面積脈波の基礎的検討,および,脈波速度の臨床的観察

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Characteristics of pressure- and volume-pulse waves recorded in central and peripheral artery at the same time were analyzed for breaking phenomenon (Hurthle-Burton), pulse wave velocity (PWV) and apparent phase velocity (APV), dicrotic wave, and "Grundschwingungsdauer". I. Experimental study Infraton Gardirex 6 System (Siemens Co.) and an intravascular microtransducer system recently devised by our collaborators were used for recording of pressure- and volume-pulse waves in man as well as in the dog. a) Contour, timing, and frequency of the pulse wave A contour of both pulse waves was similar except one of anacrotic shoulder and late systolic bump (tidal wave). Difference in timing in appearance of both waves was within 4 msec, though volumepulse wave preceded to the pressure-pulse wave under the influence of nor- or epinephrine. Frequency analysis showed a relative amplitude of both waves was practically the same (±5%). b) Breaking phenomenon The breaking phenomenon (peaking and steeping) was observed in the pressure-pulse waves. An increase or a decrease of the propagation time (ΔT) of the volume-pulse waves was not uniform toward the periphery. c) Velocity A pulse wave velocity measured (from foot-to-foot or 1/5 points of the wave height) in both waves was found to be equal to apparent phase velocity of higher frequency components (4th, 5th, 6th) of the waves, that is, so-called true phase velocity, in normal subjects. In senile hypertensives, however, this relationship was not definite. Reflexion of the wave may be considered. d) "Grundschwingungsdauer (Ta)" Ta multiplied by PWV was remained almost constant in both waves under various experimental conditions. The functional length of the aortic windkessel system therefore appeared not to be changed. e) Dicrotic wave A peaking phenomenon (increasing in height) of the dicrotic wave was noted in both waves. The 2nd and 3rd harmonics of the waves participated mainly in this phenomenon. II. Clinical study a) Central PWV, age, sex and mean arterial pressure Central PWV was determined in 778 patients of which 360 were normotensive and remaining 418, hypertensive. 1. An increase in PWV for age was more prominent in the hypertensives than in the normotensives. 2. Statistically significant increase in PWV was found in middle- or old-aged females when compared with males. 3. An increase in PWV for mean arterial pressure was more marked in old-aged subjects than in middle-aged or young subjects. b) Central and peripheral PWV Determinations were performed on 75 normotensive and 49 hypertensive patients. 1. Peripheral PWV usually was larger than central PWV in the same subject. 2. Difference between central and peripheral PWV was gradually equalized with increase in age and mean arterial pressure. These results indicate that a difference in central and peripheral PWV may be due to functional and structural difference of both arteries. Peripheral PWV, therefore, does not surve for a clinical index for arteriosclerosis of the peripheral arteries.

面積脈波の基礎的検討,および,脈波速度の臨床的観察

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