Non-invasive radial pulse wave assessment for the evaluation of left ventricular systolic performance in heart failure.
BACKGROUND
Left ventricular (LV) developed pressure (dP/dt) is a classical index of myocardial contractility related to prognosis during heart failure. We sought to assess the reproducibility and feasibility of use of the maximal first derivative of the radial pulse, Rad dP/dt, as a peripheral criterion of ventricular contractility in patients with heart failure.


METHODS
We assessed 50 consecutive, patients with heart failure using aplanation tonometry to record the radial pulse wave and calculate Rad dP/dt. Echocardiography, Doppler flow and tissue Doppler imaging were used to record classical parameters of LV function: LV ejection fraction (LVEF), Tei index, dP/dt on mitral regurgitation (MR dP/dt) and peak systolic velocity (S'). Total systemic vascular resistance (TSVR) was calculated by use of the Doppler calculated cardiac output. Preload was assessed by the E/Ea ratio. Feasibility was tested in an ongoing prospective mortality study (n=310).


RESULTS
The Bland and Altman representation of repeated measurements of the Rad dP/dt showed good agreement. Feasibility was greater than 99% for a successful assessment on the right arm during the first attempt. The Rad dP/dt correlated with the LVEF, S' or Tei index as usual parameters of impaired contractility but not preload (E/Ea) or afterload (TSVR) parameters. MR dP/dt and Rad dP/dt were closely related (r=0.75, p<0.001). The ability of the arterial dP/dt to characterize LVEF was not modified by adjustment for arterial viscoelastic properties.


CONCLUSIONS
The maximal dP/dt of the radial pulse appears to be a valuable and reproducible peripheral criterion of LV systolic performance.
Tartiere
Jean-Michel
JM
Department of Physiology, Lariboisière Hospital, Assistance Publique, Paris, France. jean-michel.tartiere@lrb.ap-hop-paris.fr
Logeart
Damien
D
Beauvais
Florence
F
Chavelas
Christophe
C
Kesri
Lamia
L
Tabet
Jean-Yves
JY
Cohen-Solal
Alain
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001132:Arm / Q000098:blood supply; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D011674:Pulse; D017534:Radial Artery / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole; D014655:Vascular Resistance; D016277:Ventricular Function, Left; D017725:Ventricular Pressure