Digital pulse plethysmography as a non-invasive method for predicting drug-induced changes in left ventricular preload

Stengele, E.; Winkler, F.; Trenk, Dietmar; Jähnchen, E.; Petersen, Jens; Roskamm, H.

doi:10.1007/s002280050108

Cited by 15 publications

(6 citation statements)

References 10 publications

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“…Nitroglycerin in therapeutic sublingual, spray, ointment, and transdermal patch doses increased the a/b ratio from 26 to 89%. 14,16,18,[25][26][27][28][29][30][31] Chowienczyk et al 14 found the highest peak increase of the a/b ratio, 205% in an adult receiving nitroglycerin, 0.1 mg IV, and 124% in an adult receiving albuterol, 20 g/min IV. Since changes of the a/b ratio from the action of NO follow a dose-response curve, whole-body, periodic acceleration appears to be much more potent in accessibility to NO than organic nitrates or ␤-adrenergic agonists in terms of vasodilatation of the resistance vessels.…”

Section: Discussionmentioning

confidence: 99%

Nitric Oxide Is Released Into Circulation With Whole-Body, Periodic Acceleration * *Dr. Sackner is Chief Executive Officer and Chairman Board of Directors, Non-Invasive Monitoring Systems, Inc., and owns approximately 37% of Non-Invasive Monitoring Systems, Inc. shares. He is also a member of the Board of Directors, Vivometrics, Inc., Ventura CA. Ms. Gummels owns approximately 0.2% of Non-Invasive Monitoring Systems shares. Dr. Adams is a member of the Scientific Advisory Board and owns approximately 0.1%

Sackner

Gummels

Adams³

2005

Chest

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Section: Discussionmentioning

confidence: 99%

Nitric Oxide Is Released Into Circulation With Whole-Body, Periodic Acceleration * *Dr. Sackner is Chief Executive Officer and Chairman Board of Directors, Non-Invasive Monitoring Systems, Inc., and owns approximately 37% of Non-Invasive Monitoring Systems, Inc. shares. He is also a member of the Board of Directors, Vivometrics, Inc., Ventura CA. Ms. Gummels owns approximately 0.2% of Non-Invasive Monitoring Systems shares. Dr. Adams is a member of the Scientific Advisory Board and owns approximately 0.1%

Sackner

Gummels

Adams³

2005

Chest

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“…Indeed, in the present direct comparison, the change in the IP of the volume pulse after NTG administration was approximately twice that seen in the pressure pulses. Such changes in the volume pulse after NTG administration have been variously attributed to alterations in left ventricular preload or afterload, 3,20,21 although no direct evidence has been presented to support these proposed mechanisms. The present study shows that the relationship between the pressure and volume pulse in the Figure 3.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Assessment of the Digital Volume Pulse

et al. 2000

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Abstract-The digital volume pulse can be recorded simply and noninvasively by photoplethysmography. The objective of the present study was to determine whether a generalized transfer function can be used to relate the digital volume pulse to the peripheral pressure pulse and, hence, to determine whether both volume and pressure pulse waveforms are influenced by the same mechanism. The digital volume pulse was recorded by photoplethysmography in 60 subjects (10 women, aged 24 to 80 years), including 20 subjects with previously diagnosed hypertension. Simultaneous recordings of the peripheral radial pulse and digital artery pulse were obtained by applanation tonometry and a servocontrolled pressure cuff (Finapres), respectively. In 20 normotensive subjects, measurements were obtained after the administration of nitroglycerin (NTG, 500 g sublingually). Transfer functions obtained by Fourier analysis of the waveforms were similar in normotensive and hypertensive subjects. In normotensive subjects, transfer functions were similar before and after NTG. By use of a single generalized transfer function for all subjects, the radial and digital artery pressure waveforms could be predicted from the volume pulse with an average root mean square error of 4.4Ϯ2.0 and 4.3Ϯ1.9 mm Hg (meanϮSD) for radial and digital artery waveforms, respectively, similar to the error between the 2 pressure waveforms (4.4Ϯ1.4 mm Hg). The peripheral pressure pulse is related to the digital volume pulse by a transfer function, which is not influenced by effects of hypertension or NTG. Effects of NTG on the volume pulse and pressure pulse are likely to be determined by a similar mechanism. (Hypertension. 2000;36:952-956.)Key Words: plethysmography Ⅲ hypertension, essential Ⅲ pulse Ⅲ nitroglycerin Ⅲ tonometry A digital volume pulse (DVP) can be obtained by measuring infrared light transmission through the finger (photoplethysmography). 1-3 The pioneering work of Takazawa et al 4 has shown that the DVP resembles the carotid pressure wave and varies, as does the carotid pressure wave, with vasodilator and vasoconstrictor drugs. Analysis of this pulse waveform has been used to characterize the effects of aging and of vasodilator drugs on the circulation. 4 However, the physical characteristics that determine the volume pulse waveform are not fully understood. By contrast, the peripheral pressure pulse derived from the radial or digital artery has been subject to much analysis by O'Rourke and colleagues, 5-7 who have established that the peripheral pressure pulse is influenced by pressure wave reflection mainly from the lower body and by pressure wave velocity. Transmission along the upper limb also influences the radial or digital artery pressure pulse (P rad and P dig , respectively), but this influence remains approximately constant across subjects and during the administration of systemically acting vasodilator drugs. 8 Thus, changes in the peripheral pressure pulse are determined mainly by changes in pressure wave reflection within the trunk and lo...

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“…Empirically, the height of the dicrotic notch is especially sensitive to the influence of nitrates, and the measured effects correlate well with nitrate plasma concentrations [30][31][32]. In contrast, minimal effects have been demonstrated after treatment with typical arteriole dilators such as prazosin and nifedipin [33,34]. Hence, arteriolar vasodilation and reduced blood pressure have little or no effect on this parameter.…”

Section: Discussionmentioning

confidence: 99%

Effects of Selective Angiotensin II Type 1 Receptor Blockade with Losartan on Arterial Compliance in Patients with Mild Essential Hypertension

Klemsdal

Moan²,

Kjeldsen³

1999

Blood Pressure

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It has been suggested that antihypertensive drugs should not only decrease blood pressure, but also improve large artery compliance. The aim of the present study was to examine the effect of losartan, a selective angiotensin II type 1 receptor antagonist, on parameters reflecting arterial compliance. In a randomized, double-blind cross-over study, 16 patients with mild essential hypertension were examined after 4 weeks of treatment with placebo/losartan. The effect on finger plethysmographic arterial pulse curves were quantified by computing the relative height of the dicrotic notch, and pulse wave velocity was estimated by measurements of the time delay from the start of the QRS-complex (electrocardiogram) to the foot of the plethysmographic pulse wave. Compared with placebo, losartan reduced the relative height of the dicrotic notch from 55% (SD 12) to 47% [14] (p < 0.01), and pulse wave velocity from 9.3 m/sec to 8.7 m/sec (p < 0.05). The supine blood pressure decreased from 146/89 mmHg to 134/82 mmHg (p < 0.01). There was no correlation between the effects on blood pressure and the effects on the arterial compliance parameters, suggesting that losartan exerted an effect on arterial compliance beyond its effect on blood pressure.

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Digital pulse plethysmography as a non-invasive method for predicting drug-induced changes in left ventricular preload

Abstract: We conclude, that the reduction in afterload did not cause the typical changes in wave contour of the peripheral pulse curve which occur with organic nitrates. Most likely changes in the a/b ratio reflect changes in LV preload.

Cited by 15 publications

References 10 publications

Noninvasive Assessment of the Digital Volume Pulse

Effects of Selective Angiotensin II Type 1 Receptor Blockade with Losartan on Arterial Compliance in Patients with Mild Essential Hypertension

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