The Incisura

Abstract

Analysis of the arterial pressure waveform remains useful in modern practice to assess alterations that may indicate significant abnormalities of cardiovascular parameters. The recognition of abnormalities of the incisura and dicrotic wave should alert the clinician to seek specific etiologic factors. Understanding the physiological origins of the incisura and dicrotic notch enhance its clinical utility in accurately diagnosing abnormal hemodynamic states. This review summarizes the hemodynamic events causing and affecting the inscription of the incisura in the arterial waveform.

Characterization of Rat Cardiovascular System by Anacrotic/Dicrotic Notches in the Condition of Increase/Decrease of NO Bioavailability

“…These data can contribute to the characterization of the specific modes of action of bioactive substances. However, only a few hemodynamic parameters (HPs) of APW in different patho-physiological conditions have been characterized so far [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. To our knowledge, except for our two recent studies [ 22 , 23 ], there was neither a detailed detection of anacrotic notch nor reports of the time dependence of the cross-relationships of HPs.…”

Systolic-dicrotic notch pressure difference can identify tachycardic patients with septic shock at risk of cardiovascular decompensation following pharmacological heart rate reduction

“…At baseline, the only significant difference between groups was the SDP difference (53 [16] mm Hg in high art dP/dt max vs 40 [19] mm Hg in patients with low art dP/dt max after HR reduction; P¼0.01). Whilst the group of patients with high art dP/dt max after esmolol maintained similar values of SDP difference after HR reduction (49 [16] mm Hg), those with low dP/dt max after esmolol showed a significant reduction in SDP difference (to 29 [11] mm Hg), resulting in a larger SDP difference between groups after esmolol administration (P<0.001). Such finding was the net result of a significant reduction in SAP in the presence of similar values of DNP in the group with low values of art dP/ dt max after HR reduction, whereas the group with higher dP/ dt max after esmolol maintained unchanged the SAP and the DNP values (Table 2).…”

Pitfalls in the assessment of ventriculo-arterial coupling from peripheral waveform analysis in septic shock. Comment on Br J Anaesth 2020; 125: 1018–1024

“…While this is certainly true at the aortic level, caution should be paid when analysing peripheral arterial waveforms: the dicrotic notch on a peripheral arterial wave is often considered a surrogate of the aortic incisura, but more than mere terminology separates the two. 4 The incisura and the following dicrotic wave reflect, respectively, aortic valve closure and rebound of the aortic root at the termination of retrograde flow; they both become less evident distally from the ascending aorta and disappear on arterial signals recorded 35e40 cm from it. 4 The appearance of one (sometimes multiple) late dicrotic notch and wave on peripheral arterial waveforms may not represent aortic valve closure, but rather the impact of backward waves reflected at the arterio-arteriolar junction.…”

“…4 The incisura and the following dicrotic wave reflect, respectively, aortic valve closure and rebound of the aortic root at the termination of retrograde flow; they both become less evident distally from the ascending aorta and disappear on arterial signals recorded 35e40 cm from it. 4 The appearance of one (sometimes multiple) late dicrotic notch and wave on peripheral arterial waveforms may not represent aortic valve closure, but rather the impact of backward waves reflected at the arterio-arteriolar junction. 4,5 In young healthy individuals, the timing of wave reflection almost coincides with the beginning of diastole to facilitate coronary perfusion (Fig.…”

“…4 The appearance of one (sometimes multiple) late dicrotic notch and wave on peripheral arterial waveforms may not represent aortic valve closure, but rather the impact of backward waves reflected at the arterio-arteriolar junction. 4,5 In young healthy individuals, the timing of wave reflection almost coincides with the beginning of diastole to facilitate coronary perfusion (Fig. 1).…”