Diagnostic Value of the First and Second Derivatives of the Arterial Pressure Pulse

IT HAS been appreciated for many years that characteristic alterations in the configuration of the central and peripheral arterial pressure pulses occur in the presence of abnormalities of the aortic valve, whether they are induced experimentally or occur in patients with aortic valve disease.1--~It is also recognized that the arterial pressure pulse is modified in patients with idiopathic hypertrophic subaortic stenosis, although the changes that occur in this disease differ strikingly from those seen in patients with valvular aortic stenosis. 6-8 In the past, the characterization of arterial pressure pulses in patients with these lesions has consisted of descriptions of the pulse contour, determination of the presence and position of the anacrotic and dicrotic notches, measurement of the duration of systole and of the systolic upstroke time, and estimation of the slope of the pressure rise. In patients with severe valvular aortic stenosis, there is often prolongation of the total duration of ejection and of the systolic upstroke time.9-13 Although the latter period is shortened in patients with idiopathic hypertrophic subaortic stenosis, there is considerable overlap in these measurements among various groups of patients and normal individuals.9 In order to derive more diagnostic information from the pressure pulse, some investigators have calculated the mean rate of arterial pressure rise by dividing the pulse pressure by the systolic upstroke time, or have estimated the slope of the pressure rise from the recorded tracing."