Diagnostic Value of the First and Second Derivatives of the Arterial Pressure Pulse in Aortic Valve Disease and in Hypertrophic Subaortic Stenosis

Mason, Dean T.; Braunwald, Eugene; Ross, John; Morrow, Andrew G.

doi:10.1161/01.cir.30.1.90

Cited by 38 publications

(13 citation statements)

References 27 publications

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“…The rate of neck chamber pressure change was low, relative to the normal maximum human arterial dP/dt [811 ± 39 mm Hg/sec in the brachial artery (Mason et al, 1964)], and to the rate of onset of the sustained stimuli I applied in the present study (maximum dP/dt: ± 2000 to 2500 mm Hg/ sec). In the study of Thron and coworkers (then- Figs.…”

Section: Comparisons With Results From Other Studiescontrasting

confidence: 53%

Nonlinearities of the human carotid baroreceptor-cardiac reflex.

Eckberg¹

1980

Circulation Research

142

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Carotid baroreceptors of nine healthy young men and women were stretched or compressed with neck suction or pressure, before and after beta-adrenergic and cholinergic blockade, to evaluate several nonlinearities of sinus node baroreflex responses. Sinus node inhibition was related linearly to the intensity of brief baroreceptor stimuli over a range extending from carotid-distending pressures of about 101 +/- 5 (mean +/- SE) to 160 +/- 6 mm Hg (the subject's average systolic pressure was 108 +/- 2 mm Hg). Sinus node response to sustained (5 seconds) neck suction or pressure were strikingly asymmetrical. Responses were abolished by atropine, or by atropine and propranolol. Propranolol alone augmented sinus node responses to both neck suction and pressure. These results suggest that, in normal human subjects, sinus node responses to abrupt alterations of afferent baroreceptor traffic are nonlinear and are mediated by fluctuations of efferent cholinergic activity. Most of the observed nonlinear behavior of the integrated reflex can be explained on the basis of known properties of afferent and central portions of the baroreflex arc.

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Section: Comparisons With Results From Other Studiescontrasting

confidence: 53%

Nonlinearities of the human carotid baroreceptor-cardiac reflex.

Eckberg¹

1980

Circulation Research

142

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“…With these stimulus parameters, responses began to decline when the dP/dt fell below -200 mmHg/sec. Comparable response patterns were observed in three subjects in whom the onset of neck suction DWAIN L. ECKBERG coincided with the P wave (when arterial dP/dt would have been nearly zero (Mason et al 1964)), and in two subjects in whom neck suction began 0 40 and 0 45 sec after the onset of the P wave. This suggests that the reponse pattern observed was not due merely to superimposition of the experimental stimulus upon the rapid rise of the natural arterial pressure.…”

Section: Resultsmentioning

confidence: 76%

“…It was assumed on the basis of previous studies (Eckberg, 1976) that the dP/dt measured in the neck chamber slightly exceeded that actually delivered to the carotid sheath. Therefore, two rates of pressure change, -1200 and -550 mmHg/sec were chosen to bracket the normal range of human arterial dP/dt (found by Mason, Braunwald, Ross & Morrow (1964) to be about 440-1180 mmHg/sec in the brachial artery), and one level, -300 mmHg/sec, was chosen to fall below the normal range. Intensities of -20 to -60 mmHg were applied for 0-6 sec, 0-75-0-85 sec before the anticipated appearance of the next P wave (see below).…”

Section: Introductionmentioning

confidence: 99%

Baroreflex inhibition of the human sinus node: importance of stimulus intensity, duration, and rate of pressure change.

Eckberg¹

1977

The Journal of Physiology

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SUMMARY1. Carotid baroreceptors were stimulated with electronically controlled neck suction in five healthy young men and pulse interval prolongation was measured. Timing of the onset of stimuli in relation to cardiac activity was held constant, and stimulus intensity, duration, and dP/dt were varied independently.2. In the subjects studied, sinus node responses to neck suction were proportional to dP/dt. However, variations of stimulus dP/dt within or above the normal range for arterial dP/dt did not influence the magnitude of integrated baroreflex responses, or the earliest portion of baroreflex sinus node inhibition.3. Carotid baroreflex responses were linear over a wide range which extended beyond the normal range for human systolic arterial pressures.4. Saturation of the carotid baroreceptor-cardiac reflex occurred at distending pressures of about 160 mmHg.5. The average baroreflex responses of the group studied were highly reproducible over time.6. Baroreflex gain correlated very strongly with base line pulse interval. 7. The magnitude of baroreflex responses increased linearly with the duration of carotid sinus distension and reached a maximum level with stimuli lasting 0*5 sec or more.8. The results demonstrate that carotid sinus transfer characteristics can be measured in normal man, and that human response patterns are strikingly similar to those observed earlier in experimental animals.

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“…34 -36 Because of this rapid emptying, the brachial artery dp/dt and the d 2 p/dt 2 are higher in patients with obstructive HCM than in normal control subjects. 37 ␤-Blocker prevention of the B-agonist-induced rise in dp/dt has been shown. 1,2 Figure 5.…”

Section: Comparison With Control Subjectsmentioning

confidence: 93%

Mechanism of Benefit of Negative Inotropes in Obstructive Hypertrophic Cardiomyopathy

1998

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Background-Drugs with negative inotropic effect are widely used to decrease obstruction in hypertrophic cardiomyopathy (HCM). However, the mechanism of therapeutic benefit has not been studied. Methods and Results-We used M-mode, two-dimensional, and pulsed Doppler echocardiography to study 11 patients with obstructive HCM before and after medical elimination of left ventricular outflow tract obstruction. We measured 148 digitized pulsed Doppler tracings recorded in the left ventricular cavity 2.5 cm apical of the mitral valve. Successful treatment slowed average acceleration of left ventricular ejection by 34% (Pϭ.001). Mean time to peak velocity in the left ventricle was prolonged 31% (Pϭ.001). Mean time to an ejection velocity of 60 cm/s was prolonged 91% (Pϭ.001). Before treatment, left ventricular ejection velocity peaked in the first half of systole; after successful treatment, it peaked in the second half (Pϭ.001). In contrast, after treatment, we found no change in peak left ventricular ejection velocity. We also found no change in the distance between the mitral coaptation point and the septum, as measured in two planes, indicating no treatment-induced alteration of this anatomic relationship. Conclusions-Medical

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Diagnostic Value of the First and Second Derivatives of the Arterial Pressure Pulse in Aortic Valve Disease and in Hypertrophic Subaortic Stenosis

Cited by 38 publications

References 27 publications

Nonlinearities of the human carotid baroreceptor-cardiac reflex.

Nonlinearities of the human carotid baroreceptor-cardiac reflex.

Baroreflex inhibition of the human sinus node: importance of stimulus intensity, duration, and rate of pressure change.

Mechanism of Benefit of Negative Inotropes in Obstructive Hypertrophic Cardiomyopathy

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