Slopes of the Carotid Pulse Wave in Normal Subjects, Aortic Valvular Diseases, and Hypertrophic Subaortic Stenosis

Variations in certain slopes of the carotid pulse which exist among normal subjects, patients with aortic valvular disease, and those with hypertrophic subaortic stenosis were examined. Records from 256 subjects were quantified with computer technics. The externally recorded volume pulses were related to simultaneously recorded brachial artery pressures (cuff); thus the slopes are expressed in mm Hg/sec. Several slopes were studied: the maximum rate of pressure rise, the mean systolic upstroke (onset of carotid upstroke to peak systolic excursion), and the least square fits of the first twothirds of the upstroke and the first two-thirds of diastole. The least square slopes of 98% of the patients with aortic stenosis were <457 mm Hg/sec, whereas none of those with hypertrophic subaortic stenosis was that low. The greatest overlap was between patients with aortic stenosis and those with aortic stenosis and aortic insufficiency. The slopes correlated poorly with valve areas and gradient in aortic stenosis and combined aortic stenosis and aortic insufficiency. The least square slope in normal subjects is not related to heart rate or age. Thus, the decreased slopes in patients with aortic stenosis are related to many factors, including myocardial function, but influenced by the size of the aortic valve opening and the properties of the vessels.