliance
• Windkessel effect

References

1. ^ Physiology at MCG 3/3ch7/s3ch7_10
2. ^ Vascular compliance
3. ^ Tozzi, Piergiorgio; Corno, Antonio; Hayoz, Daniel (April 2000). "Definition of arterial compliance". American journal of physiology 278. http://ajpheart.physiology.org/content/278/4/H1407.full#xref-ref-3-1. Retrieved 2011-11-09. 
4. ^ Nestel, PJ.; Pomeroy, S.; Kay, S.; Komesaroff, P.; Behrsing, J.; Cameron, JD.; West, L. (March 1999). "Isoflavones from red clover improve systemic arterial compliance but not plasma lipids in menopausal women.". J Clin Endocrinol Metab 84(3): 895–898.. http://ajpheart.physiology.org/content/278/4/H1407.full#xref-ref-3-1. Retrieved 2011-11-09. 
5. ^ "Arterial Compliance Experts". http://www2.intota.com/experts.asp?strSearchType=all&strQuery=arterial+compliance. Retrieved 2011-11-09. 
6. ^ Cohn, Jay N. (August 2001). "Arterial compliance to stratify cardiovascular risk: more precision in therapeutic decision making". American Journal of Hypertension 14: 258–263. http://www.sciencedirect.com/science/article/pii/S0895706101021549. Retrieved 2011-11-09. 
7. ^ Nestel, PJ.; Pomeroy, S.; Kay, S.; Komesaroff, P.; Behrsing, J.; Cameron, JD.; West, L. (March 1999). "Isoflavones from red clover improve systemic arterial compliance but not plasma lipids in menopausal women.". J Clin Endocrinol Metab 84(3): 895–898.. http://ajpheart.physiology.org/content/278/4/H1407.full#xref-ref-3-1. Retrieved 2011-11-09. 

External links

• MeSH Compliance