1 – QRS complexes are detected with the ECG cable placed on the chest.
Joël Constans(a), Christine Germain(b), Philippe Gossec(c), Jacques Taillard(a),
Kiet Tiev(d), Isabelle Delevaux(e), Luc Mouthon(f), Claude Schmidt(g),
Florence Granel(h), Pascale Soria(i), François Lifermann(j), Gabriel Etienne(k),
Fabrice Bonnet(l), Karim Zoulim(m), Dominique Farge-Bancel(n), Isabelle Marie(o),
Yannick Allanore(p), Jean Cabane(d), Alain Amonchot(q), Isabelle Macquin-Mavier(r),
Journal of Hypertension 2007, 25:1900–1906
(a)Vascular and Internal Medicine Unit, CHU Bordeaux, (b)Clinical Epidemiology Unit, CHU Bordeaux, (c)Cardiology and Hypertension Unit, CHU Bordeaux, (d)Internal Medicine Unit, CHU Saint-Antoine, Paris, (e)Internal Medicine Unit, CHU Clermont-Ferrand, (f)Internal Medicine Unit, CHU Cochin, Paris, (g)Vascular Medicine Unit, CHU Nancy, (h)Dermatology Unit, CHU Nancy, (i)Internal Medicine Unit, CHU Limoges, (j)Internal Medicine Unit, CHG Dax, (k)Internal Medicine and Tropical Diseases Unit, CHU Bordeaux, (l)Internal Medicine and Infectious Diseases Unit, CHU Bordeaux, (m)Internal Medicine Unit, CHU Caen, (n)Internal Medicine Unit, CHU Saint-Louis, Paris, (o)Internal Medicine Unit, CHU Rouen, (p)Rheumatology Unit, CHU Cochin, Paris, (q)Cardiology Unit, CHU Clermont-Ferrand, (r)Clinical Investigation Unit, CHU Henri Mondor, Créteil and (s)Clinical Investigation Unit, CHU Nancy, France
P. Gosse(1), R. Lasserre(1), C. Minifie(1), P. Lemetayer(1)
(1) Hopital Saint André, Bordeaux, France
Philippe GOSSE, MD; Raphael LASSERRE, MD; Catherine MINIFIE, MD; Philippe LEMETAYER, MD; Jacques CLEMENTY, MD
Keywords: Arterial stiffness, QKD interval, ambulatory measurement of blood pressure, cardiovascular complications, hypertension
American Journal of Hypertension, AJH 2005;18:470-476
Philippe Gosse, Corinne Braunstein and Jacques Clementy
We have recently proposed a new method to evaluate the physical properties of arteries based on measurement of the QKD interval together with blood pressure arid heart rate with an ambulatory blood pressure monitoring device. This interval is the time
Key words: ambulatory blood pressure monitoring, arterial distensibility
Philippe Gosse, Pascal Guillo, Gilles Ascher, and Jacques Clementy
The timing of Korotkoff sounds, blood pressure, and heart rate can now be monitored in the ambulatory patient the QKD interval is the time between the onset of the depolarization on the electrodiogram (Q) and detection of the last Korotkoff sound (K) at the level of brachial artery during cuff deflation, corresponding to diastolic blood pressure (D). Because this interval is inversely related to pulse wave velocity, this recently developed device enables evaluation of the influence of blood pressure on arterial rigidity, providing valuable information on the properties of the arteries. In this study, we examined the influence of hypertension and age on the above parameters and their correlations to left ventricular mass.
QKD interval, blood pressure, and heart rate were monitored over a period of 24 h (four measurements/hour) in 33 normotensive and 70 untreated essential hypertensive patients. The slopes of the plots of QKD interval versus systolic and pulse pressure during the 24 h were calculated for each patient. The influence of age and hypertension on these slopes was tested by comparison of matched groups and multivariate analysis. Moreover the relationships between these parameters and echocardiographically assessed left ventricular mass were studied in 37 patients. We found a reduction in mean QKD interval with age and hypertension, reflecting the recognized higher pulse wave velocity in these patients. The slopes of the plots of QKD interval versus blood pressure were also lower in these patients, indicating the smaller influence of a change in blood pressure on pulse wave velocity in patients with stiffer arteries. Both average 24-h systolic blood pressure and the slope of QKD interval versus pulse pressure were significantly and independently correlated to left ventricular mass index. The influence of blood pressure on arterial rigidity can be evaluated by this new monitoring device. Our results showed that pulse wave velocity was less affected by a change in blood pressure in the patients with the stiffer arteries.
Key words : Pulse wave velocity, arterial distensibility, hypertension, ambulatory blood pressure monitoring, Korotkoff sounds.
American Journal of Hypertension 7, p.228-233, 1994
Philippe Abassade, Yves Baudouy. Cardiology.
Timing of Korotkoff sounds (QKd) is the time interval between Q wave ECG and pressure diastolic sound, determined by a routine ambulatory pressure monitoring (AMP) (Diasys Integra, Novacor). It is known to be an arterial distensibility index. However, this interval time includes pre-ejection time (PET) which is related to left ventricular (LV) function.
The aim of the study is to define the relative influences of LV function and arterial distensibility in QKd interval.
Sixty consecutive patients, with or without cardiac disease, out or in-hospital, were included. Patients with left bundle branch block, pace maker, or atrial fibrillation were excluded. The echocardiography-Doppler (ED) study collected LV function index : Shortening Fraction (SF), Ejection Fraction (EF), stroke index (SI), (PET), ejection time (ET). Pulse Wave velocity (PWV) was determined by ED in two points of the descending thoracic aorta. The AMP study collected-usual-pressure data : systolic (Ps), diastolic, mean (Pm), pulse pressure (Pp), simultaneously with PWV and over 24h. An automatic assessment of the QKd interval simultaneously with PWV was performed by the monitoring device. Another arterial distensibility index was calculated from ED and AMP:
QKd is correlated with PWV (n = 53 , p = 0.007, r = 0.37), with Burton index (n = 50 , p = 0,001,
QKd is correlated with CV function index like FE (n = 55, p < 0,001, r = 0,66), Ps/systolic diameter
No correlation was found between QKd and EF when PET are withdrawn from QKd (n = 35, p = 0.21,
QKd interval is a composite index which reflects not only arterial distensibility but also LV function.
Key words : Arterial distensibility, left ventricular function, echocardiography.American Journal of Hypertension 15:4, p.67A, 2002
Gosse*, Raphael Lasserre*, Catherine Minifié*, Philippe
Lemetayer*, Jacques Clementy*
Journal of Hypertension, volume 21 (Suppl. 41), June 2003, page S245, abstract P3.67
Prognostic Value of Ambulatory Measurement of the Timing of Korotkoff Sounds
in Elderly Hypertensives, a Pilot Study
Alteration of arterial distensibility in systemic sclerosis
Assesment of arterial distensibility in hemodialyzed patients. Is it related to
secondary hyperparathyroidism (HPT)?
Changes on arterial distensibility induced by hormonal replacement therapy in
both hypertensive and normotensive post-menopausal women: non-invasive
C. Rajkumar, J.D.
Cameron, J.S. Joshi, D. Lyons, P. Nihoyannopoulos, C.J. Bulpitt.
Design and Methods
adjusted for SBP
adjusted for DBP
|Carotid toe interval||220||-0.518**||-0.660**||-0.594*||3.9|
Journal of Hypertension 1999, vol 17 (suppl 13)
Influence of Age and Height
Philippe Gosse, Véronique
Jullien, Philippe Lemetayer, Philippe Jarnier and Jacques Clementy.
Ambulatory measurement of timing of Korotkoff sounds (QKd interval) gives an estimate of arterial distensibility derived from the velocity of the pulse wave over a vascular territory that includes the ascending aorta. The main advantages of the method are that it is entirely automatic, non-operator-dependent, and highly reproducible, and produces a measure independent of instantaneous blood pressure. This study of a group of 180 normal subjects aged between 10 and 78 years was designed to produce references values and to study the influence of height. The results confirmed the reduction with age of arterial distensibility in the whole population. However before the age of 30, QKd 100-60 was positively correlated with height according to the relationship QKd 100-60 = 0.73 height (cm) + 91, but not with age. This equation enables calculation of the theoretical value of QKd 100-60 as a function of height for any patient to which the observed value can be expressed as a percentage. This effectively eliminates the influence of height, which reflects the lenght of the arterial segment under investigation.
Key words: Arterial distensibility, QKd interval, Korotkoff sounds, ambulatory blood pressure measurement.
Am J Hypertens 1999; 12:231-235 1999 Amercian Journal of Hypertension, Ltd.
C. Lasseur, Y. Delmas, M.C. Cazin, B. Vendrely, P. Chauveau, P. Gosse
and C. Combe
Key words: Arterial compliance, chronic renal failure, hemodialysis, arteriosclerosis, QKd interval.
Clinical Nephrology, Vol 56, N° 6/2001 (435-444)
J. Taillard, J. Constans on behalf of the ERAMS study investigators
Patients with systemic sclerosis commonly exhibit increased arterial stiffness, which may be predictive of the overall severity of the disease. The aim of the present study was to check the stability of parameters of arterial stiffness after 1 year in this population. ERAMS is a French multicentric prospective study designed to identify a link between arterial distensibility and outcome in 100 patients with systemic sclerosis. Arterial distensibility was evaluated by 24-h ambulatory monitoring of QKD interval along with blood pressure (BP) and heart rate (HR) (four measurements/hour). The index QKD100-60, which is linked to aortic distensibility, was calculated automatically. QKD100-60 is the value of QKD (which depends on pulse wave velocity) for 100 mm Hg sBP and 60 bpm HR. The reproducibility of QKD100-60 was assessed on the first patients to be followed up for a complete year. So far the 100 patients have been recruited from 14 participating centres and 48 were re-evaluated after 1 year. QKD100-60 was highly reproducible: 201 +/- 6 vs 202 +/- 18 msec, standard deviation of difference = 13 msec. In conclusion: determination of QKD100-60 to assess arterial stiffness gives stable results over 1 year in patients with systemic sclerosis.
Journal of Human Hypertension
(2002) 16, 627-630.
Gosse, Veronique Jullien. Philippe Jarnier. Philippe Lernetayer, and Jacques
J Hypertens 1999;12:1252-1255 © 1999 American Journal of Hypertension,
Key words: Left ventricular hypertrophy, concentric remodeling, ambulatory blood pressure monitoring, arterial distensibility, QKD interval.