Summary
Wave intensity (WI) is a new hemodynamic index, which is defined as (dP/dt)(dU/dt) at any site of the circulation, where dP/dt and dU/dt are the time derivatives of blood pressure and velocity, respectively. Arterial WI in normal subjects has two positive sharp peaks. The first peak occurs during early systole when a forward-traveling compression wave is generated by the left ventricle. The magnitude of this peak increases markedly with an increase in cardiac contractility. The second peak, which occurs towards the end of systole, is caused by generation of a forward-traveling expansion wave by the ability of the left ventricle to actively stop aortic blood flow. The interval between the R wave of the ECG and the first peak of WI (R-lst peak interval) and the interval between the first and second peaks (lst–2nd interval) are approximately equal to the preejection period and left ventricular ejection time, respectively. Using a combined Doppler and echotracking system, we obtained carotid arterial WI non-invasively. We examined the characteristics of WI in 11 patients with mitral regurgitation (MR) before and after surgery, and 24 normal volunteers. In the MR group before surgery, the second peak was decreased and the (lst–2nd interval)/(R-R interval) ratio was reduced, compared with the normal group (140 ± 130 vs 750 ± 290mmHgm/s3, P < 0.0083; 20.7% ± 3.4% vs 26.7% ± 2.8%, P < 0.0083). There were no significant differences in the first peak between the normal group and the MR group before and after surgery. The second peak in the MR group was increased significantly (P < 0,016 vs before surgery) to 1150 ± 830mmHgm/s3 in the early period after surgery (stage I), and to 1090 ± 580mmHgm/s3 in the late period after surgery (stage II). These values did not differ significantly from that of the normal group. At stage I, the (R-1st peak interval)/(R-R interval) ratio was increased from 13.4% ± 2.7% to 2.6% ± 5.6% (P < 0.016 vs before surgery). At stage II, this ratio decreased to 16.2% ± 2.8% (P < 0.016 vs stage I), but was still significantly higher than that before surgery. The (1st–2nd inteval)/(R-R interval) ratio increased significantly after surgery (P < 0.016 vs before surgery) to values (27.0% ± 4.5% at stage I and 28.9% ± 2.6% at stage II) which did not differ significantly from that of the normal group. The recovery of the second peak after surgery suggests that the left ventricle had recovered the ability to actively stop aortic blood flow. Wave intensity is useful for analyzing changes in the working condition of the heart.
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K.N. and M.S. were supported by Grants-in-Aid for Scientific Research (B)-11695092 and (C)-11670713 from the Ministry of Education, Science, Sports and Culture of Japan.
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Niki, K., Sugawara, M., Uchida, K. et al. A noninvasive method of measuring wave intensity, a new hemodynamic index: application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart and Vessels 14, 263–271 (1999). https://doi.org/10.1007/BF03257237
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DOI: https://doi.org/10.1007/BF03257237