Introduction: Left ventricular (LV) developed pressure (dP / dt) is a classical index of myocardial contractility related to prognosis during heart failure. We sought to assess the reproducibility and feasibility of use of the maximal first derivative of the radial pulse, Rad dP / dt, as a peripheral criterion of ventricular contractility in patients with heart failure. Methods: We assessed 50 consecutive, patients with heart failure using aplanation tonometry to record the radial pulse wave and calculate Rad dP / dt. Echocardiography, Doppler flow and tissue Doppler imaging were used to record classical parameters of LV function: LV ejection fraction (LVEF), Tei index, dP / dt on mitral regurgitation (MR dP / dt) and peak systolic velocity (S′). Total systemic vascular resistance (TSVR) was calculated by use of the Doppler calculated cardiac output. Preload was assessed by the E/Ea ratio. Feasibility was tested in an ongoing prospective mortality study (n = 310). Results: The Bland and Altman representation of repeated measurements of the Rad dP / dt showed good agreement. Feasibility was greater than 99% for a successful assessment on the right arm during the first attempt. The Rad dP / dt correlated with the LVEF, S′ or Tei index as usual parameters of impaired contractility but not preload (E/Ea) or afterload (TSVR) parameters. MR dP / dt and Rad dP / dt were closely related (r = 0.75, p b 0.001). The ability of the arterial dP / dt to characterize LVEF was not modified by adjustment for arterial viscoelastic properties. Conclusion: The maximal dP / dt of the radial pulse appears to be a valuable and reproducible peripheral criterion of LV systolic performance.

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) o140 mmHg and diastolic BP (DBP) o90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBPo140 mmHg and DBPo90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.

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