title: Relationship between pulse transit time and blood pressure is impaired in patients with chronic heart failure.
abstract: OBJECTIVE
  Pulse transit time (PTT), the interval between ventricular electrical activity and arrival of the peripheral pulse wave, has been used to detect changes in autonomic tone during sleep and anesthesia. The purpose of this study was to evaluate PTT in patients with chronic heart failure (HF).
  
  
  RESULTS
  Pulse transit time was measured with R-wave gated photoplethysmography in 24 healthy volunteers and in 112 patients with chronic HF and ejection fraction (EF) <40%. PTT was mildly elevated in patients with HF (468 ± 12 vs. 430 ± 23 ms, p = 0.001). In healthy volunteers, PTT was directly proportional to blood pressure (BP): when BP increased, PTT shortened, and vice versa. This relationship between PTT and BP (PTTi) was altered in patients with HF and particularly in the 26 patients with decompensated HF (3.6 ± 0.4 vs. 4.2 ± 0.9, p = 0.04). PTTi did not correlate with functional NYHA class and levels of pro-BNP, epinephrine or norepinephrine. There was a modest correlation between PTTi and EF (p = 0.01, r = -0.48) and PTTi tended to correlate with microvascular flow measured with Laser Doppler (p = 0.08). However, there was an excellent correlation between PTTi and systolic time intervals, left ventricular ejection time (LVET) (p = 0.0014, r = -0.75) and pre-ejection time/LVET (p = 0.006, r = 0.80). The latter ratio reflects ventricular-arterial coupling.
  
  
  CONCLUSIONS
  The relationship between PTT and BP is altered in severe HF and may indicate impaired ventricular-arterial coupling. It merits further investigation as both parameters can be easily determined and used for serial monitoring in HF.
authors.affiliation: Centre Hospitalier Luxembourg, G.D. of Luxembourg. wagner.daniel@chl.lu
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wagner
authors.forename: Norbert
authors.initials: N
authors.lastname: Roesch
authors.forename: Patrick
authors.initials: P
authors.lastname: Harpes
authors.forename: Heinrich
authors.initials: H
authors.lastname: Körtke
authors.forename: Pierre
authors.initials: P
authors.lastname: Plumer
authors.forename: Amir
authors.initials: A
authors.lastname: Saberin
authors.forename: Viviane
authors.initials: V
authors.lastname: Chakoutio
authors.forename: Denis
authors.initials: D
authors.lastname: Oundjede
authors.forename: Charles
authors.initials: C
authors.lastname: Delagardelle
authors.forename: Jean
authors.initials: J
authors.lastname: Beissel
authors.forename: Georges
authors.initials: G
authors.lastname: Gilson
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kindermann
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011674:Pulse; D013997:Time Factors
references.citation: Circulation. 1991 Dec;84(6):2418-25
references.pmid: 1959197
references.citation: J Clin Monit Comput. 2007 Oct;21(5):283-93
references.pmid: 17701385
references.citation: Circ Res. 1985 Apr;56(4):586-95
references.pmid: 3978773
references.citation: FASEB J. 1995 Mar;9(5):411-8
references.pmid: 7896012
references.citation: Clin Res Cardiol. 2008 Dec;97(12):865-71
references.pmid: 18696023
references.citation: Heart. 2000 Sep;84(3):272-6
references.pmid: 10956289
references.citation: Circulation. 1988 Jun;77(6):1203-12
references.pmid: 3286035
references.citation: Eur Heart J. 2005 Jan;26(1):65-9
references.pmid: 15615801
references.citation: Heart. 2004 Dec;90 Suppl 6:vi10-6
references.pmid: 15564419
references.citation: Eur J Heart Fail. 2005 Mar 16;7(3):423-8
references.pmid: 15718184
references.citation: Eur J Heart Fail. 2007 Sep;9(9):865-71
references.pmid: 17644472
references.citation: J Hypertens. 2002 Dec;20(12):2415-22
references.pmid: 12473866
references.citation: Eur J Heart Fail. 2008 Dec;10(12):1192-200
references.pmid: 19004668
references.citation: Circulation. 1968 Feb;37(2):149-59
references.pmid: 5640345
references.citation: Int J Cardiol. 1998 Jun 1;65(1):33-40
references.pmid: 9699928
references.citation: Chest. 2003 Oct;124(4):1487-93
references.pmid: 14555584
references.citation: Circ Res. 1958 May;6(3):319-25
references.pmid: 13523814
references.citation: J Am Coll Cardiol. 2007 Apr 3;49(13):1413-26
references.pmid: 17397669
references.citation: Br J Anaesth. 2006 Jan;96(1):100-5
references.pmid: 16257996
references.citation: J Cardiol. 1995 Dec;26(6):357-66
references.pmid: 8558414
references.citation: Am Heart J. 1997 Jun;133(6):703-12
references.pmid: 9200399
references.citation: Physiol Meas. 2007 Apr;28(4):439-52
references.pmid: 17395998
references.citation: Br J Anaesth. 2003 Nov;91(5):662-6
references.pmid: 14570787
references.citation: J Am Coll Cardiol. 2000 Dec;36(7):2284-6
references.pmid: 11127474
references.citation: Hypertension. 2001 Dec 1;38(6):1433-9
references.pmid: 11751731
references.citation: Eur J Heart Fail. 2008 Dec;10(12):1186-91
references.pmid: 18851926
references.citation: Thorax. 1999 May;54(5):452-7
references.pmid: 10212114