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Kataoka Y, Fukuda Y, Shelly I, Peterson J, Yokota S, Uemura K, Saku K, Alexander J, Sunagawa K. Inverse ESPVR Estimation with Singularity Avoidance via Constrained EDPVR Parameter Optimization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38083332 DOI: 10.1109/embc40787.2023.10340472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Left ventricular end-systolic elastance Ees, as an index of cardiac contractility, can play a key role in continuous patient monitoring during cardiac treatment scenarios such as drug therapies. The clinical feasibility of Ees estimation remains challenging because most techniques have been built on left ventricular pressure and volume, which are difficult to measure or estimate in the regular ICU/CCU setting. The purpose of this paper is to propose and validate a novel approach to estimate Ees, which is independent of left ventricular pressure and volume. Our methods first derive an analytical representation of Ees as the inverse function of the gradient of the Frank-Starling Curve based on cardiac mechanics. Second, elucidating the mechanism of singularities in the inverse function, we derive multiple conditions in both end-systolic pressure-volume relationship (ESPVR) and end-diastolic pressure-volume relationship (EDPVR) parameters to avoid these singularities analytically. Third, we formulate a constrained nonlinear least squares problem to optimize both ESPVR and EDPVR parameters simultaneously to avoid singularities. The effectiveness of the proposed method in avoiding singularities was evaluated in an animal experiment. Compared to the conventional Ees estimation by linear regression, our proposed method reproduced in-vivo hemodynamics more accurately when simulating the estimated Ees variation during drug administration. Our method can be applied using the available data in the regular ICU/CCU setting. The improved clinical feasibility can support not only physicians' decision-making, including adjusting drug dosages in current clinical treatment, but also a closed-loop hemodynamic control system requiring accurate continuous Ees estimation.
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Giraldi T, Cecilio Fernandes D, Matos-Souza JR, Santos TM. A Hemodynamic Echocardiographic Evaluation Predicts Prolonged Mechanical Ventilation in Septic Patients: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:626-634. [PMID: 36456376 DOI: 10.1016/j.ultrasmedbio.2022.11.001] [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: 05/11/2022] [Revised: 10/04/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
Prolonged mechanical ventilation (PMV) is common among critically ill septic patients and leads to serious adverse effects. Transthoracic echocardiography (TTE) is an efficient tool for the assessment of septic shock. Our study investigated the relationship between TTE parameters and PMV in mechanically ventilated septic shock patients. TTE was performed in the first 24 h of intensive care unit admission, acquiring data on cardiac output (CO), cardiac index (CI), s' wave (s'), E wave (E), e' wave (e') and E/e' ratio. We compared data on patients who met the criteria for PMV with data on patients who did not. Sixty-four patients were included, 26 of whom met the criteria for PMV. CO, CI and s' were higher in patients who required PMV (5.49 vs. 4.20, p = 0.02; 2.95 vs. 2.34, p = 0.04; and 12.56 vs. 9.81, p = 0.01, respectively). CI correlated with s' (r = 0.37, p < 0.01). The areas under the receiver operating characteristic curves for CO, CI and s' in assessing the need for PMV were, respectively, 0.7 (fair results), 0.69 and 0.68 (poor results). Despite a lack of a prognostic model, the observed differences suggest that hemodynamic TTE could provide information on the risk of PMV in septic shock.
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Affiliation(s)
- Tiago Giraldi
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
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Fischer M, Moralez G, Sarma S, MacNamara JP, Cramer MN, Huang M, Romero SA, Hieda M, Shibasaki M, Ogoh S, Crandall CG. Altered cardiac β1 responsiveness in hyperthermic older adults. Am J Physiol Regul Integr Comp Physiol 2022; 323:R581-R588. [PMID: 36094450 PMCID: PMC9602700 DOI: 10.1152/ajpregu.00040.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/22/2022]
Abstract
Compared with younger adults, passive heating induced increases in cardiac output are attenuated by ∼50% in older adults. This attenuated response may be associated with older individuals' inability to maintain stroke volume through ionotropic mechanisms and/or through altered chronotropic mechanisms. The purpose of this study was to identify the interactive effect of age and hyperthermia on cardiac responsiveness to dobutamine-induced cardiac stimulation. Eleven young (26 ± 4 yr) and 8 older (68 ± 5 yr) participants underwent a normothermic and a hyperthermic (baseline core temperature +1.2°C) trial on the same day. In both thermal conditions, after baseline measurements, intravenous dobutamine was administered for 12 min at 5 µg/kg/min, followed by 12 min at 15 µg/kg/min. Primary measurements included echocardiography-based assessments of cardiac function, gastrointestinal and skin temperatures, heart rate, and mean arterial pressure. Heart rate responses to dobutamine were similar between groups in both thermal conditions (P > 0.05). The peak systolic mitral annular velocity (S'), i.e., an index of left ventricular longitudinal systolic function, was similar between groups for both thermal conditions at baseline. While normothermic, the increase in S' between groups was similar with dobutamine administration. However, while hyperthermic, the increase in S' was attenuated in the older participants with dobutamine (P < 0.001). Healthy, older individuals show attenuated inotropic, but maintained chronotropic responsiveness to dobutamine administration during hyperthermia. These data suggest that older individuals have a reduced capacity to increase cardiomyocyte contractility, estimated by changes in S', via β1-adrenergic mechanisms while hyperthermic.
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Affiliation(s)
- Mads Fischer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew N Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Michinari Hieda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
- School of Medicine, Kyushu University, Fukuoka, Japan
| | - Manabu Shibasaki
- Department of Environmental Health, Nara Women's University, Nara, Japan
| | - Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Saitama, Japan
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
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Dilmen S, Uzun M, Çınar T, Keser N, Selçuk M, Orhan AL. The relation between left ventricular systolic function parameters and preceding or prepreceding beat-to-beat distance in patients with atrial fibrillation: an echocardiographic study. Int J Cardiovasc Imaging 2021; 38:341-350. [PMID: 34550507 DOI: 10.1007/s10554-021-02412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
We aimed at investigating the relation between left ventricle (LV) systolic parameters and beat-to-beat distances and also whether this relation is different in heart failure with reduced ejection fraction (HFrEF) patients with atrial fibrillation (AF). The relation between peak velocity in left ventricular outflow (VLVOT), left atrioventricular plane displacement (LAVPD) or peak systolic tissue Doppler velocity of lateral mitral annulus (Lateral S') and preceding beat-to-beat distance (RR1) or prepreceding beat-to-beat distance (RR2) were analyzed by linear regression analysis. From this analysis, three parameters were obtained: slope of regression line, constant of regression line, and square of regression coefficient (r2) of linear relation. In the group with HFrEF, the slope and r2 values of the regression line showing the relationship between the RR1 interval and VLVOT, LAVPD, and Lateral S' values were higher and the constants were lower. In the Kendall rank correlation analysis, the slope, constant, and r2 values of the regression analysis between RR1 interval and VLVOT or Lateral S' were in significant correlation with LVEF. The r2 of VLVOT-RR1 analysis, slope of this analysis, and slope of Lateral S'-RR1 regression line values were mostly predictive for detecting HFrEF. It was concluded that the novel parameters obtained by linear regression analysis between LV systolic function parameters and RR1 interval, but not RR2, might be beneficial for evaluating systolic heart failure in patients with AF. They might have potential for future research about the physiopathology of heart and prognosis in patient with AF.
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Affiliation(s)
- Serkan Dilmen
- Department of Cardiology, Manisa Demirci State Hospital, Manisa, Turkey
| | - Mehmet Uzun
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, 34668, Uskudar, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, 34668, Uskudar, Istanbul, Turkey.
| | - Nurgül Keser
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, 34668, Uskudar, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, 34668, Uskudar, Istanbul, Turkey
| | - Ahmet Lütfullah Orhan
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Tibbiye Street, 34668, Uskudar, Istanbul, Turkey
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Pecchiari M, Pontikis K, Alevrakis E, Vasileiadis I, Kompoti M, Koutsoukou A. Cardiovascular Responses During Sepsis. Compr Physiol 2021; 11:1605-1652. [PMID: 33792902 DOI: 10.1002/cphy.c190044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection. Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection, and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer, and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro- and the microcirculation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however, our defective diagnostic tools preclude its clinical recognition. © 2021 American Physiological Society. Compr Physiol 11:1605-1652, 2021.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Konstantinos Pontikis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Emmanouil Alevrakis
- 4th Department of Pulmonary Medicine, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Maria Kompoti
- Intensive Care Unit, Thriassio General Hospital of Eleusis, Magoula, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
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Ince ME, Turgut K, Akar A, Naseri A, Sen I, Süleymanoglu H, Ertan M, Sagmanligil V. Prognostic importance of tissue Doppler imaging of systolic and diastolic functions in dogs with severe sepsis and septic shock. Acta Vet Hung 2019; 67:517-528. [PMID: 31842599 DOI: 10.1556/004.2019.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The goal of this study was to determine the distribution of left ventricular (LV) systolic and diastolic dysfunctions and their prognostic value in canine parvovirus-infected dogs suffering from severe sepsis and septic shock (SS/SS). Twenty dogs with SS/SS (experimental group) and 18 healthy dogs (control group) were used in the study. Systolic and diastolic dysfunction was present in three (15%) and 14 (70%) diseased dogs, respectively, with both types of dysfunction present in two (10%) of the patients. These dogs were split into two groups: survivors (Sv, n = 14) and non-survivors (non-Sv, n = 6). The pulsed wave tissue Doppler (PW-TDI) septal mitral annulus systolic velocity (LVS'), an index of systolic dysfunction, had a high sensitivity and specificity to differentiate Sv and non-Sv animals, with values of 83.3% (95% CI: 41.6-98.4) and 83.3% (95% CI: 59.8-94.8), respectively, at an optimum cut-off point of ≥ 9.90. The PW-TDI septal early mitral annulus early-diastolic peak velocity (E'), an index of diastolic dysfunction, had the best sensitivity and specificity to differentiate Sv and non-Sv dogs, with values of 100% (95% CI: 55.2-100) and 100% (95% CI: 78.9-100), respectively, at an optimum cut-off point of ≤ 6.50. Therefore, diastolic dysfunction determined by E' is a good independent outcome predictor.
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Affiliation(s)
- Mehmet Ege Ince
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Kursad Turgut
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Aybars Akar
- 2Department of Internal Medicine, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Turkey
| | - Amir Naseri
- 3Department of Internal Medicine, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Ismail Sen
- 4Department of Internal Medicine, Faculty of Veterinary Medicine, Kyrgyz Turkish Manas University, Bishkek, Kyrgyzstan
| | - Havva Süleymanoglu
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Merve Ertan
- 1Department of Internal Medicine, Faculty of Veterinary Medicine, Near East University, 99138 Nicosia, North Cyprus, Turkey
| | - Vedat Sagmanligil
- 5Department of Physiology, Faculty of Veterinary Medicine, Near East University, Nicosia, North Cyprus, Turkey
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Bang JY, Kim S, Choi BM, Kim TY. Pharmacodynamic Analysis of the Influence of Propofol on Left Ventricular Long-Axis Systolic Performance in Cardiac Surgical Patients. J Korean Med Sci 2019; 34:e132. [PMID: 31020819 PMCID: PMC6484179 DOI: 10.3346/jkms.2019.34.e132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Propofol induced a decline in the left ventricular (LV) systolic performance in non-cardiac surgery. We tested the hypothesis that propofol decreased the LV contractile function by dose dependent manner in cardiac surgery patients. METHODS Anesthesia was maintained with target-controlled infusions of propofol and remifentanil in cardiac surgery patients. With a fixed effect-site concentration (Ce) of remifentanil (20 ng/mL) after sternotomy, the Ce of propofol was adjusted to maintain a Bispectral index of 40-60 (Ce1). Mitral annular Doppler tissue image tracings and other echocardiographic variables, including end-diastolic and end-systolic volumes, stroke volume, and mitral inflow pulse wave Doppler profile at Ce1, were recorded using transesophageal echocardiography. Echocardiographic recordings were repeated after the Ce-values of propofol were doubled and tripled at 10-minute intervals (defined as Ce2 and Ce3, respectively). Serial changes in echocardiographic variables for each Ce of propofol were assessed using generalized linear mixed effect modeling. The pharmacodynamic relationship between the Ce of propofol and peak systolic mitral annular velocity (Sm) was analyzed by logistic regression using non-linear mixed effect modeling (NONMEM). RESULTS Means of Ce1, Ce2, and Ce3 were 0.8, 1.6, and 2.4 μg/mL, respectively, and their means of Sm (95% confidence interval) were 9.7 (9.3-10.2), 8.7 (8.2-9.1), and 7.5 cm/sec (7.0-8.0), respectively (P < 0.01). Ce values of propofol and Sm showed a significant inter-correlation and predictability (intercept, 10.8; slope-1.0 in generalized mixed linear modeling; P < 0.01). Ce values producing 10% and 20% decline of Sm with 50%-probability were 1.4 and 2.1 μ/mL, respectively. CONCLUSION Propofol reduces LV systolic long-axis performance in a dose-dependent manner. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01826149.
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Affiliation(s)
- Ji Yeon Bang
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sooyoung Kim
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Moon Choi
- Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Yop Kim
- Department of Anesthesiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
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Wohlmuth C, Boudreaux D, Moise KJ, Johnson A, Papanna R, Bebbington M, Gardiner HM. Cardiac pathophysiology in twin-twin transfusion syndrome: new insights into its evolution. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:341-348. [PMID: 28370497 DOI: 10.1002/uog.17480] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/15/2017] [Accepted: 03/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In twin-twin transfusion syndrome (TTTS), unbalanced transfer of vasoactive mediators and fluid from the donor to the recipient cotwin alters their cardiovascular function. The aims of this study were to describe the impact of TTTS on fetal cardiac function in a large cohort of monochorionic-diamniotic (MCDA) pregnancies, and determine the early hemodynamic response to selective fetoscopic laser photocoagulation (SFLP). METHODS Echocardiography was performed in 145 MCDA pregnancies, including 26 uncomplicated MCDA, 61 TTTS Stages I+II and 58 TTTS Stages III+IV pregnancies, prior to SFLP for TTTS. Echocardiographic data after SFLP were available in a subset of 41/119 (34%) TTTS cases at a mean of 1.7 ± 1.9 days. Mitral (MAPSE) and tricuspid (TAPSE) annular systolic excursion, myocardial performance index (MPI), tissue Doppler velocities (E', A', S') and filling pressures (E/E') were measured and transformed into Z-scores. Ventricular pressure was estimated from peak atrioventricular regurgitation velocity. RESULTS Left ventricular hemodynamics of the recipient twin were affected in early TTTS. In all stages of TTTS, left MPI and E/E' of the recipient twin were elevated in comparison to those of the donor (all P < 0.05), with reduced recipient left S' in TTTS Stages III+IV (P < 0.001). Ventricular pressure was elevated for gestational age (median, 42 mmHg (range, 20-65 mmHg)) in 11 of 14 recipients in which this parameter was measured. Between-group difference in right ventricular E/E' was significant only in TTTS Stages III+IV recipients compared with TTTS Stages I+II (P = 0.007) and uncomplicated MCDA (P = 0.041). Recipient left and right MPI decreased while S', MAPSE and TAPSE increased after SFLP; in donors, left E/E' and cardiac output increased. CONCLUSIONS Cardiac function of the recipient twin in TTTS is abnormal, even in the early stages of the disease. Left ventricular filling pressures are elevated and systolic function is decreased before abnormalities in the right heart become apparent. SFLP produces rapid hemodynamic improvement. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Wohlmuth
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
- Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - D Boudreaux
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
| | - K J Moise
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
| | - R Papanna
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
| | - M Bebbington
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
| | - H M Gardiner
- The Fetal Center, Children's Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA
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Wohlmuth C, Wertaschnigg D, Wieser I, Arzt W, Tulzer G. Tissue Doppler imaging in fetuses with aortic stenosis and evolving hypoplastic left heart syndrome before and after fetal aortic valvuloplasty. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:608-615. [PMID: 25914144 DOI: 10.1002/uog.14885] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Fetal aortic valvuloplasty can improve filling and reduce afterload of the left ventricle in critical aortic stenosis. Success of an intrauterine intervention is currently measured by technical success, clinical survival and eventual postnatal biventricular physiology. In the present study we investigated the use of tissue Doppler imaging (TDI) to evaluate changes in ventricular function assessed before and after prenatal aortic valvuloplasty. METHODS Between October 2008 and December 2012, cardiac function was assessed by TDI before and after intervention in 23 fetuses that underwent technically successful valvuloplasty for critical aortic stenosis and in which postnatal outcome was known. The measurements were transformed into gestational age-independent Z-scores where appropriate. RESULTS Mean ± SD gestational age at intervention was 27.5 ± 3.1 weeks. Of the 23 fetuses, 14 had biventricular outcome. Before intervention all left ventricular (LV) TDI-derived parameters and mitral annular plane systolic excursion (MAPSE) were severely abnormal. It was possible to demonstrate considerably improved cardiac function after technically successful valvuloplasty. Among fetuses with postnatal biventricular outcome, TDI-derived LV myocardial peak velocity during early diastole (E') and myocardial peak velocity during systole in the ejection phase (S') significantly increased, E'/myocardial peak velocity during late diastole with atrial contraction (A') increased towards normal values, and LV transmitral-to-mitral-annular diastolic velocity ratio (E/E') and myocardial performance index (MPI') decreased but remained abnormally elevated. In addition, right ventricular A', S' and MPI' significantly improved after intervention. CONCLUSION Technically successful fetal aortic valvuloplasty led to significantly improved myocardial performance. It was possible to use TDI to detect distinct changes in ventricular function and TDI-derived parameters correlated with a biventricular outcome after birth. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Wohlmuth
- The Children's Heart Center Linz, Linz, Austria
- Department of Obstetrics and Gynaecology, Paracelsus Medical University, Salzburg, Austria
| | - D Wertaschnigg
- Department of Obstetrics and Gynaecology, Paracelsus Medical University, Salzburg, Austria
| | - I Wieser
- Department of Obstetrics and Gynaecology, Paracelsus Medical University, Salzburg, Austria
| | - W Arzt
- Institute for Prenatal Medicine, Women's and Children's Hospital, Linz, Austria
| | - G Tulzer
- The Children's Heart Center Linz, Linz, Austria
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Left Ventricle Tissue Doppler Imaging Predicts Disease Severity in Septic Patients Newly Admitted in an Emergency Unit. J Emerg Med 2015; 49:907-15. [DOI: 10.1016/j.jemermed.2015.06.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 11/22/2022]
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11
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Ferreira DLS, Fraser A, Howe LD, Jones S, Smith GD, Lawlor DA, Tapp RJ, Ness AR, Deanfield J, Chaturvedi N, Hughes AD. Associations of Central and Peripheral Blood Pressure With Cardiac Structure and Function in an Adolescent Birth Cohort: The Avon Longitudinal Study of Parents and Children. J Am Coll Cardiol 2015; 65:2048-2050. [PMID: 25953754 DOI: 10.1016/j.jacc.2015.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/20/2015] [Accepted: 01/27/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Diana L S Ferreira
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Abigail Fraser
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Laura D Howe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Siana Jones
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Robyn J Tapp
- Ocular Epidemiology Unit, Department of Optometry and Vision Sciences, The University of Melbourne, Australia
| | - Andy R Ness
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
| | - Nish Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
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12
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Uemura K, Inagaki M, Zheng C, Li M, Kawada T, Sugimachi M. A novel technique to predict pulmonary capillary wedge pressure utilizing central venous pressure and tissue Doppler tricuspid/mitral annular velocities. Heart Vessels 2014; 30:516-26. [PMID: 24879503 DOI: 10.1007/s00380-014-0525-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/09/2014] [Indexed: 11/28/2022]
Abstract
Assessing left ventricular (LV) filling pressure (pulmonary capillary wedge pressure, PCWP) is an important aspect in the care of patients with heart failure (HF). Physicians rely on right ventricular (RV) filling pressures such as central venous pressure (CVP) to predict PCWP, assuming concordance between CVP and PCWP. However, the use of this method is limited because discordance between CVP and PCWP is observed. We hypothesized that PCWP can be reliably predicted by CVP corrected by the relationship between RV and LV function, provided by the ratio of tissue Doppler peak systolic velocity of tricuspid annulus (S(T)) to that of mitral annulus (S(M)) (corrected CVP:CVP·S(T)/S(M)). In 16 anesthetized closed-chest dogs, S T and S M were measured by transthoracic tissue Doppler echocardiography. PCWP was varied over a wide range (1.8-40.0 mmHg) under normal condition and various types of acute and chronic HF. A significantly stronger linear correlation was observed between CVP·S(T)/S(M) and PCWP (R2 = 0.78) than between CVP and PCWP (R2 = 0.22) (P < 0.01). Receiver-operating characteristic (ROC) analysis indicated that CVP·S(T)/S(M) >10.5 mmHg predicted PCWP >18 mmHg with 85% sensitivity and 88% specificity. Area under ROC curve for CVP·S T/S M to predict PCWP >18 mmHg was 0.93, which was significantly larger than that for CVP (0.66) (P < 0.01). Peripheral venous pressure (PVP) corrected by S T/S M (PVP·S(T)/S(M) also predicted PCWP reasonably well, suggesting that PVP·S(T)/S (M) may be a minimally invasive alternative to CVP·S(T)/S(M) In conclusion, our technique is potentially useful for the reliable prediction of PCWP in HF patients.
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Affiliation(s)
- Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, 565-8565, Japan,
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13
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Uemura K, Kawada T, Inagaki M, Sugimachi M. A minimally invasive monitoring system of cardiac output using aortic flow velocity and peripheral arterial pressure profile. Anesth Analg 2013; 116:1006-1017. [PMID: 23492964 DOI: 10.1213/ane.0b013e31828a75bd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In managing patients with unstable hemodynamics, monitoring cardiac output (CO) can provide critical diagnostic data. However, conventional CO measurements are invasive, intermittent, and/or inaccurate. The purpose of this study was to validate our newly developed CO monitoring system. METHODS This system automatically determines peak velocity of the ascending aortic flow using continuous-wave Doppler transthoracic echocardiography and estimates cardiac ejection time and aortic cross-sectional area using the pulse contour of the radial arterial pressure. These parameters are continuously processed to estimate CO (CO(est)). In 10 anesthetized closed-chest dogs instrumented with an aortic flowprobe to measure reference CO (CO(ref)), hemodynamic conditions were varied over wide ranges by infusing cardiovascular drugs or by random atrial pacing. Under each condition, CO(ref) and CO(est) were determined. Absolute changes of CO(ref) (ΔCOref) and CO(est) (ΔCO(est)), and relative changes of CO(ref) (%ΔCO(ref)) and CO(est) (%ΔCO(est)) from the corresponding baseline values were determined in each animal. We calibrated CO(est) against CO(ref) to obtain proportionally scaled CO(est) (CO(est)(N)). RESULTS A total of 1335 datasets of CO(ref) and CO(est) were obtained, in which CO(ref) ranged from 0.17 to 5.34 L/min. Bland-Altman analysis between CO(ref) and CO(est) indicated that the limits of agreement (the bias ± 1.96 × SD of the difference) and the percentage error (1.96 × [SD of the difference]/[mean CO] × 100) were from -1.01 to 1.13 L/min (95% confidence interval, -1.76 to 1.88 L/min) and 43%, respectively. The agreement between CO(ref) and CO(est)(N) was improved, with limits of agreement from -0.53 to 0.49 L/min (95% confidence interval, -0.62 to 0.59 L/min) and the percentage error of 20%. Polar plot analysis between ΔCO(ref) and ΔCO(est) indicated that mean ± 1.96 × SD of polar angle was -2° ± 22°. Four quadrant plot analysis indicated that %ΔCO(est) correlated tightly with %ΔCO(ref) (R(2) = 0.93). The %ΔCO(est) and %ΔCO(ref) changed in the same direction in 95% of the datasets. Reliability of this system was well preserved under conditions of random atrial pacing and also in a continuous manner. CONCLUSION Over a wide range of hemodynamic conditions, irrespective of cardiac beat irregularity, this system may allow minimally invasive monitoring of CO with a good trending ability. The present results warrant further research and development of this system for future clinical application.
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Affiliation(s)
- Kazunori Uemura
- From the Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan
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14
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Uemura K, Kawada T, Zheng C, Li M, Shishido T, Sugimachi M. Myocardial performance index is sensitive to changes in cardiac contractility, but is also affected by vascular load condition. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:695-698. [PMID: 24109782 DOI: 10.1109/embc.2013.6609595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Myocardial performance index (MPI), or Tei index, is measured by Doppler echocardiography in clinical practice. MPI has been shown to be useful in evaluating left ventricular (LV) performance and predicting prognosis in cardiac patients. However, the effects of LV load and contractile states on MPI remain to be thoroughly investigated. In 14 anesthetized dogs, we obtained LV pressure-volume relationship with use of sonomicrometry and catheter-tip manometry. MPI was determined from the time derivative of LV volume and pressure. LV end-systolic pressure-volume ratio (Ees'), effective arterial elastance (Ea) and LV end-diastolic volume (Ved) were used as indices of LV contractility, afterload and preload, respectively. Hemodynamic conditions were varied over wide ranges [heart rate (HR), 66-192 bpm; mean arterial pressure, 71-177 mmHg] by infusing cardiovascular agents, by inducing ischemic heart failure and by electrical atrial pacing. Multiple linear regression analysis of pooled data (66 data sets) indicated that MPI (0.6-1.8) significantly correlated with Ees' [1.5-17.5 mmHg · ml(-1), p<0.0001, standard partial regression coefficient (β) =-0.66], Ea (3.6-21.9 mmHg · ml(-1), p<0.001, β = 0.4) and Ved (11-100 ml, p<0.0001, β = -0.69). MPI directly correlated with the time constant of isovolumic relaxation (19-66 ms, p<0.05), but not with HR or LV diastolic-stiffness (all p>0.1). Theoretical analysis also indicated that MPI decreases following the increases in LV contractility and in preload, while it increases in response to an increase in LV afterload. We conclude that MPI sensitively detects changes in LV contractility. However, MPI is also affected by changes in LV afterload and preload.
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15
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Egstrup M, Gustafsson I, Andersen MJ, Kistorp CN, Schou M, Tuxen CD, Møller JE. Haemodynamic response during low-dose dobutamine infusion in patients with chronic systolic heart failure: comparison of echocardiographic and invasive measurements. Eur Heart J Cardiovasc Imaging 2012; 14:659-67. [PMID: 23136446 DOI: 10.1093/ehjci/jes234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS To investigate whether left ventricular (LV) systolic shortening velocity (s'), diastolic lengthening velocity (e'), and non-invasively estimated LV filling pressure (E/e') during low-dose dobutamine echocardiography (LDDE) reflect invasive measures of cardiac output and pulmonary capillary wedge pressure (PCWP) in stable patients with chronic systolic heart failure. METHODS AND RESULTS Fourteen patients with heart failure (aged 65 ± 8 years, LVEF 36 ± 8%) underwent simultaneous tissue Doppler echocardiography and invasive measurements of cardiac output and PCWP by right heart catheterization at rest and during dobutamine infusion at rates of 10 and 20 µg/kg/min. Cardiac output increased from rest to peak dobutamine (4.9 ± 1.2 to 6.6 ± 2.0 L/min, P < 0.001) and correlated with the peak systolic tissue velocity (s') at rest (R = 0.61, P = 0.02) and during dobutamine stimulation (R = 0.79, P < 0.001). Increases in early diastolic mitral inflow (E, 74.9 ± 29.0-90.8 ± 29.5 cm/s) and LV lengthening (e', 6.5 ± 2.4-8.2 ± 2.8 cm/s) velocities were observed during LDDE leaving the E/e' ratio unchanged. Although a mean PCWP was also unchanged from rest to peak dobutamine (16.6 ± 8.3-14.2 ± 9.2, P = 0.25), E/e' and PCWP only correlated at rest (R = 0.64, P = 0.014). CONCLUSION The LV systolic shortening velocity is closely associated with cardiac output during LDDE in CHF patients. Dobutamine stimulation increases early diastolic mitral inflow and lengthening velocities, but the E/e' ratio does not reflect the PCWP during LDDE, which warrants some caution in converting changes in E/e' into changes in LV filling pressure. The sample size is, however, small and the observation need to be confirmed in a larger population.
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Affiliation(s)
- Michael Egstrup
- Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 59, Frederiksberg, Denmark
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The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R71. [PMID: 22554063 PMCID: PMC3580613 DOI: 10.1186/cc11328] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/03/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Left ventricular (LV) dysfunction is common in septic shock. Its association with the clinical outcome is still controversial. Tissue Doppler imaging (TDI) is a useful tool to quantify LV function; however, little knowledge is available about the prognostic value of these TDI variables in septic shock. Therefore, we performed this prospective study to determine the role of TDI variables in septic shock. METHODS Patients with septic shock in a medical intensive care unit were studied with transthoracic echocardiography with TDI within 24 hours after the onset of septic shock. Baseline clinical, laboratory, and echocardiographic variables were prospectively collected. Independent predictors of 90-day mortality were analyzed with the Cox regression model. RESULTS During a 20-month period, 61 patients were enrolled in the study. The 90-day mortality rate was 39%; the mean APACHE IV score was 84 (68 to 97). Compared with survivors, nonsurvivors exhibited significantly higher peak systolic velocity measured at the mitral annulus (Sa) (11.0 (9.1 to 12.5) versus 7.8 (5.5 to 9.0) cm/sec; P < 0.0001), lower PaO2/FiO2 (123 (83 to 187) versus 186 (142 to 269) mm Hg; P = 0.002], higher heart rate (120 (90 to 140) versus 103 (90 to 114) beats/min; P = 0.004], and a higher dose of norepinephrine (0.6 (0.2 to 1.0) versus 0.3 (0.2 to 0.5) μg/kg/min; P = 0.007]. In the multivariate analysis, Sa > 9 cm/sec (hazard ratio (HR), 5.559; 95% confidence interval (CI), 2.160 to 14.305; P < 0.0001), dose of norepinephrine (HR, 1.964; 95% CI, 1.338 to 2.883; P = 0.001), and PaO2/FiO2 (HR, 0.992; 95% CI, 0.984 to 0.999; P = 0.031) remain independent predictors of 90-day mortality in septic-shock patients. CONCLUSIONS Our study demonstrated that LV systolic function as determined by TDI, in particular, Sa, might be associated with mortality in patients with septic shock.
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