Aortic and Brachial Pulse Wave Contour and Timing in Aortic Valve Disease

Abstract

The arrival time (QK_d) and contour (ΔP/Δt) of the brachial arterial pressure wave was recorded noninvasively by Sphygmo-Recording, and was correlated with clinical and catheterization data for 23 patients with aortic stenosis, aortic regurgitation, or combined valvular disease. The mean normal values in 57 healthy subjects were 203 msec for QK_d and 0.48 mm Hg msec^-1 for ΔP/Δt. In 9 cases of documented aortic stenosis, mean QK_d was prolonged (240 msec), and the mean ΔP/Δt of the brachial pressure wave was decreased (0.25 mm Hg msec^-1). In 7 patients with aortic regurgitation, QK_d tended to be shorter than normal (182 msec) and the upstroke exhibited a steeper slope (1.0 mm Hg msec^-1). Patients with combined aortic stenosis and regurgitation showed a QK_d in the normal range, and the slope of the arterial upstroke was also normal. QK_d and brachial arterial ΔP/Δt obtained noninvasively show a systematic relationship with data from catheterization studies; e.g. the calculated aortic valve orifice; the interval between peak ventricular and aortic pressures ΔP/Δt in the ascending aorta, and the ratio of aortic ΔP/Δt to that in the left ventricle. The indices based on the Korotkoff sounds did not correlate well with cardiac output, cardiac index, left ventricular ejection time or left ventricular end-diastolic pressure. After surgical placement of prosthetic aortic valves in 10 patients with aortic insufficiency, the QKd and ΔP/Δt returned into the normal range, or were slightly prolonged. Thus, the Sphygmo-Recorder provides a useful approach to cardiac evaluation both pre- and postoperatively.