Diagnostic Value of the First and Second Derivatives of the Arterial Pressure Pulse in Aortic Valve Disease and in Hypertrophic Subaortic Stenosis
Key result
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.
Why the study?
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?
Population
117 patients with aortic valve disease or hypertrophic subaortic stenosis and 23 normal subjects.
Comparison
Continuous computation of the first and second… vs Comparison between different disease states and…
Design
Cross-sectional
Authors
Discussion
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Implication
May aid differentiation of LV outflow obstruction; leaves open prospective validation against modern imaging.
Key Points
- The aim is to evaluate the diagnostic value of the first and second derivatives of arterial pressure pulse in distinguishing types of aortic valve disease.
- Continuous measurement of brachial arterial dp/dt in 117 patients and 23 normal subjects.
- Calculation of the second derivative of arterial pressure pulse to differentiate between patient groups.
- Comparison of peak dp/dt across different aortic valve conditions.
- Peak dp/dt was highest in patients with pure aortic regurgitation (1736±530 mm. Hg/sec.), indicating significant outflow changes.
- Patients with valvular aortic stenosis showed lower peak dp/dt compared to normals (358±85 vs. 811±185 mm. Hg/sec.).
- The second derivative improved differentiation between various aortic valve diseases significantly.
Study Design
Type
Observational (n=140)
Structured PICO
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?
P
Population
117 patients with aortic valve disease or hypertrophic subaortic stenosis (32 idiopathic hypertrophic subaortic stenosis, 6 discrete subvalvular subaortic stenosis, 29 valvular aortic stenosis, 25 combined aortic stenosis and regurgitation, 24 pure aortic regurgitation) and 23 normal subjects (total n=140).
I
Intervention
Continuous computation of the first (dp/dt) and second (d2p/dt2) derivatives of the brachial arterial pressure pulse.
C
Comparator
Comparison between different disease states and normal subjects.
O
Outcome
Peak dp/dt and d2p/dt2 values to differentiate the nature and location of left ventricular outflow obstruction.surrogate
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.
Cite This Study
Mason et al. (1964) conducted an 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.