Compliance is the ability of a hollow organ (vessel) to distend and increase volume with increasing transmural pressure or the tendency of a hollow organ to resist recoil toward its original dimensions on application of a distending or compressing force. The reciprocal of compliance is elastance, a measure of the tendency of a hollow organ to recoil toward its original dimensions upon removal of a distending or compressing force.
Blood vessels
The terms elastance and compliance are of particular significance in
cardiovascular physiology Cardiovascular physiology is the study of the cardiovascular system, specifically addressing the physiology of the heart ("cardio") and blood vessels ("vascular").
These subjects are sometimes addressed separately, under the names cardiac physiolog ...
and
respiratory physiology. In compliance, an increase in volume occurs in a vessel when the pressure in that vessel is increased. The tendency of the
arteries
An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...
and
veins
Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal c ...
to stretch in response to pressure has a large effect on perfusion and blood pressure. This physically means that blood vessels with a higher compliance deform easier than lower compliance blood vessels under the same pressure and volume conditions.
Venous compliance is approximately 30 times larger than arterial compliance.
Compliance is calculated using the following equation, where
is the change in volume (mL), and
is the change in pressure (
mmHg
A millimetre of mercury is a manometric unit of pressure, formerly defined as the extra pressure generated by a column of mercury one millimetre high. Currently, it is defined as exactly , or approximately 1 torr = atmosphere = &nb ...
):
:
Physiologic compliance is generally in agreement with the above and adds ''
'' as a common academic physiologic measurement of both pulmonary and cardiac tissues. Adaptation of equations initially applied to
rubber
Rubber, also called India rubber, latex, Amazonian rubber, ''caucho'', or ''caoutchouc'', as initially produced, consists of polymers of the organic compound isoprene, with minor impurities of other organic compounds.
Types of polyisoprene ...
and
latex
Latex is an emulsion (stable dispersion) of polymer microparticles in water. Latices are found in nature, but synthetic latices are common as well.
In nature, latex is found as a wikt:milky, milky fluid, which is present in 10% of all floweri ...
allow modeling of the dynamics of pulmonary and cardiac tissue compliance.
Veins have a much higher compliance than arteries (largely due to their thinner walls.) Veins which are abnormally compliant can be associated with
edema
Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...
.
Pressure stockings are sometimes used to externally reduce compliance, and thus keep blood from pooling in the legs.
Vasodilation
Vasodilation, also known as vasorelaxation, is the widening of blood vessels. It results from relaxation of smooth muscle cells within the vessel walls, in particular in the large veins, large arteries, and smaller arterioles. Blood vessel wa ...
and
vasoconstriction are complex phenomena; they are functions not merely of the
fluid mechanics
Fluid mechanics is the branch of physics concerned with the mechanics of fluids (liquids, gases, and plasma (physics), plasmas) and the forces on them.
Originally applied to water (hydromechanics), it found applications in a wide range of discipl ...
of pressure and tissue
elasticity but also of active
homeostatic regulation with
hormone
A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
s and
cell signaling
In biology, cell signaling (cell signalling in British English) is the Biological process, process by which a Cell (biology), cell interacts with itself, other cells, and the environment. Cell signaling is a fundamental property of all Cell (biol ...
, in which the body produces
endogenous
Endogeny, in biology, refers to the property of originating or developing from within an organism, tissue, or cell.
For example, ''endogenous substances'', and ''endogenous processes'' are those that originate within a living system (e.g. an ...
vasodilators and vasoconstrictors to modify its vessels' compliance. For example, the
muscle tone
In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state.O’Sullivan, S. B. (2007) ...
of the
smooth muscle tissue
Smooth muscle is one of the three major types of vertebrate muscle tissue, the others being skeletal muscle, skeletal and cardiac muscle. It can also be found in invertebrates and is controlled by the autonomic nervous system. It is non-striated ...
of the
tunica media
The tunica media (Neo-Latin "middle coat"), or media for short, is the middle tunica (layer) of an artery or vein. It lies between the internal elastic lamina of the tunica intima on the inside and the tunica externa on the outside.
Artery
The ...
can be adjusted by the
renin–angiotensin system
The renin–angiotensin system (RAS), or renin–angiotensin–aldosterone system (RAAS), is a hormone system that regulates blood pressure, fluid, and electrolyte balance, and systemic vascular resistance.
When renal blood flow is reduced, ...
. In patients whose endogenous homeostatic regulation is not working well, dozens of
pharmaceutical drug
Medication (also called medicament, medicine, pharmaceutical drug, medicinal product, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the ...
s that are also
vasoactive can be added. The response of vessels to such vasoactive substances is called vasoactivity (or sometimes vasoreactivity). Vasoactivity can vary between persons because of
genetic and
epigenetic
In biology, epigenetics is the study of changes in gene expression that happen without changes to the DNA sequence. The Greek prefix ''epi-'' (ἐπι- "over, outside of, around") in ''epigenetics'' implies features that are "on top of" or "in ...
differences, and it can be impaired by pathosis and by age. This makes the topic of
haemodynamic response
In hemodynamics, haemodynamics, the body must respond to physical activities, external temperature, and other factors by homeostasis, homeostatically adjusting its blood flow to deliver nutrients such as oxygen and glucose to stressed tissue (biol ...
(including vascular compliance and
vascular resistance
Vascular resistance is the resistance that must be overcome for blood to flow through the circulatory system. The resistance offered by the systemic circulation is known as the systemic vascular resistance or may sometimes be called by another ter ...
) a matter of medical and
pharmacologic complexity beyond mere
hydraulic
Hydraulics () is a technology and applied science using engineering, chemistry, and other sciences involving the mechanical properties and use of liquids. At a very basic level, hydraulics is the liquid counterpart of pneumatics, which concer ...
considerations (which are complex enough by themselves).
The relationship between vascular compliance, pressure, and flow rate is:
Arterial compliance
The classic definition by MP Spencer and AB Denison of compliance (
) is the change in arterial blood volume (
) due to a given change in
arterial blood pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
(
). They wrote this in the "Handbook of Physiology" in 1963 in work entitled "Pulsatile Flow in the Vascular System". So,
.
Arterial compliance is 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
Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...
as a pressure (
carotid artery) and volume (outflow into
aorta
The aorta ( ; : aortas or aortae) is the main and largest artery in the human body, originating from the Ventricle (heart), left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at ...
) relationship.
Compliance, in simple terms, is the degree to which a container experiences pressure or force without disruption. It is used as an indication of
arterial stiffness. An increase in the age and also in the systolic
blood pressure
Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...
(SBP) is accompanied with decrease on arterial compliance.
Endothelial dysfunction results in reduced compliance (increased arterial stiffness), especially in the smaller arteries. This is characteristic of patients with
hypertension
Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
. 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
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
and also in smokers. It is actually a part of a vicious cycle that further elevates blood pressure, aggravates
atherosclerosis
Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...
(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.
See also
*
Cardiovascular System Dynamics Society
*
Windkessel effect
References
External links
*
{{Cardiovascular physiology
Respiratory physiology
Cardiovascular physiology