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CLINICAL STUDIES

Photoplethysmographic assessment of pulse wave reflection

Blunted response to endothelium-dependent beta₂-adrenergic vasodilation in type II diabetes mellitus

Philip J. Chowienczyk, FRCP^a* , Ronan P. Kelly, PhD^a* , Helen MacCallum, BN^a* , Sandrine C. Millasseau, MS^a* , Tomas L. G. Andersson, PhD^*, Raymond G. Gosling, PhD^a* , James M. Ritter, FRCP^a* and Erik E. Änggård, PhD

^a Department of Clinical Pharmacology, Centre for Cardiovascular Biology and Medicine, King’s College, London, United Kingdom
^* Department of Clinical Pharmacology, Institute of Laboratory Medicine, Lund University Hospital, Lund, Sweden
the William Harvey Research Institute, St. Bartholomew’s Hospital Medical College, London, United Kingdom

Manuscript received February 19, 1999; revised manuscript received June 18, 1999, accepted August 23, 1999.

Reprint requests and correspondence: Dr. P. J. Chowienczyk, Department of Clinical Pharmacology, St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom
p.chowienczyk{at}umds.ac.uk

OBJECTIVES

We sought to determine whether a simple index of pressure wave reflection may be derived from the digital volume pulse (DVP) and used to examine endothelium-dependent vasodilation in patients with type II diabetes mellitus.

BACKGROUND

The DVP exhibits a characteristic notch or inflection point that can be expressed as percent maximal DVP amplitude (IP_DVP). Nitrates lower IP_DVP, possibly by reducing pressure wave reflection. Response of IP_DVP to endothelium-dependent vasodilators may provide a measure of endothelial function.

METHODS

The DVP was recorded by photoplethysmography. Albuterol (salbutamol) and glyceryl trinitrate (GTN) were administered locally by brachial artery infusion or systemically. Aortic pulse wave transit time from the root of the subclavian artery to aortic bifurcation (T_Ao) was measured by simultaneous Doppler velocimetry.

RESULTS

Brachial artery infusion of drugs producing a greater than threefold increase in forearm blood flow within the infused limb was without effect on IP_DVP, whereas systemic administration of albuterol and GTN produced dose-dependent reductions in IP_DVP. The time between the first and second peak of the DVP correlated with T_Ao (r = 0.75, n = 20, p < 0.0001). The effects of albuterol but not GTN on IP_DVP were attenuated by N^G-monomethyl-L-arginine. The IP_DVP response to albuterol (400 µg by inhalation) was blunted in patients with type II diabetes mellitus as compared with control subjects (fall 5.9 ± 1.8% vs. 11.8 ± 1.8%, n = 20, p < 0.02), but that to GTN (500 µg sublingually) was preserved (fall 18.3 ± 1.2% vs. 18.6 ± 1.9%, p = 0.88).

CONCLUSIONS

The IP_DVP is influenced by pressure wave reflection. The effects of albuterol on IP_DVP are mediated in part through the nitric oxide pathway and are impaired in patients with type II diabetes.

Abbreviations and Acronyms   DVP = digital volume pulse   GTN = glyceryl trinitrate   IPDVP = inflection point in digital volume pulse expressed as percent DVP amplitude   iv = intravenous   LAo = distance from the root of the subclavian artery to the bifurcation of the aorta   L-NMMA = NG-monomethyl-L-arginine   NO = nitric oxide   PWVAo = aortic pulse wave velocity   sl = sublingual   TAo = aortic pulse wave transit time (root of subclavian artery to aortic bifurcation)   TDVP = time between first and second peak of digital volume pulse

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