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Relationship between pulse transit time and blood pressure is impaired in patients with chronic heart failure

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Abstract

Aims

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).

Methods and 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.

Conclusion

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.

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References

  1. Stewart S (2005) Financial aspects of heart failure programs of care. Eur J Heart Fail 7:423–428

    Article  PubMed  Google Scholar 

  2. Massie BM, Shah NB (1997) Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J 133:703–712

    Article  CAS  PubMed  Google Scholar 

  3. Khand A, Gemmel I, Clark A, Cleland JGF (2000) Is the prognosis of heart failure improving? J Am Coll Cardiol 36:2284–2286

    Article  CAS  PubMed  Google Scholar 

  4. Mitchell GF, Tardif JC, Arnold MO, Marchiori G, O’Brien TX, Dunlap ME, Pfeffer MA (2001) Pulsatile hemodynamics in congestive heart failure. Hypertension 38:1433–1439

    Article  CAS  PubMed  Google Scholar 

  5. Fischer D, Rossa S, Landmesser U, Spiekermann S, Engberding N, Hornig B, Drexler H (2005) Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death. Eur Heart J 26:65–69

    Article  CAS  PubMed  Google Scholar 

  6. Balmain S, Padmanabhan N, Ferrell WR, Morton JJ, McMurray JJ (2007) Differences in arterial compliance, microvascular function and venous capacitance between patients with heart failure and either preserved or reduced left ventricular systolic function. Eur J Heart Fail 9:865–871

    Article  PubMed  Google Scholar 

  7. Andreassen AK, Kirkeboen KA, Gullestad L, Simonsen S, Kvernebo K (1998) Effect of heart transplantation on impaired peripheral microvascular perfusion and reactivity in congestive heart failure. Int J Cardiol 65:33–40

    Article  CAS  PubMed  Google Scholar 

  8. Warren JA, Loi RK (1995) Captopril increases skin microvascular blood flow secondary to bradykinin, nitric oxide, and prostaglandins. FASEB J 9:411–418

    CAS  PubMed  Google Scholar 

  9. Chan GS, Middleton PM, Celler BG, Wang L, Novell NH (2007) Automatic detection of left ventricular ejection time from a finger photoplethysmographic pulse oximetry waveform: comparison with Doppler aortic measurement. Physiol Meas 28:439–452

    Article  PubMed  Google Scholar 

  10. Chan GS, Middleton PM, Celler BG, Wang L, Novell NH (2007) Change in pulse transit time and pre-ejection period during head-up tilt-induced progressive central hypovolemia. J Clin Monit Comput 21:283–293

    Article  PubMed  Google Scholar 

  11. Smith RP, Argod J, Pepin JL, Levy PA (1999) Pulse transit time: an appraisal of potential clinical applications. Thorax 54:452–457

    Article  CAS  PubMed  Google Scholar 

  12. Pagani J, Villa MP, Calcagni G, Alterio A, Ambrosio R, Censi F, Ronchetti R (2003) Pulse transit time as a measure of inspiratory effort in children. Chest 124:1487–1493

    Article  PubMed  Google Scholar 

  13. Singham S, Voss L, Barnard J, Sleigh J (2003) Nociceptive and anaesthetic-induced changes in pulse transit time during general anaesthesia. Br J Anaesth 91:662–666

    Article  CAS  PubMed  Google Scholar 

  14. Sharwood-Smith G, Bruce J, Drummond G (2006) Assessment of pulse transit time to indicate cardiovascular changes during obstetric spinal anaesthesia. Br J Anaesth 96:100–105

    Article  CAS  PubMed  Google Scholar 

  15. Tei C, Ling L, Hodge D, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol 26:357–366

    CAS  PubMed  Google Scholar 

  16. Zhou Q, Henein M, Coats A, Gibson D (2000) Different effects of abnormal activation and myocardial disease on left ventricular ejection and filling times. Heart 84:272–276

    Article  CAS  PubMed  Google Scholar 

  17. Arnold JM, Marchiori GE, Imrie JR, Burton GL, Pflugfelder PW, Kostuk WJ (1991) Large artery function in patients with chronic heart failure. Studies of brachial artery diameter and hemodynamics. Circulation 84:2418–2425

    CAS  PubMed  Google Scholar 

  18. Hashimoto J, Chonan K, Aoki Y, Nishimura T, Ohkubo T, Hozawa A, Suszuki M, Matsubara M, Michimata M, Araki T, Imai Y (2002) Pulse wave velocity and the second derivative of the finger photoplethysmogram in treated hypertensive patients: their relationship and associating factors. J Hypertens 20:2415–2422

    Article  CAS  PubMed  Google Scholar 

  19. Kullo IJ, Malik AR (2007) Arterial ultrasonography and tonometry as adjuncts to cardiovascular risk stratification. J Am Coll Cardiol 49:1413–1426

    Article  PubMed  Google Scholar 

  20. Hertzman AB, Spealman C (1937) Observations of the finger volume pulse recorded photo-electrically. Am J Physiol 119:334–335

    Google Scholar 

  21. Grassi G, Bolla G, Quarti-Trevano, Arenare F, Brambilla G, Mancia G (2008) Sympathetic activation in congestive heart failure: reproducibility of neuroadrenergic markers. Eur J Heart Fail 10:1186–1191

  22. Delagardelle C, Feiereisen P, Vaillant M, Gilson G, Lasar Y, Beissel J, Wagner DR (2008) Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure. Clin Res Cardiol 97:865–871

    Article  PubMed  Google Scholar 

  23. Braunwald E, Sarnoff SJ, Stainsby WN (1953) Determinants of duration and mean rate of ventricular ejection. Circ Res 6:319–325

    Google Scholar 

  24. Weissler AM, Harris WS, Schoenfeld CD (1968) Systolic time intervals in heart failure in man. Circulation 37:149–159

    CAS  PubMed  Google Scholar 

  25. Lane RE, Chow WC, Chin D, Mayet J (2004) Selection and optimization of biventricular pacing: the role of echocardiography. Heart 90(Suppl):10–16

    Article  Google Scholar 

  26. Chen HM, Yu WC, Sung SH, Wang KL, Chuang SY, Chen CH (2008) Usefulness of systolic time intervals in the identification of abnormal ventriculo-arterial coupling in stable heart failure patients. Eur J Heart Fail 10:1192–1200

    Article  PubMed  Google Scholar 

  27. Sunagawa K, Maughan WL, Sagawa K (1985) Optimal arterial resistance for the maximal stroke work studied in isolated canine left ventricle. Circ Res 56:586–595

    CAS  PubMed  Google Scholar 

  28. Kass D, Maughan WL (1988) From ‘Emax’ to pressure–volume relations: a broader view. Circulation 77:1203–1212

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work has been supported by grants from the Fonds National de la Recherche (FNR), Luxembourg, the Ministry of Research, Luxembourg, the Société pour la Recherche sur les Maladies Cardiovasculaires, Luxembourg, Centre de Recherche Public Henri-Tudor, Luxembourg and the Deutsche Forschungsgemeinschaft, Klinische Forschergruppe KFO 196, Zentralprojekt, Germany. The authors would like to thank Malou Gloesener and Loredana Jacobs for expert technical assistance.

Conflict of interest statement

Wagner DR, Roesch N, Harpes P and Plumer P hold a patent on measuring device for pulse transit time.

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Authors and Affiliations

  1. Centre Hospitalier Luxembourg, Cardiology, 4, rue Barblé, 1210, Luxembourg, G.D. of Luxembourg

    Daniel R. Wagner, Amir Saberin, Viviane Chakoutio, Denis Oundjede, Charles Delagardelle, Jean Beissel & Georges Gilson

  2. Centre de Recherche Public Henri Tudor, Luxembourg, G.D. of Luxembourg

    Norbert Roesch, Patrick Harpes & Pierre Plumer

  3. Herzzentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany

    Heinrich Körtke

  4. Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Ingrid Kindermann & Michael Böhm

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  1. Daniel R. Wagner
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  2. Norbert Roesch
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  3. Patrick Harpes
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  9. Charles Delagardelle
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Correspondence to Daniel R. Wagner.

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Wagner, D.R., Roesch, N., Harpes, P. et al. Relationship between pulse transit time and blood pressure is impaired in patients with chronic heart failure. Clin Res Cardiol 99, 657–664 (2010). https://doi.org/10.1007/s00392-010-0168-0

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  • DOI: https://doi.org/10.1007/s00392-010-0168-0

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