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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

View larger version (18K): [in a new window]   Figure 1 The digital volume pulse (DVP) and first derivative (dV/dt, lower trace) recorded before and after systemic administration of GTN (500 µg sublingually). The notch or point of inflection at height, b, is identified by the local maximum in the first derivative. The height of the inflection point (IPDVP) is expressed as percent DVP amplitude, a. The IPDVP falls after GTN. The time between the first and second peak of the DVP (TDVP) was measured in some experiments.

View larger version (12K): [in a new window]   Figure 2 Ratios of forearm blood flow (FBF, open squares) and inflection point of the digital volume pulse (IPDVP, circles) in the infused-noninfused arms during brachial artery infusion of albuterol (ALB, n = 5) and glyceryl trinitrate (GTN, n = 5).

View larger version (23K): [in a new window]   Figure 3 Typical DVP traces showing responses to sublingual (s.l.) and intravenous (i.v.) and to inhaled and i.v. albuterol (ALB).

View larger version (17K): [in a new window]   Figure 4 Changes from baseline in hemodynamic measurements after GTN (n = 10) and albuterol (ALB, n = 10) after saline placebo or L-NMMA administered 15 min before GTN/ALB. CO = cardiac output; DBP = diastolic blood pressure; HR = heart rate; IPDVP = height of inflection point of DVP measured as percent amplitude; SBP = systolic blood pressure; SVR = systemic vascular resistance. Percent change from baseline of the IPDVP refers to change in percent units (e.g., fall from 80% to 60% = [80–60]/80 = 25%). *p < 0.05 for L-NMMA vs. saline. **p < 0.01 for L-NMMA vs. saline. Open box = saline; dotted box = L-NMMA.

View larger version (28K): [in a new window]   Figure 5 Height of the inflection point of the digital volume pulse relative to the amplitude (IPDVP) and aortic pulse wave velocity (PWVAo) in healthy men (n = 5) at baseline, 5 min after GTN (500 µg sublingually) and after 20 min of recovery.

View larger version (13K): [in a new window]   Figure 6 Correlation between the time from the first to second peak of the digital volume pulse (TDVP) and pressure wave transit time from the root of the subclavian artery to the aortic bifurcation (TAo) in 20 healthy men (r = 0.75, p < 0.0001).

View larger version (15K): [in a new window]   Figure 7 Decrease from baseline in the height of the inflection point of the digital volume pulse (IPDVP) after GTN (500 µg sublingually) and albuterol (ALB, 400 µg by inhalation through spacer) in patients with type II diabetes (n = 20) and control subjects (n = 20).