Brachial arterial peak dp/dt differentiated left ventricular outflow obstructions, averaging 1092±372 mm Hg/sec in hypertrophic subaortic stenosis vs 811±185 in normal subjects.
Observational (n=140)
Does the analysis of the first and second derivatives of the brachial arterial pressure pulse differentiate the nature and location of left ventricular outflow obstruction in patients with aortic valve disease and hypertrophic subaortic stenosis?
The first and second derivatives of the brachial arterial pressure pulse provide a simple and reliable method to differentiate the nature and location of left ventricular outflow obstruction.
The brachial arterial dp/dt was continuously computed by means of an electronic differentiating circuit in 117 patients and 23 normal subjects. The peak dp/dt averaged 1092±372 (S.D.) mm. Hg/sec. in 32 patients with idiopathic hypertrophic subaortic stenosis, 547±94 mm. Hg/sec. in six patients with discrete subvalvular subaortic stenosis, 811±185 mm. Hg/sec. in 23 normal subjects, 358±85 mm. Hg/sec. in 29 patients with valvular aortic stenosis, 724±212 mm. Hg/sec. in 25 patients with combined aortic stenosis and regurgitation, and 1736±530 mm. Hg/sec. in 24 patients with pure aortic regurgitation. It is suggested that the elevated peak dp/dt seen in patients with hypertrophic stenosis is due to the absence of obstruction to ejection early in systole. In contrast, patients with valvular and discrete subvalvular stenosis, who exhibit fixed obstruction to outflow throughout ventricular systole, had a peak dp/dt that tended to be lower than normal. Calculation of the second derivative (d 2 p/dt 2 ) of the arterial pressure pulse provided even better separation of the various groups of patients studied. The analyses of the dp/dt and of the d 2 p/dt 2 of the brachial artery pressure pulse afford a simple and reliable assessment of the nature and location of left ventricular outflow obstruction and are helpful in the differentiation of valvular aortic stenosis, combined stenosis and regurgitation, and pure aortic regurgitation.
Mason et al. (Wed,) conducted a observational in Aortic Valve Disease and Hypertrophic Subaortic Stenosis (n=140). First and second derivatives of the brachial arterial pressure pulse vs. Normal subjects was evaluated on Peak dp/dt of the brachial arterial pressure pulse. Brachial arterial peak dp/dt differentiated left ventricular outflow obstructions, averaging 1092±372 mm Hg/sec in hypertrophic subaortic stenosis vs 811±185 in normal subjects.