Key result
CT calculations suggest dicrotic notch formation involves aortic valve apparatus acceleration at closure.
Why the study?
Despite its clinical importance, no physical mechanism for the formation of the central arterial dicrotic notch has been convincingly demonstrated.
The formation of the dicrotic notch may be explained by the acceleration of the aortic valve apparatus at the time of valve closure, rather than wavefront reflection.
Challenges reflection-based dicrotic notch models; leaves open prospective hemodynamic validation before clinical adoption.
The dicrotic notch is a prominent and distinctive feature of the pressure waveform in the central arteries. It is universally used to demarcate the end of systole and the beginning of diastole in these arteries. Despite its importance clinically, no physical mechanism for the formation of the dicrotic notch has been demonstrated convincingly. We first explore a mechanism based on the reflection of a backward wavefront from the aortic valve at the time of closure. This hypothesis is rejected on the basis of experimental evidence from measurements made in dogs. A new hypothesis is presented involving the acceleration of the aortic valve apparatus at the time of valve closure. This hypothesis is supported by new calculations of the acceleration of the aortic valve apparatus during the cardiac cycle based on computed tomography scans in man.
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Gamrah et al. (2020) studied Dicrotic notch mechanics. The formation of the dicrotic notch is hypothesized to involve the acceleration of the aortic valve apparatus at closure, supported by calculations from human computed tomography scans.
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