Dawber, Thomas R.; THomas Jr., H. Emerson; McNamara, Patricia M.
April 1973
Angiology;Apr1973, Vol. 24 Issue 4, p244
Academic Journal
From the studies of others it appears that the normal pattern of the peripheral pulse wave as measured in young healthy children shows a clear-cut dierotic notch. With increasing age a smaller percentage of persons demonstrate this dicrotic incisura. Our observations indicate that in males the number of �normals� (definite dicrotic notch) has dropped to less than 50 per cent by age 45�54 and to less than 10 per cent by age 65�74. Distribution of the prevalence cases of coronary heart disease shows significantly higher percentages of CHD in subjects with vaseulograms with no distinct incisura, and the less pronounced the incisura the greater the amount of CHD. Vasculogram class is age related. However, when observations are made in ten-year age brackets the relationship still holds. Blood pressure level also shows an association with vasculogram class. However, the prevalence of coronary heart disease is still found to be related to vasculogram classes when examined in non-hypertensives. Cigarette smoking also shows a weak relationship to vasculogram class but again CHD in non-smokers is found to relate to vasculogram class indicating the relationship is independent of cigarette smoking. Relative weight is inversely related to vasculogram class for reasons which are not clear. No physiologic reason is known which would lead us to attribute disappearance of the dicrotic notch to the development of coronary heart disease. It is therefore concluded that the changes in the appearance of the peripheral pulse wave reflect changes in the arterial walls, including the coronary arteries, and may be a measure of the degree of atherosclerosis. Vaseulograms may be an additional useful test procedure in separating those with coronary heart disease from non-CHD subjects although their use in detection is clearly limited. The finding of an association with prevalence of coronary heart disease suggests that possibly this association may hold true for incidence as well. Following a further period of observation we will be able to report on the ability of the vasculogram class measured in apparently healthy persons to predict subsequent CHD. The data presented suggest that the persistence of a clearly defined dicrotic notch in the peripheral pulse wave tracing is a favorable sign. We suspect that the important factor is the age at which the notch disappears, i.e. the longer it persists the better the prognosis with regard to coronary heart disease development.


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