While parameters from pressure analysis could be related to arterial stiffness and prognosis in general populations, the results for patients with severely reduced ejection fraction (rEF) are rather puzzling. The aim of this study is to use wave intensity analysis (WIA), based on aortic pressure and velocity curves, and compare forward wave intensity in 61 patients with rEF and 122 controls with normal ejection fraction.

Typically WIA yields two distinct forward waves. The first (S-wave) is a compression wave (increasing pressure and flow) generated by systolic ventricular contraction. The second (D-wave) is an expansion wave (decreasing pressure and flow) occurring around valve closure. The ratio of these wave peaks (SDR) was calculated for patients matched for age, height, weight, gender, and brachial blood pressures with two methods: First, aortic pressure waves from the SphygmoCor system were aligned with Doppler velocity measurements from left ventricular outflow tract. Second, a flow model based on Windkessel theory was used to replace Doppler measurements.

In the whole group, SDRs, as calculated with both methods, showed highly significant direct relationships with measures of systolic function (ejection fraction, stroke volume, cardiac output, S′, invasive left ventricular dp/dt).

SDR, calculated using aortic pressure and Doppler velocity curves, was significantly reduced for the rEF group (2.9 vs. 5.3, p<0.0001). Using the flow model, a similar reduction could be found (2.9 vs. 4.8, p<0.0001).

These results suggest that peak forward wave intensity is capable to reflect reduced systolic ventricular function, even when Doppler flow measurements are omitted.