A new ventricular-performance variable using electrocardiogram and carotid pulse contour derivative.

The pre-ejection period (PEP) of systole is a widely used, non-invasive index of ventricular performance. For precise measurements, simultaneous recordings are required from which the Q-wave on the electrocardiogram, second heart sound on the phonocardiogram, and upstroke and incisura of the carotid pulse contour are discretely identifiable and temporally accurate. This is frequently difficult to accomplish. We, therefore, have compared 2 other noninvasive indices of ventricular performance for correlation with PEP in 17 female and 18 male subjects while supine and during head-up tilt. We also examined similarity of these indices to PEP in correlations with heart rate and blood pressure and compared them for ease in monitoring and precision in measurement. The ratio of the peak amplitude of the carotid pulse contour derivative to its total amplitude (DAR) is easier to monitor and more reliably measured than PEP; however, it is poorly correlated with PEP. Time from electrocardiographic Q-wave to peak dD/dt (Q-MAX) is also easier to monitor and somewhat more reliably measured than PEP. Although correlations of PEP and Q-MAZ with subject age are dissimilar, Q-MAX is correlated with PEP in supine and tilted subjects; the 2 variables are similarly correlated with heart rate and arterial pressure; and in 6 subjects both variables were prolonged after intravenous administration of propranolol-hydrochloride. We, therefore, propose Q-MAX as an alternative measure of ventricular performance.