Continuous recording of dicrotic and pulse pressures during head-up tilting test: the vasodepressive profile. Preliminary data.
BACKGROUND
The aim of this study was to assess whether a non-invasive automatic evaluation of the pulse wave characteristics could provide clinical clues when monitoring the hemodynamic adjustments to head-up tilting.


METHODS
A continuous assessment of the peripheral pulse wave characteristics (systolic, diastolic, dicrotic and pulse pressures) in 8 control subjects with a negative response to head-up tilting (60 degrees for 45 min) compared to 13 syncopal patients with a vasodepressive one was performed.


RESULTS
Controls exhibited, when up-tilted, an increase in blood pressure as well as in the dicrotic and pulse pressures and no changes in heart rate. On the contrary, syncopal patients showed a progressive increase in heart rate associated with a progressive decrease in dicrotic pressure and a trend towards lower values of pulse pressure, but no changes in systolic pressure. Thereafter and until the pre-syncopal symptoms supervened, the systolic, diastolic and dicrotic pressures progressively declined. A decrease in dicrotic pressure mainly characterized the early vasodepressive response while its increase identified the negative one.


CONCLUSIONS
Our data, even though preliminary, strongly suggest that automatic hemodynamic evaluation is to be used in the clinical setting as a monitor of the sudden changes in blood pressure induced by head-up tilting. Furthermore, the dicrotic and pulse pressures, even those measured during the early phases of the test, should be considered as non-invasive parameters characterizing the vasodepressive response to head-up tilting.
Romano
Salvatore M
SM
Department of Critical Care, University of Florence, School of Medicine, Florence, Italy.
Lazzeri
Chiara
C
Chiostri
Marco
M
Toso
Anna
A
Foschi
Marco
M
Pistolesi
Massimo
M
Di Donato
Marisa
M
Franchi
Franco
F
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D012815:Signal Processing, Computer-Assisted; D013575:Syncope / Q000175:diagnosis*; D018667:Tilt-Table Test