From The Second Department of Internal Medicine, Tokyo Medical College,
Tokyo, Japan.
Correspondence to Kenji Takazawa, MD, The Second Department of Internal Medicine, Tokyo Medical College Hospital, 6–7-1, Nishishinjuku Shinjuku Tokyo 160, Japan.
Abstract
Abstract—To evaluate the clinical
application of the second derivative of the fingertip
photoplethysmogram waveform, we performed drug administration studies
(study 1) and epidemiological studies (study 2). In study 1, ascending
aortic pressure was recorded simultaneously with the
fingertip photoplethysmogram and its second derivative in 39 patients
with a mean±SD age of 54±11 years. The augmentation index was defined
as the ratio of the height of the late systolic peak to that of
the early systolic peak in the pulse. The second derivative
consists of an a, b, c, and d wave in systole and an e wave in
diastole. Ascending aortic pressure increased after
injection of 2.5 µg angiotensin from 126/74 to
160/91 mm Hg and decreased after 0.3 mg sublingual
nitroglycerin to 111/73 mm Hg. The d/a, the ratio
of the height of the d wave to that of the a wave, decreased after
angiotensin from -0.40±0.13 to -0.62±0.19 and increased
after nitroglycerin to -0.25±0.12
(P<0.001 and P<0.001, respectively).
The negative d/a increased with increases in plethysmographic and
ascending aortic augmentation indices (r=0.79,
P<0.001, and r=0.80,
P<0.001, respectively). The negative d/a reflects the
late systolic pressure augmentation in the ascending aorta and
may be useful for noninvasive evaluation of the effects of vasoactive
agents. In study 2, the second derivative of the plethysmogram waveform
was measured in a total of 600 subjects (50 men and 50 women in each
decade from the 3rd to the 8th) in our health assessment center. The
b/a ratio increased with age, and c/a, d/a, and e/a ratios decreased
with age. Thus, the second derivative aging index was defined as
b-c-d-e/a. The second derivative wave aging index (y)
increased with age (x) (r=0.80,
P<0.001,
y=0.023x-1.515). The second derivative
aging index was higher in 126 subjects with any history of diabetes
mellitus, hypertension, hypercholesterolemia,
and ischemic heart disease than in age-matched subjects without
such a history (-0.06±0.36 versus -0.22±0.41,
P<0.01). Women had a higher aging index than men
(P<0.01). The b-c-d-e/a ratio may be useful for
evaluation of vascular aging and for screening of arteriosclerotic
disease.
© 1998 American Heart Association, Inc.
Third Workshop on Structure and Function of Large Arteries: Part II
Assessment of Vasoactive Agents and Vascular Aging by the Second Derivative of Photoplethysmogram Waveform
Key Words: photoplethysmography • second derivative wave • augmentation index • vasoactive agents • vascular aging • angiotensin • nitroglycerin
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