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Gamarra A, Díez-Villanueva P, Salamanca J, Aguilar R, Mahía P, Alfonso F. Development and Clinical Application of Left Ventricular-Arterial Coupling Non-Invasive Assessment Methods. J Cardiovasc Dev Dis 2024; 11:141. [PMID: 38786963 PMCID: PMC11122267 DOI: 10.3390/jcdd11050141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
The constant and dynamic interaction between ventricular function and arterial afterload, known as ventricular-arterial coupling, is key to understanding cardiovascular pathophysiology. Ventricular-arterial coupling has traditionally been assessed invasively as the ratio of effective arterial elastance over end-systolic elastance (Ea/Ees), calculated from information derived from pressure-volume loops. Over the past few decades, numerous invasive and non-invasive simplified methods to estimate the elastance ratio have been developed and applied in clinical investigation and practice. The echocardiographic assessment of left ventricular Ea/Ees, as proposed by Chen and colleagues, is the most widely used method, but novel echocardiographic approaches for ventricular-arterial evaluation such as left ventricle outflow acceleration, pulse-wave velocity, and the global longitudinal strain or global work index have arisen since the former was first published. Moreover, multimodal imaging or artificial intelligence also seems to be useful in this matter. This review depicts the progressive development of these methods along with their academic and clinical application. The left ventricular-arterial coupling assessment may help both identify patients at risk and tailor specific pharmacological or interventional treatments.
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Affiliation(s)
- Alvaro Gamarra
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Rio Aguilar
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Patricia Mahía
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
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Şahin M, Kazaz SN, Kartaler F, Kodal B, Altuntaş S, Yüce E, Turan OE, Kutlu M. Arterial Stiffness May Predict Subsequent Cancer Therapy-Related Cardiac Dysfunction in Breast Cancer Patients. Cardiovasc Toxicol 2024; 24:375-384. [PMID: 38457021 PMCID: PMC10998812 DOI: 10.1007/s12012-024-09841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Cancer therapy-related cardiac dysfunction (CTRCD) is still a serious problem. Existing risk scores are insufficient for risk classification, especially in low and medium-risk patients. This study aims to evaluate if arterial stiffness (AS) measurement, which is associated with most of the known risk factors, can be a useful parameter for predicting subsequent CTRCD in patients with breast cancer (BC). Patients with BC were included in the study. All patients' AS parameters such as pulse wave velocity (PWV), augmentation index (AIx), augmentation pressure (AP), and echocardiographic parameters were obtained before treatment. During treatment, echocardiographic follow-up with routine parameters and left ventricle global longitudinal strain (LVGLS) were measured. Patients were evaluated on whether CTRCD occurred or not. A total of 67 patients were analyzed. The mean age of the study population was 54.9 ± 11 years. Baseline characteristics were similar except for age. No CTRCD diagnosis was obtained according to left ventricle ejection fraction (LVEF) reduction, but 18 patients (26.8%) developed CTRCD regarding the decline in LVGLS. Left ventricle hypertrophy and diastolic dysfunction were more frequent in patients with CTRCD (p = 0.016 and p = 0.015, respectively). PWV, AIx, and AP as AS parameters were significantly higher in patients with CTRCD, but Alx@75 were not (p = 0.005, p = 0.034, p = 0.008, p = 0.077, respectively). A positive correlation between PWV and a decreased percent in LVGS (R = 0.607, p < 0.001) was observed. ROC curve analyses revealed an AUC of 0.747 (p = 0.02, 95% CI 0.632-0.832) for PWV. A PWV value of 9.2 m/s predicted CTRCD with 94% sensitivity and 73% specificity. AS measurement may be useful for predicting CTRCD in patients with low to medium-risk BC.
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Affiliation(s)
- Mürsel Şahin
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey.
| | - Seher Nazlı Kazaz
- Department of Medical Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | | | - Burcu Kodal
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
| | - Seda Altuntaş
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
| | - Elif Yüce
- Department of Medical Oncology, Karaman Training and Research Hospital, Karaman, Turkey
| | - Oğuzhan Ekrem Turan
- Department of Cardiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Merih Kutlu
- Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61000, Trabzon, Turkey
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Karasu BB, Emekli E. The Relationship of Renal Augmented Velocity Index With Ventricular-Arterial Coupling in Comparison to Renal Resistive Index: Analysis by Means of Arterial and Ventricular Elastances in Hypertensive Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2143-2154. [PMID: 37310113 DOI: 10.1002/jum.16285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE It's a well-known scientific statement that the heart and kidney functions are frequently tied together and the impairment of one directly alters the other. However, there exist knowledge gaps about this intricate pathophysiologic link and the exact unifying mechanism is not established. Herein, we aimed to investigate the presence of cardiorenal interaction at subclinical level while the conventional cardiac and renal clinical parameters are not disrupted yet in patients with hypertension. METHODS We chose a novel renal Doppler ultrasonographic parameter-augmented velocity index (Avi)-and an echocardiographic measure-ventriculoarterial coupling-which is complex to analyze but increasingly used after its acceptance about being a key determinant of cardiovascular efficiency. We recruited 137 patients without a previous history of antihypertensive medication use (47.4% women; median age, 49 years). Renal Avi, renal resistive index (RI), arterial elastance (Ea ), ventricular elastance (Ees ) and Ea /Ees (ventriculoarterial coupling) parameters were all examined. RESULTS Renal Avi, Ea , and Ea /Ees values were higher in females. Correlation analysis revealed that renal Avi was correlated with many hemodynamic variables including Ea and Ea /Ees . On multiple linear regression analysis, Ea and Ea /Ees remained as significant independent predictors of renal Avi but not of renal RI after adjustments for co-variables (β = 0.488, P < .001 for Ea ; β = 0.380, P < .001 for Ea /Ees ). CONCLUSIONS In comparison to renal RI, we suggest that renal Avi is a more reliable and promising index that can even measure subclinical changes in the cardiorenal circulation which needs to be elucidated.
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Affiliation(s)
- Betul Banu Karasu
- Department of Cardiology, Etimesgut Sehit Sait Erturk State Hospital, Ankara, Turkey
| | - Emre Emekli
- Department of Radiology, Etimesgut Sehit Sait Erturk State Hospital, Ankara, Turkey
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Zuo ML, Chen QY, Pu L, Shi L, Wu D, Li H, Luo X, Yin LX, Siu CW, Hong DQ, Gan H. Impact of Hemodialysis on Left Ventricular-Arterial Coupling in End-Stage Renal Disease Patients. Blood Purif 2023; 52:702-711. [PMID: 37579725 DOI: 10.1159/000531188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/18/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION As a key determinant of cardiovascular performance, vascular-arterial coupling (VAC) has been reported to be a predictor of clinical outcomes in various clinical scenarios. However, few studies have explored how acute fluid removal during hemodialysis (HD) impacts the interaction between cardiac function and the arterial system. METHODS We recruited 317 HD patients from an established renal dialysis unit for this cross-sectional study and a total of 285 were included in the final analyses. We measured left ventricle end-systolic elastance (Ees), the effective arterial elastance (Ea), and VAC before and after HD using noninvasive echocardiographic measurements. We also compared echocardiographic and hemodynamic parameters in ventriculo-arterial coupling and ventriculo-arterial uncoupling patients. RESULTS HD significantly altered partial ventricular and vascular function parameters such as blood pressure, left ventricular end-diastolic volume, stroke volume, left ventricular ejection fraction, and systemic vascular resistance index. Ea increased following HD from 3.5 ± 1.4 to 4.2 ± 1.8 mm Hg/mL (p < 0.0001), Ees increased following HD from 7.9 ± 5.5 to 9.2 ± 6.9 mm Hg/mL (p = 0.04), whereas VAC did not markedly alter as a result of HD. Ventriculo-arterial uncoupling was found to be related to abnormal cardiac structure and worse systolic function. CONCLUSIONS VAC obtained from echocardiography is likely to be load-independent and useful as a reliable index for stratifying the risk of cardiovascular diseases in HD patients. Further investigations on larger patient cohorts are needed to further validate our findings.
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Affiliation(s)
- Ming-Liang Zuo
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
| | - Qiu-Yi Chen
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Pu
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lan Shi
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Wu
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Li
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xian Luo
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Li-Xue Yin
- Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Da-Qing Hong
- Department of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Gan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Vriz O, Pirisi M, Habib E, Galzerano D, Fadel B, Antonini-Canterin F, Veldtman G, Bossone E. Age related structural and functional changes in left ventricular performance in healthy subjects: a 2D echocardiographic study. Int J Cardiovasc Imaging 2019; 35:2037-2047. [PMID: 31297672 DOI: 10.1007/s10554-019-01665-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/03/2019] [Indexed: 12/19/2022]
Abstract
Left ventricular (LV) adaptation to aging is currently poorly understood. We aimed to characterize age related changes in LV structure and function by studying a large group of healthy subjects across a wide age range. Prospectively enrolled healthy volunteers (n = 778, 327 females; age 18 to 100 years, mean age 49.8 ± 18.1 years), were divided into 4 age groups: 18 to 34 years (n = 165); 35 to 49 years (n = 242), 50 to 79 years (n = 334) and ≥ 80 years (n = 40). All subjects underwent clinical examination, as well as comprehensive transthoracic echocardiogram [TTE]. Body mass index, systolic blood pressure (BP), and left atrial volume (p < 0.0001) increased with age while diastolic BP (p < 0.0001) decreased over time. LV mass/body surface area (BSA) and relative wall thickness increased with age (p < 0.0001) coincident with worsening parameters of diastolic function (E/A and E/Em, p < 0.0001). The ejection fraction and Sm did not change significantly. Stroke volume, ejection time index, flow rate and stroke work significantly increased with age (p < 0.01). The arterial elastance (Ea), a measure of ventricular afterload, and ventricular elastance (Ees), an index of LV systolic stiffness did not change with age nor did their ratio (Ees/Ea) the latter being an expression of ventricular-arterial coupling. Age, gender and LVM were the main independent variables associated with LV systolic function. In conclusion, LV adaptation to aging in a healthy cohort is characterized by concentric LV remodeling, increased contractility and preserved ventricular-arterial coupling.
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Affiliation(s)
- Olga Vriz
- Heart Centre Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia. .,Cardiology and Emergency San Antonio Hospital, San Daniele del Friuli, Italy.
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Eiad Habib
- Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Domenico Galzerano
- Heart Centre Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Bahaa Fadel
- Heart Centre Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | | | - Gruschen Veldtman
- Heart Centre Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Eduardo Bossone
- U.O.C Riabilitazione Cardiovascolare, A Cardarelli, Naples, Italy
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Corazza I, Casadei L, Bonafè E, Cercenelli L, Marcelli E, Zannoli R. How to transform a fixed stroke alternating syringe ventricle into an adjustable elastance ventricle. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2018; 89:074301. [PMID: 30068143 DOI: 10.1063/1.5030100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Most devices used for bench simulation of the cardiovascular system are based either on a syringe-like alternating pump or an elastic chamber inside a fluid-filled rigid box. In these devices, it is very difficult to control the ventricular elastance and simulate pathologies related to the mechanical mismatch between the ventricle and arterial load (i.e., heart failure). This work presents a possible solution to transforming a syringe-like pump with a fixed ventricle into a ventricle with variable elastance. Our proposal was tested in two steps: (1) fixing the ventricle and the aorta and changing the peripheral resistance (PHR); (2) fixing the aorta and changing the ventricular elastance and the PHR. The signals of interest were acquired to build the ventricular pressure-volume (P-V) loops describing the different physiological conditions, and the end-systolic pressure-volume relationships (ESPVRs) were calculated with linear interpolation. The results obtained show a good physiological behavior of our mock for both steps. (1) Since the ventricle is the same, the systolic pressures increase and the stroke volumes decrease with the PHR: the ESPVR, obtained by interpolating the pressure and volume values at end-systolic phases, is linear. (2) Each ventricle presents ESPVR with different slopes depending on the ventricle elastance with a very good linear behavior. In conclusion, this paper demonstrates that a fixed stroke alternating syringe ventricle can be transformed into an adjustable elastance ventricle.
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Affiliation(s)
- Ivan Corazza
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Lorenzo Casadei
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Elisa Bonafè
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
| | - Romano Zannoli
- Experimental, Diagnostic and Specialty Medicine Department, University of Bologna, Bologna, Italy
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Dobson GP, Arsyad A, Letson HL. The Adenosine Hypothesis Revisited: Modulation of Coupling between Myocardial Perfusion and Arterial Compliance. Front Physiol 2017; 8:824. [PMID: 29104545 PMCID: PMC5654924 DOI: 10.3389/fphys.2017.00824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/06/2017] [Indexed: 12/25/2022] Open
Abstract
For over four decades the thoracic aortic ring model has become one of the most widely used methods to study vascular reactivity and electromechanical coupling. A question that is rarely asked, however, is what function does a drug-mediated relaxation (or contraction) in this model serve in the intact system? The physiological significance of adenosine relaxation in rings isolated from large elastic conduit arteries from a wide range of species remains largely unknown. We propose that adenosine relaxation increases aortic compliance in acute stress states and facilitates ventricular-arterial (VA) coupling, and thereby links compliance and coronary artery perfusion to myocardial energy metabolism. In 1963 Berne argued that adenosine acts as a local negative feedback regulator between oxygen supply and demand in the heart during hypoxic/ischemic stress. The adenosine VA coupling hypothesis extends and enhances Berne's "adenosine hypothesis" from a local regulatory scheme in the heart to include conduit arterial function. In multicellular organisms, evolution may have selected adenosine, nitric oxide, and other vascular mediators, to modulate VA coupling for optimal transfer of oxygen (and nutrients) from the lung, heart, large conduit arteries, arterioles and capillaries to respiring mitochondria. Finally, a discussion of the potential clinical significance of adenosine modulation of VA coupling is extended to vascular aging and disease, including hypertension, diabetes, obesity, coronary artery disease and heart failure.
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Affiliation(s)
- Geoffrey P Dobson
- Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Aryadi Arsyad
- Physiology Department, Medical Faculty, Hasanuddin University, Makassar, Indonesia
| | - Hayley L Letson
- Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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