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Andersen S, Laursen PH, Wood GJ, Lyhne MD, Madsen TL, Hansen ESS, Johansen P, Kim WY, Andersen MJ. Comparison of admittance and cardiac magnetic resonance generated pressure-volume loops in a porcine model. Physiol Meas 2024; 45:055014. [PMID: 38729184 DOI: 10.1088/1361-6579/ad4a03] [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: 02/21/2024] [Accepted: 05/10/2024] [Indexed: 05/12/2024]
Abstract
Objective. Pressure-volume loop analysis, traditionally performed by invasive pressure and volume measurements, is the optimal method for assessing ventricular function, while cardiac magnetic resonance (CMR) imaging is the gold standard for ventricular volume estimation. The aim of this study was to investigate the agreement between the assessment of end-systolic elastance (Ees) assessed with combined CMR and simultaneous pressure catheter measurements compared with admittance catheters in a porcine model.Approach. Seven healthy pigs underwent admittance-based pressure-volume loop evaluation followed by a second assessment with CMR during simultaneous pressure measurements.Main results. Admittance overestimated end-diastolic volume for both the left ventricle (LV) and the right ventricle (RV) compared with CMR. Further, there was an underestimation of RV end-systolic volume with admittance. For the RV, however, Ees was systematically higher when assessed with CMR plus simultaneous pressure measurements compared with admittance whereas there was no systematic difference in Ees but large differences between admittance and CMR-based methods for the LV.Significance. LV and RV Ees can be obtained from both admittance and CMR based techniques. There were discrepancies in volume estimates between admittance and CMR based methods, especially for the RV. RV Ees was higher when estimated by CMR with simultaneous pressure measurements compared with admittance.
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Affiliation(s)
- Stine Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pernille Holmberg Laursen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gregory John Wood
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Dam Lyhne
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Lynge Madsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, MR research Centre, Aarhus University, Aarhus, Denmark
| | | | - Peter Johansen
- Department of Electrical and Computer Engineering, Aarhus University, Aarhus, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cardiac Magnetic Resonance Imaging in Appraising Myocardial Strain and Biomechanics: A Current Overview. Diagnostics (Basel) 2023; 13:diagnostics13030553. [PMID: 36766658 PMCID: PMC9914753 DOI: 10.3390/diagnostics13030553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics.
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Bruce CG, Khan JM, Rogers T, Yildirim DK, Jaimes AE, Seemann F, Chen MY, O’Brien K, Herzka DA, Schenke WH, Eckhaus MA, Potersnak AG, Campbell-Washburn A, Babaliaros VC, Greenbaum AB, Lederman RJ. Reshaping the Ventricle From Within: MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) Ventriculoplasty in Swine. JACC. BASIC TO TRANSLATIONAL SCIENCE 2022; 8:37-50. [PMID: 36777171 PMCID: PMC9911325 DOI: 10.1016/j.jacbts.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/11/2022]
Abstract
MIRTH (Myocardial Intramural Remodeling by Transvenous Tether) is a transcatheter ventricular remodeling procedure. A transvenous tension element is placed within the walls of the beating left ventricle and shortened to narrow chamber dimensions. MIRTH uses 2 new techniques: controlled intramyocardial guidewire navigation and EDEN (Electrocardiographic Radial Depth Navigation). MIRTH caused a sustained reduction in chamber dimensions in healthy swine. Midventricular implants approximated papillary muscles. MIRTH shortening improved myocardial contractility in cardiomyopathy in a dose-dependent manner up to a threshold beyond which additional shortening reduced performance. MIRTH may help treat dilated cardiomyopathy. Clinical investigation is warranted.
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Key Words
- CMR, cardiac magnetic resonance
- CTO, chronic total occlusion
- EDEN, electrocardiographic radial depth navigation
- EDV, end-diastolic volume
- ESPVR, end-systolic pressure-volume relationship
- ESV, end-systolic volume
- Ees, end-systolic elastance
- LVEDP, left ventricular end-diastolic pressure
- LVESP, left ventricular end systolic pressure
- MIRTH, myocardial intramural remodeling by transvenous tether
- PRSW, preload recruitable stroke work
- PVA, pressure-volume area
- cardiac repair
- cardiomyopathy
- heart failure/etiology/mortality/surgery
- surgical ventricular restoration
- ventricular remodeling
- ventriculoplasty
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Affiliation(s)
- Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - D. Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea E. Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Felicia Seemann
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus Y. Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O’Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A. Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael A. Eckhaus
- Division of Veterinary Resources, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda G. Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Adam B. Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Address for correspondence: Dr Robert J. Lederman, Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538, USA. @TheBethesdaLabs@ChrisGBruce13
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Matsuura K, Shiraishi K, Mandour AS, Sato K, Shimada K, Goya S, Yoshida T, Kitpipatkun P, Hamabe L, Uemura A, Yilmaz Z, Ifuku M, Iso T, Takahashi K, Tanaka R. The Utility of Intraventricular Pressure Gradient for Early Detection of Chemotherapy-Induced Subclinical Cardiac Dysfunction in Dogs. Animals (Basel) 2021; 11:1122. [PMID: 33919889 PMCID: PMC8070943 DOI: 10.3390/ani11041122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 01/04/2023] Open
Abstract
Early detection of doxorubicin (DXR)-induced cardiomyopathy (DXR-ICM) is crucial to improve cancer patient outcomes and survival. In recent years, the intraventricular pressure gradient (IVPG) has been a breakthrough as a sensitive index to assess cardiac function. This study aimed to evaluate the usefulness of IVPG for the early detection of chemotherapy-related cardiac dysfunction. For this purpose, six dogs underwent conventional, speckle tracking, and color M-mode echocardiography concomitantly with pressure-and-volume analysis by conductance catheter. The cardiac function measurements were assessed before DXR administration (baseline, Pre), at the end of treatment protocol (Post), and at 1.5 years follow-up (Post2). The result showed a significant reduction in the left ventricular end-systolic pressure-volume (Emax: 4.4 ± 0.7, 6.1 ± 1.6 vs. 8.4 ± 0.8 mmHg/mL), total-IVPG (0.59 ± 0.12, 0.62 ± 0.15 vs. 0.86 ± 0.12 mmHg), and mid-IVPG (0.28 ± 0.12, 0.31 ± 0.11 vs. 0.48 ± 0.08 mmHg), respectively in Post2 and Post compared with the baseline (p < 0.05). Mid-to-apical IVPG was also reduced in Post2 compared with the baseline (0.29 ± 0.13 vs. 0.51 ± 0.11). Meanwhile, the fraction shortening, ejection fraction, and longitudinal strain revealed no change between groups. Total and mid-IVPG were significantly correlated with Emax (R = 0.49; p < 0.05, both) but only mid-IVPG was a predictor for Emax (R2 = 0.238, p = 0.040). In conclusion, this study revealed that impairment of contractility was the initial changes observed with DXR-ICM in dogs and only IVPG could noninvasively detect subclinical alterations in cardiac function. Color M-mode echocardiography-derived IVPG could be a potential marker for the early detection of doxorubicin cardiomyopathy.
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Affiliation(s)
- Katsuhiro Matsuura
- VCA Japan Shiraishi Animal Hospital, Saitama 350-1304, Japan;
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Kenjirou Shiraishi
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Ahmed S. Mandour
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
- Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Kotomi Sato
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Kazumi Shimada
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Seijirow Goya
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Tomohiko Yoshida
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Pitipat Kitpipatkun
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Lina Hamabe
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
| | - Akiko Uemura
- Department of Veterinary Surgery, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido 080-8555, Japan;
| | - Zeki Yilmaz
- Department of Internal Medicine, Faculty of Veterinary Medicine, Uludag University, Bursa 16120, Turkey;
| | - Mayumi Ifuku
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Takeshi Iso
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Ken Takahashi
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; (M.I.); (T.I.); (K.T.)
| | - Ryou Tanaka
- Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo 183-0054, Japan; (K.S.); (K.S.); (K.S.); (S.G.); (T.Y.); (P.K.); (L.H.)
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5
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van der Ven JPG, Bossers SSM, van den Bosch E, Dam N, Kuipers IM, van Iperen GG, Kroft LJM, Kapusta L, Ten Harkel ADJ, Helbing WA. Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients. Open Heart 2021; 8:openhrt-2020-001487. [PMID: 33712485 PMCID: PMC7959216 DOI: 10.1136/openhrt-2020-001487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the atrial and ventricular diastolic function response to dobutamine stress in Fontan patients, and to relate these measurements to exercise capacity and events during the follow-up. Methods We performed a secondary analysis of a cross-sectional multicentre study of Fontan patients with intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) modification. Subjects underwent cardiac MRI during rest and low-dose dobutamine stress, and cardiopulmonary exercise testing. Atrial and diastolic ventricular function parameters were derived from volume-time curves. Medical records were abstracted for a composite end-point of death, listing for transplant, arrhythmia and reintervention. Spearman’s r correlation tests and Cox proportional hazards models were used to assess the relation between the dobutamine response for atrial and diastolic ventricular function and outcomes, including exercise capacity. Results We included 57 patients (26 ECC; 31 ILT) aged 12.8 (IQR (10.3–15.5)) years. During dobutamine stress atrial cyclic volume change increased (3.0 (0.4–5.9) mL/m2, p<0.001), as did early (1.9 (−1.6 to 3.6) mL/m2, p=0.001) and late emptying volume (2.2 (0.2–4.4) mL/m2, p<0.001). Ventricular early filling decreased (−1.6 (−5.7 to 0.7) mL/m2, p=0.046) and ventricular late filling increased (1.0 (−0.4 to 3.4) mL/m2, p<0.001) while stroke volume remained similar. Only for patients with the ECC modification, atrial early emptying volume increase correlated with peak oxygen uptake (ρ=0.66, p=0.002). No other parameter related to exercise capacity. During a median 7.1-year follow-up, 22 patients reached the composite endpoint. No parameter predicted events during the follow-up. Conclusions Dobutamine stress augmented atrial reservoir and pump function for Fontan patients. Atrial early emptying reserve related to exercise capacity in ECC patients. No other atrial or diastolic ventricular function parameter related to outcomes.
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Affiliation(s)
- Jelle P G van der Ven
- Pediatric Cardiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands.,Netherlands Heart Institute, Utrecht, Utrecht, The Netherlands
| | - Sjoerd S M Bossers
- Pediatric Cardiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Eva van den Bosch
- Pediatric Cardiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands.,Netherlands Heart Institute, Utrecht, Utrecht, The Netherlands
| | - Niels Dam
- Pediatric Cardiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Irene M Kuipers
- Department of Pediatrics, Division of Cardiology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Gabrielle G van Iperen
- Department of Pediatrics, Division of Cardiology, UMC Utrecht, Utrecht, Utrecht, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Livia Kapusta
- Department of Pediatrics, Division of Cardiology, Radboudumc, Nijmegen, Gelderland, The Netherlands.,Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Arend D J Ten Harkel
- Department of Paediatric Cardiology, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Willem A Helbing
- Paediatric Cardiology and Radiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
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Anselmino M, De Ferrari GM. Future Perspectives and New "Frontiers" in Cardiac Rhythmology. Front Cardiovasc Med 2020; 7:126. [PMID: 33005631 PMCID: PMC7479197 DOI: 10.3389/fcvm.2020.00126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022] Open
Abstract
In the last three decades the Cardiac Rhythmology field has experienced tremendous change and evolution. Our understanding of the underlying mechanism of arrhythmic diseases has dramatically improved, starting from the genetic and molecular mechanisms. Innovative pharmacological and non-pharmacological treatment options have been introduced, and arrhythmias previously considered “untreatable” are now successfully managed in most referral centers. The increasing awareness of the detrimental effects of arrhythmias on any underlying cardiac substrate, targeted as a potentially modifiable cause, has therefore led to an increasingly stronger effort in developing novel methods and approaches to treat arrhythmia and improve patients' health and quality of life. Of all potentially significant developments in the field, we have decided to focus on the approaches generally applicable to multiple arrhythmic cardiac disorders and related to the advancement of technology. More specifically, we will deal with electroanatomical mapping and lesion creation during interventional procedures.
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Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute e Della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute e Della Scienza di Torino" Hospital, University of Turin, Turin, Italy
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Peng HY, Lai CY, Hsieh MC, Ho YC, Lin TB. Pressure-volume analysis of rat's micturition cycles in vivo. Neurourol Urodyn 2020; 39:1304-1312. [PMID: 32293055 PMCID: PMC7318613 DOI: 10.1002/nau.24363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/01/2020] [Indexed: 11/10/2022]
Abstract
AIMS Though the pressure-volume analysis (PVA), a method based on thermodynamics, is broadly used for assaying cardiac functions, its potential application on the physiology/pathophysiology of the urinary bladder, which processes resemble thermodynamic cycles to the heart, has not been established. METHODS Cystometry recording intravesical pressure (IVP) and intravesical volume (IVV) of rhythmic voiding contractions caused by a constant saline infusion (0.04 mL/min) were carried out in forty urethane-anesthetized female Sprague-Dawley rats, and the PVA was established by plotting IVP against IVV. RESULTS Pressure-volume points shaped coincident enclosed loops, and loop-associated urodynamic parameters kept stable under a constant infusion rate (0.04 mL/min). Enhancing preload (by elevating infusion rates to 0.08 and 0.12 mL/min) increased the area enclosed by the loop (Apv) and shifted loops to the right and slightly upward. Augmenting afterload (by enhancing resistances using 1/4 and 1/2 urethra clamping) increased Apv and shifted loops markedly to the right and upward. Without affecting Apv, muscarine (0.01 and 0.1 mM)-induced inotropic states shifted loop to the left and upward that was as opposed to the atropine (0.01 and 0.1 mM)-induced anti-inotropic state. CONCLUSIONS Not only consistently assayed baseline bladder functions, PVA but also validly measured modified bladder functions due to altered extrinsic environment and intrinsic contractility of the bladder itself. In accompanied by cystometry, PVA could provide a clear concept about the relationship between time, pressure, and volume in the voiding activity.
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Affiliation(s)
- Hsien-Yu Peng
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Cheng-Yuan Lai
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Ming-Chun Hsieh
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Yu-Cheng Ho
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Tzer-Bin Lin
- Department of Physiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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8
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Model-Based Quantification of Left Ventricular Diastolic Function in Critically Ill Patients with Atrial Fibrillation from Routine Data: A Feasibility Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:9682138. [PMID: 31223333 PMCID: PMC6541946 DOI: 10.1155/2019/9682138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/17/2019] [Indexed: 12/16/2022]
Abstract
Introduction Left ventricular diastolic dysfunction (LVDD) and atrial fibrillation (AF) are connected by pathophysiology and prevalence. LVDD remains underdiagnosed in critically ill patients despite potentially significant therapeutic implications since direct measurement cannot be performed in routine care at the bedside, and echocardiographic assessment of LVDD in AF is impaired. We propose a novel approach that allows us to infer the diastolic stiffness, β, a key quantitative parameter of diastolic function, from standard monitoring data by solving the nonlinear, ill-posed inverse problem of parameter estimation for a previously described mechanistic, physiological model of diastolic filling. The beat-to-beat variability in AF offers an advantageous setting for this. Methods By employing a global optimization algorithm, β is inferred from a simple six parameter and an expanded seven parameter model of left ventricular filling. Optimization of all parameters was limited to the interval ]0, 400[ and initialized randomly on large intervals encompassing the support of the likelihood function. Routine ECG and arterial pressure recordings of 17 AF and 3 sinus rhythm (SR) patients from the PhysioNet MGH/MF Database were used as inputs. Results Estimation was successful in 15 of 17 AF patients, while in the 3 SR patients, no reliable estimation was possible. For both models, the inferred β (0.065 ± 0.044 ml−1 vs. 0.038 ± 0.033 ml−1 (p=0.02) simple vs. expanded) was compatible with the previously described (patho) physiological range. Aortic compliance, α, inferred from the expanded model (1.46 ± 1.50 ml/mmHg) also compared well with literature values. Conclusion The proposed approach successfully inferred β within the physiological range. This is the first report of an approach quantifying LVDF from routine monitoring data in critically ill AF patients. Provided future successful external validation, this approach may offer a tool for minimally invasive online monitoring of this crucial parameter.
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Gufler H, Niefeldt S, Boltze J, Prietz S, Klopsch C, Wagner S, Vollmar B, Yerebakan C. Right Ventricular Function After Pulmonary Artery Banding: Adaptive Processes Assessed by CMR and Conductance Catheter Measurements in Sheep. J Cardiovasc Transl Res 2019; 12:459-466. [PMID: 30847657 DOI: 10.1007/s12265-019-09881-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/26/2019] [Indexed: 01/23/2023]
Abstract
This experimental study describes the adaptive processes of the right ventricular (RV) myocardium after pulmonary artery banding (PAB) evaluated by cine cardiac magnetic resonance (CMR), phase-contrast CMR (PC-CMR), and conductance catheter. Seven sheep were subjected to CMR 3 months after PAB. Conductance catheter measurements were performed before and 3 months after PAB. Four nonoperated, healthy, age-matched animals served as controls. Higher RV masses (p < 0.01), elevated RV end-systolic volumes (p < 0.05), and lower RV ejection fraction (p < 0.01) were observed in the operated group. The time-to-peak pulmonary artery flow was longer in the banding group (p < 0.01). RV maximal pressure and RV end-diastolic pressure correlated with the time-to-peak flow in the pulmonary artery (r = - 0.70 and - 0.69, respectively). In summary, PAB caused RV hypertrophy, increased myocardial contractility, and decreased RV-EF and cardiac output. The time-to-peak pulmonary artery flow correlated with RV pressures.
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Affiliation(s)
- Hubert Gufler
- Department of Diagnostic and Interventional Radiology, University Clinic, Schillingallee 35, 10857, Rostock, Germany. .,Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany.
| | - Sabine Niefeldt
- Department of Cardiac Surgery, University Clinic, Schillingallee 35, 10857, Rostock, Germany
| | - Johannes Boltze
- Fraunhofer Research Institution for Marine Biotechnology, Department of Medical Cell Technology and Institute for Medical and Marine Biotechnology, University of Lübeck, Lübeck, Germany.,University of Warwick, School of Life Science, Gibbet Hill Road, CV4 7AL, Coventry, United Kingdom
| | - Stephanie Prietz
- Department of Cardiac Surgery, University Clinic, Schillingallee 35, 10857, Rostock, Germany
| | - Christian Klopsch
- Department of Cardiac Surgery, University Clinic, Schillingallee 35, 10857, Rostock, Germany
| | - Sabine Wagner
- Department of Diagnostic and Interventional Radiology, University Clinic, Schillingallee 35, 10857, Rostock, Germany
| | - Brigitte Vollmar
- Institute for Experimental Surgery, Rostock University Medical Center, Schillingallee 69a, 18057, Rostock, Germany
| | - Can Yerebakan
- Department of Cardiac Surgery, University Clinic, Schillingallee 35, 10857, Rostock, Germany
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Gabr RE, El-Sharkawy AMM, Schär M, Panjrath GS, Gerstenblith G, Weiss RG, Bottomley PA. Cardiac work is related to creatine kinase energy supply in human heart failure: a cardiovascular magnetic resonance spectroscopy study. J Cardiovasc Magn Reson 2018; 20:81. [PMID: 30526611 PMCID: PMC6287363 DOI: 10.1186/s12968-018-0491-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It has been hypothesized that the supply of chemical energy may be insufficient to fuel normal mechanical pump function in heart failure (HF). The creatine kinase (CK) reaction serves as the heart's primary energy reserve, and the supply of adenosine triphosphate (ATP flux) it provides is reduced in human HF. However, the relationship between the CK energy supply and the mechanical energy expended has never been quantified in the human heart. This study tests whether reduced CK energy supply is associated with reduced mechanical work in HF patients. METHODS Cardiac mechanical work and CK flux in W/kg, and mechanical efficiency were measured noninvasively at rest using cardiac pressure-volume loops, magnetic resonance imaging and phosphorus spectroscopy in 14 healthy subjects and 27 patients with mild-to-moderate HF. RESULTS In HF, the resting CK flux (126 ± 46 vs. 179 ± 50 W/kg, p < 0.002), the average (6.8 ± 3.1 vs. 10.1 ± 1.5 W/kg, p <0.001) and the peak (32 ± 14 vs. 48 ± 8 W/kg, p < 0.001) cardiac mechanical work-rates, as well as the cardiac mechanical efficiency (53% ± 16 vs. 79% ± 3, p < 0.001), were all reduced by a third compared to healthy subjects. In addition, cardiac CK flux correlated with the resting peak and average mechanical power (p < 0.01), and with mechanical efficiency (p = 0.002). CONCLUSION These first noninvasive findings showing that cardiac mechanical work and efficiency in mild-to-moderate human HF decrease proportionately with CK ATP energy supply, are consistent with the energy deprivation hypothesis of HF. CK energy supply exceeds mechanical work at rest but lies within a range that may be limiting with moderate activity, and thus presents a promising target for HF treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00181259 .
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Affiliation(s)
- Refaat E. Gabr
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Texas USA
| | - AbdEl-Monem M. El-Sharkawy
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
- Systems and Biomedical Engineering Department, Faculty of Engineering, Cairo University, Giza, Egypt
| | - Michael Schär
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
| | - Gurusher S. Panjrath
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
- The GW Heart and Vascular Institute, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
| | - Robert G. Weiss
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD USA
| | - Paul A. Bottomley
- Division of MR Research, Department of Radiology, The Johns Hopkins University, Park Building, 600 N Wolfe St, Baltimore, MD 21287 USA
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11
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Casas B, Viola F, Cedersund G, Bolger AF, Karlsson M, Carlhäll CJ, Ebbers T. Non-invasive Assessment of Systolic and Diastolic Cardiac Function During Rest and Stress Conditions Using an Integrated Image-Modeling Approach. Front Physiol 2018; 9:1515. [PMID: 30425650 PMCID: PMC6218619 DOI: 10.3389/fphys.2018.01515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background: The possibility of non-invasively assessing load-independent parameters characterizing cardiac function is of high clinical value. Typically, these parameters are assessed during resting conditions. However, for diagnostic purposes, the parameter behavior across a physiologically relevant range of heart rate and loads is more relevant than the isolated measurements performed at rest. This study sought to evaluate changes in non-invasive estimations of load-independent parameters of left-ventricular contraction and relaxation patterns at rest and during dobutamine stress. Methods: We applied a previously developed approach that combines non-invasive measurements with a physiologically-based, reduced-order model of the cardiovascular system to provide subject-specific estimates of parameters characterizing left ventricular function. In this model, the contractile state of the heart at each time point along the cardiac cycle is modeled using a time-varying elastance curve. Non-invasive data, including four-dimensional magnetic resonance imaging (4D Flow MRI) measurements, were acquired in nine subjects without a known heart disease at rest and during dobutamine stress. For each of the study subjects, we constructed two personalized models corresponding to the resting and the stress state. Results: Applying the modeling framework, we identified significant increases in the left ventricular contraction rate constant [from 1.5 ± 0.3 to 2 ± 0.5 (p = 0.038)] and relaxation constant [from 37.2 ± 6.9 to 46.1 ± 12 (p = 0.028)]. In addition, we found a significant decrease in the elastance diastolic time constant from 0.4 ± 0.04 s to 0.3 ± 0.03 s (p = 0.008). Conclusions: The integrated image-modeling approach allows the assessment of cardiovascular function given as model-based parameters. The agreement between the estimated parameter values and previously reported effects of dobutamine demonstrates the potential of the approach to assess advanced metrics of pathophysiology that are otherwise difficult to obtain non-invasively in clinical practice.
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Affiliation(s)
- Belén Casas
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Matts Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Division of Applied Thermodynamics and Fluid Mechanics, Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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12
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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13
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Bellofiore A, Vanderpool R, Brewis MJ, Peacock AJ, Chesler NC. A novel single-beat approach to assess right ventricular systolic function. J Appl Physiol (1985) 2017; 124:283-290. [PMID: 29025899 DOI: 10.1152/japplphysiol.00258.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Clinical assessment of right ventricular (RV) contractility in diseases such as pulmonary arterial hypertension (PAH) has been hindered by the lack of a robust methodology. Here, a novel, clinically viable, single-beat method was developed to assess end-systolic elastance (Ees), a measure of right ventricular (RV) contractility. We hypothesized that this novel approach reduces uncertainty and interobserver variability in the estimation of the maximum isovolumic pressure (Piso), the key step in single-beat methods. The new method was designed to include a larger portion of the RV pressure data and minimize subjective adjustments by the operator. Data were obtained from right heart catheterization of PAH patients in a multicenter prospective study ( data set 1) and a single-center retrospective study ( data set 2). To obtain Piso, three independent observers used an established single-beat method (based on the first derivative of the pressure waveform) and the novel method (based on the second derivative). Interobserver variability analysis included paired t-test, one-way ANOVA, interclass correlation (ICC) analysis, and a modified Bland-Altman analysis. The Piso values obtained from the two methods were linearly correlated for both data set 1 ( R2 = 0.74) and data set 2 ( R2 = 0.91). Compared with the established method, the novel method resulted in smaller interobserver variability ( P < 0.001), nonsignificant differences between observers, and a narrower confidence interval. By reducing uncertainty and interobserved variability, this novel approach may pave the way for more effective clinical management of PAH. NEW & NOTEWORTHY A novel methodology to assess right ventricular contractility from clinical data is demonstrated. This approach significantly reduces interobserver variability in the analysis of ventricular pressure data, as demonstrated in a relatively large population of subjects with pulmonary hypertension. This study may enable more accurate clinical monitoring of systolic function in subjects with pulmonary hypertension.
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Affiliation(s)
- Alessandro Bellofiore
- Department of Biomedical, Chemical and Materials Engineering, San Jose State University , San Jose, California.,Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin
| | - Rebecca Vanderpool
- Vascular Medicine Institute, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Melanie J Brewis
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital , Glasgow , United Kingdom
| | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital , Glasgow , United Kingdom
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison , Madison, Wisconsin.,Department of Medicine, University of Wisconsin-Madison , Madison, Wisconsin
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14
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment). Curr Cardiol Rep 2017; 19:9. [PMID: 28176279 DOI: 10.1007/s11886-017-0815-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
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15
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Velasco Forte MN, Pushparajah K, Schaeffter T, Valverde Perez I, Rhode K, Ruijsink B, Alhrishy M, Byrne N, Chiribiri A, Ismail T, Hussain T, Razavi R, Roujol S. Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT). J Cardiovasc Magn Reson 2017; 19:60. [PMID: 28806996 PMCID: PMC5556659 DOI: 10.1186/s12968-017-0368-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation. METHODS The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization. RESULTS The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization. CONCLUSIONS The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients.
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Affiliation(s)
- Mari Nieves Velasco Forte
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Tobias Schaeffter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Medical Physics, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Israel Valverde Perez
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiovascular Pathology Unit, Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, Seville, Spain
| | - Kawal Rhode
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Mazen Alhrishy
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tevfik Ismail
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sébastien Roujol
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, St Thomas’ Hospital, 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK
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16
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Beyond Pressure Gradients: The Effects of Intervention on Heart Power in Aortic Coarctation. PLoS One 2017; 12:e0168487. [PMID: 28081162 PMCID: PMC5231370 DOI: 10.1371/journal.pone.0168487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage. OBJECTIVES The aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization. METHODS In a collective of 52 patients with aortic coarctation 25 patients received stenting and/or balloon angioplasty, and 20 patients underwent MRI before and after an interventional treatment procedure. EHP and IHP were computed based on catheterization and MRI measurements. Along with the power efficiency these were combined in a cardiac energy profile. RESULTS By intervention, the catheter gradient was significantly reduced from 21.8±9.4 to 6.2±6.1mmHg (p<0.001). IHP was significantly reduced after intervention, from 8.03±5.2 to 4.37±2.13W (p < 0.001). EHP was 1.1±0.3 W before and 1.0±0.3W after intervention, p = 0.044. In patients initially presenting with IHP above 5W intervention resulted in a significant reduction in IHP from 10.99±4.74 W to 4.94±2.45W (p<0.001), and a subsequent increase in power efficiency from 14 to 26% (p = 0.005). No significant changes in IHP, EHP or power efficiency were observed in patients initially presenting with IHP < 5W. CONCLUSION It was demonstrated that interventional treatment of coarctation resulted in a decrease in IHP. Pressure gradients, as the most widespread clinical parameters in coarctation, did not show any correlation to changes in EHP or IHP. This raises the question of whether they should be the main focus in coarctation interventions. Only patients with high IHP of above 5W showed improvement in IHP and power efficiency after the treatment procedure. TRIAL REGISTRATION clinicaltrials.gov NCT02591940.
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17
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Wong J, Pushparajah K, de Vecchi A, Ruijsink B, Greil GF, Hussain T, Razavi R. Pressure-volume loop-derived cardiac indices during dobutamine stress: a step towards understanding limitations in cardiac output in children with hypoplastic left heart syndrome. Int J Cardiol 2016; 230:439-446. [PMID: 28043677 PMCID: PMC5267632 DOI: 10.1016/j.ijcard.2016.12.087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/21/2016] [Accepted: 12/16/2016] [Indexed: 11/29/2022]
Abstract
Background Children with a single systemic right ventricle, such as in hypoplastic left heart syndrome (HLHS), frequently experience reduced exercise capacity. Elucidating the causes could help with optimising treatment strategies. Methods Prospective data from 10 consecutive symptomatic patients with HLHS undergoing clinical cardiac magnetic resonance with catheterisation (XMR) were analysed. Mean age 8.6 years (range 3.5–11.6 years), mean time since Fontan completion 5.5 years. MR-compatible catheters were placed in the systemic right ventricle and branch pulmonary arteries to record pressures at rest, with dobutamine infusion at 10 mcg/kg/min and at 20 mcg/kg/min. Cine short-axis stacks of the ventricle were performed at each condition and used to construct pressure–volume loops. Results Compared to rest, cardiac index increased with low-dose dobutamine (p < 0.01) with no further rise at peak stress despite a further, albeit, blunted rise in heart rate (p = 0.002). A fall in stroke volume occurred (p = 0.014) despite good contractility (74% increase, p = 0.045) and a well-coupled ventriculo-arterial ratio. End-diastolic pressure and early active relaxation, markers of diastolic function, were normal at rest. However, preload fell at peak stress (p < 0.008) while pulmonary vascular resistance (PVR) was low throughout. This group of HLHS patients demonstrated a fall in SV at peak stress, coinciding with a fall in preload. Conclusions Markers of systolic and diastolic function remained normal. Failure to adequately fill the ventricle implies a ceiling of maximal flow through the Fontan circuit despite low PVR.
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Affiliation(s)
- James Wong
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Adelaide de Vecchi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Gerald F Greil
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
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18
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3D Real-Time Echocardiography Combined with Mini Pressure Wire Generate Reliable Pressure-Volume Loops in Small Hearts. PLoS One 2016; 11:e0165397. [PMID: 27776179 PMCID: PMC5077139 DOI: 10.1371/journal.pone.0165397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/11/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data. METHODS In 17 piglets (weight range: 3.6-8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets. RESULTS Correlation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters. CONCLUSIONS PVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.
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19
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Contijoch FJ, Witschey WRT, McGarvey J, Lee ME, Gorman J, Gorman RC, Pilla JJ. Slice-by-Slice Pressure-Volume Loop Analysis Demonstrates Native Differences in Regional Cardiac Contractility and Response to Inotropic Agents. Ann Thorac Surg 2016; 102:796-802. [PMID: 27112654 DOI: 10.1016/j.athoracsur.2016.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regional changes in diastolic and systolic properties after myocardial infarction contribute to adverse left ventricular (LV) remodeling. Regional function is currently assessed using load-dependent measures such as slice ejection fraction (sEF), wall motion abnormalities, or strain imaging. However, load-independent measures of cardiac function may be useful in the study of the infarction-induced remodeling. METHODS In this study, we used a recently validated 2-dimensional (2D) real-time magnetic resonance imaging (MRI) technique to evaluate regional variations in load-independent slice-by-slice measures of systolic and diastolic function and compared the values to a load-dependent measure in 11 sheep at rest and during inotropic agent infusion. RESULTS Slice-derived ejection fraction (sEF) was greater in the apex relative to the midventricular and basal regions, and inotropic infusion increased sEF in the base more than in the apex and midventricle. Slice-derived ESPVR (sESPVR) in the apex was significantly lower than in the midventricle and the base, and inotropic infusion increased sESPVR in the apical slices more than in the midventricle. Similarly, slice-derived volume-axis intercept V0 (sV0) was higher in the base relative to the midventricle and apex. sEDPVR did not demonstrate significant regional variations, but inotropic infusion resulted in a small increase in the apex. CONCLUSIONS In conclusion, acquisition of slice-derived load-independent measures demonstrated variations that contradict those observed with load-dependent sEF. The approach may provide advanced slice-based measures of function during the LV remodeling process and aid in the development of therapies.
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Affiliation(s)
- Francisco J Contijoch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter R T Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy McGarvey
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madonna E Lee
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - James J Pilla
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Ma SP, Vunjak-Novakovic G. Tissue-Engineering for the Study of Cardiac Biomechanics. J Biomech Eng 2016; 138:021010. [PMID: 26720588 PMCID: PMC4845250 DOI: 10.1115/1.4032355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 12/13/2022]
Abstract
The notion that both adaptive and maladaptive cardiac remodeling occurs in response to mechanical loading has informed recent progress in cardiac tissue engineering. Today, human cardiac tissues engineered in vitro offer complementary knowledge to that currently provided by animal models, with profound implications to personalized medicine. We review here recent advances in the understanding of the roles of mechanical signals in normal and pathological cardiac function, and their application in clinical translation of tissue engineering strategies to regenerative medicine and in vitro study of disease.
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Affiliation(s)
- Stephen P. Ma
- Department of Biomedical Engineering,
Columbia University,
622 West 168th Street,
VC12-234,
New York, NY 10032
e-mail:
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering
and Department of Medicine,
Columbia University,
622 West 168th Street,
VC12-234,
New York, NY 10032
e-mail:
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Abi-Abdallah Rodriguez D, Durand E, de Rochefort L, Boudjemline Y, Mousseaux E. Simultaneous pressure-volume measurements using optical sensors and MRI for left ventricle function assessment during animal experiment. Med Eng Phys 2014; 37:100-8. [PMID: 25500196 DOI: 10.1016/j.medengphy.2014.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/15/2014] [Accepted: 11/16/2014] [Indexed: 12/22/2022]
Abstract
Simultaneous pressure and volume measurements enable the extraction of valuable parameters for left ventricle function assessment. Cardiac MR has proven to be the most accurate method for volume estimation. Nonetheless, measuring pressure simultaneously during MRI acquisitions remains a challenge given the magnetic nature of the widely used pressure transducers. In this study we show the feasibility of simultaneous in vivo pressure-volume acquisitions with MRI using optical pressure sensors. Pressure-volume loops were calculated while inducing three inotropic states in a sheep and functional indices were extracted, using single beat loops, to characterize systolic and diastolic performance. Functional indices evolved as expected in response to positive inotropic stimuli. The end-systolic elastance, representing the contractility index, the diastolic myocardium compliance, and the cardiac work efficiency all increased when inducing inotropic state enhancement. The association of MRI and optical pressure sensors within the left ventricle successfully enabled pressure-volume loop analysis after having respective data simultaneously recorded during the experimentation without the need to move the animal between each inotropic state.
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Affiliation(s)
| | - Emmanuel Durand
- Univ Paris-Sud, IR4M, UMR8081 Orsay, France; CNRS, IR4M, UMR8081 Orsay, France
| | | | - Younes Boudjemline
- Univ Paris 05, France; Hôpital Necker-Enfants malades, AP HP, Paris, France
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Grong K, Salminen PR, Stangeland L, Dahle GO. Haemodynamic differences between pancuronium and vecuronium in an experimental pig model. Vet Anaesth Analg 2014; 42:242-9. [PMID: 24985148 DOI: 10.1111/vaa.12198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/12/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare baseline cardiovascular function in anesthetised pigs using either pancuronium or vecuronium as a neuromuscular blocker. STUDY DESIGN Retrospective, non-randomized comparison. ANIMALS Norwegian Land Race pigs (Sus scrofa domesticus) weighing mean 42 ± SD 3 kg. METHODS One hundred and sixteen animals from four different research protocols premedicated with identical doses of ketamine, diazepam, atropine and isoflurane, and anaesthetised with pentobarbital, fentanyl, midazolam and N(2)O were arranged into three uniform groups with respect to neuromuscular blocking agent: pancuronium bolus of 0.063 mg kg(-1) followed by 0.14 mg kg(-1) hour(-1) (n = 54), low-dose vecuronium 0.4 mg kg(-1) /0.2 mg kg(-1) hour(-1) (n = 29) and high-dose vecuronium 0.6 mg kg(-1) /0.3 mg kg(-1) hour(-1) (n = 33). RESULTS The majority of cardiovascular parameters demonstrated no significant differences between groups. For heart rate, there was an overall group difference, p = 0.036. Dromotropy was low in the pancuronium group, with an increased normalised PR-interval compared to the high-dose vecuronium group, median 0.200 interquartile range (0.190, 0.215) versus 0.182 (0.166, 0.199), p < 0.05. Left ventricular compliance was increased in pancuronium-treated animals, demonstrated as a reduction in the nonlinear end-diastolic pressure volume relationship β compared to both vecuronium groups, 0.021 (0.016, 0.025) versus 0.031 (0.025, 0.046) and 0.031 (0.022, 0.048), p < 0.05. The linear end-diastolic pressure volume relationship EDPVR(lin) was reduced as well in the pancuronium group, compared to the low-dose vecuronium group, 0.131 (0.116, 0.169) versus 0.181 (0.148, 0.247), p < 0.05. CONCLUSIONS There are only minor haemodynamic differences when using pancuronium compared to vecuronium in the fentanyl-pentobarbital-midazolam-N(2)O anesthetised domestic pigs. Furthermore, increasing doses of vecuronium have minimal haemodynamic effects. CLINICAL RELEVANCE Experimental studies in pigs using either pancuronium or vecuronium as a neuromuscular blocking agent are comparable with regard to cardiac and haemodynamic performance.
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Affiliation(s)
- Kristoffer Grong
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Real-time magnetic resonance imaging technique for determining left ventricle pressure-volume loops. Ann Thorac Surg 2014; 97:1597-603. [PMID: 24629301 DOI: 10.1016/j.athoracsur.2014.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rapid determination of the left ventricular (LV) pressure-volume (PV) relationship as loading conditions are varied is the gold standard for assessment of LV function. Cine magnetic resonance imaging (MRI) does not have sufficient spatiotemporal resolution to assess beat-to-beat changes of the LV PV relationship required to measure the LV end-systolic elastance (EES) or preload-recruitable stroke work (PRSW). Our aim was to investigate real-time MRI and semiautomated LV measurement of LV volume to measure PV relations in large animals under normal and inotropically stressed physiologic conditions. METHODS We determined that PV relationships could be accurately measured using an image exposure time Tex less than 100 ms and frame rate Tfr less than 50 ms at elevated heart rates (∼140 beats per minute) using a golden angle radial MRI k-space trajectory and active contour segmentation. RESULTS With an optimized exposure time (Tex=95 ms and frame rate Tfr=2.8 ms), we found that there was no significant difference between cine and real-time MRI at rest in end-diastolic volume, end-systolic volume, ejection fraction, stroke volume, or cardiac output (n=5, p<0.05) at either normal or elevated heart rates. We found EES increased from 1.9±0.7 to 3.1±0.3 mm Hg/mL and PRSW increased from 6.2±1.2 to 9.1±0.9 mm Hg during continuous intravenous dobutamine infusion (n=5, p<0.05). CONCLUSIONS Real-time MRI can assess LV volumes, EES, and PRSW at baseline and elevated inotropic states.
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Kutty S, Li L, Padiyath A, Gribben P, Gao S, Lof J, Bidasee KR, Danford DA, Kuehne T. Combination of real time three-dimensional echocardiography with diagnostic catheterization to derive left ventricular pressure-volume relations. Echocardiography 2013; 31:179-87. [PMID: 23895571 DOI: 10.1111/echo.12326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was to investigate the left ventricular (LV) myocardial contractility index-Emax using transesophageal real time three-dimensional echocardiography (RT3DE) combined with catheterization. METHODS Transesophageal RT3DE (single beat, X7-2 × matrix, iE33, Philips) was used to obtain real time LV volumes in pigs. Volumes were integrated with LV pressures from conductance catheterization (CC) to create RT3DE pressure-volume relations. At the same time, CC was used for measuring conventional pressure-volume relations that served as reference. The slope Emax was determined from RT3DE and CC end-systolic pressure-volume relations. All measurements were made at rest and during dobutamine infusion. RESULTS In six pigs, the mean ± SD (mmHg/mL) values were Emax-CC 1.86 ± 1.1 and Emax-RT3DE 1.78 ± 1.2 (P = 0.502) at baseline. On dobutamine, mean Emax-CC was 3.43 ± 1.5 and Emax-RT3DE 3.60 ± 1.23 (P = 0.171). Bland-Altman analysis showed good agreements between the RT3DE- and CC-derived Emax for measurements performed at baseline and on dobutamine. CONCLUSIONS Emax can be determined from RT3DE integrated with catheterization-derived pressures. RT3DE is a promising method for enhancing clinical applicability of pressure-volume relations for assessment of myocardial contractility.
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Affiliation(s)
- Shelby Kutty
- Division of Cardiology, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, Nebraska
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Kutty S, Kottam AT, Padiyath A, Bidasee KR, Li L, Gao S, Wu J, Lof J, Danford DA, Kuehne T. Validation of admittance computed left ventricular volumes against real-time three-dimensional echocardiography in the porcine heart. Exp Physiol 2013; 98:1092-101. [DOI: 10.1113/expphysiol.2012.070821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kutty S, Li L, Padiyath A, Nordmeyer S, Gribben P, Gao S, Lof J, Bidasee KR, Berger F, Danford DA, Kuehne T. Real-time three-dimensional echocardiography integrated with diagnostic catheterization to derive left ventricular pressure-volume relations: a feasibility study. Eur Heart J Cardiovasc Imaging 2013; 14:301. [DOI: 10.1093/ehjci/jes308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Herberg U, Gatzweiler E, Breuer T, Breuer J. Ventricular pressure–volume loops obtained by 3D real-time echocardiography and mini pressure wire—a feasibility study. Clin Res Cardiol 2013; 102:427-38. [DOI: 10.1007/s00392-013-0548-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/28/2013] [Indexed: 01/01/2023]
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Lumped parameter model for heart failure with novel regulating mechanisms of peripheral resistance and vascular compliance. ASAIO J 2012; 58:223-31. [PMID: 22395118 DOI: 10.1097/mat.0b013e31824ab695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To research the change in the physiological mechanism between the heart failure (HF) patient and healthy persons, the physiology parameters, which include the myocardial contractility, systemic vascular resistance (SVR), and vascular compliance, were studied. Through clinical data of HF patients, the computing method of the myocardial contractility was proposed; SVR as a function with respect to mean arterial pressure (MAP) was represented; and the vascular compliance was defined as a function with respect to MAP and cardiac output. Based on these parameters, a lumped parameter model of the cardiovascular system was established to reproduce the hemodynamic status of HF patients and verify the validity of the physiological mechanism. The simulation results demonstrate that the proportional error of mean flow, arterial pressure, and systolic blood pressure is 11.9%, 2.3%, and 4.7% compared with the clinical data, respectively. The proportional error of end-diastolic volume, end-systolic volume , and ejection fraction is 13.4%, 3%, and 3.9%, respectively.
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Leopaldi AM, Vismara R, Lemma M, Valerio L, Cervo M, Mangini A, Contino M, Redaelli A, Antona C, Fiore GB. In vitro hemodynamics and valve imaging in passive beating hearts. J Biomech 2012; 45:1133-9. [PMID: 22387122 DOI: 10.1016/j.jbiomech.2012.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 02/03/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
Due to their high complexity, surgical approaches to valve repair may benefit from the use of in vitro simulators both for training and for the investigation of those measures which can lead to better clinical results. In vitro tests are intrinsically more effective when all the anatomical substructures of the valvular complexes are preserved. In this work, a mock apparatus able to house an entire explanted porcine heart and subject it to pulsatile fluid-dynamic conditions was developed, in order to enable the hemodynamic analysis of simulated surgical procedures and the imaging of the valvular structures. The mock loop's hydrodynamic design was based on an ad-hoc defined lumped-parameter model. The left ventricle of an entire swine heart was dynamically pressurized by an external computer-controlled pulse duplicator. The ascending aorta was connected to a hydraulic circuit which simulated the input impedance of the systemic circulation; a reservoir passively filled the left atrium. Accesses for endoscopic imaging were located in the apex of the left ventricle and in the aortic root. The experimental pressure and flow tracings were comparable with the typical in vivo curves; a mean flow of 3.5±0.1l pm and a mean arterial pressure of 101±2 mmHg was obtained. High-quality echographic and endoscopic video recordings demonstrated the system's excellent potential in the observation of the cardiac structures dynamics. The proposed mock loop represents a suitable in vitro system for the testing of minimally-invasive cardiovascular devices and surgical procedures for heart valve repair.
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Affiliation(s)
- A M Leopaldi
- ForCardio.Lab, Università di Milano, Politecnico di Milano, Milano, Italy.
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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Schmitt B, Steendijk P, Ovroutski S, Lunze K, Rahmanzadeh P, Maarouf N, Ewert P, Berger F, Kuehne T. Pulmonary vascular resistance, collateral flow, and ventricular function in patients with a Fontan circulation at rest and during dobutamine stress. Circ Cardiovasc Imaging 2010; 3:623-31. [PMID: 20631032 DOI: 10.1161/circimaging.109.931592] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role, interplay, and relative importance of the multifactorial hemodynamic and myocardial mechanisms causing dysfunction of the Fontan circulation remain incompletely understood. METHODS AND RESULTS Using an MRI catheterization technique, we performed a differential analysis of pulmonary vascular resistance and aortopulmonary collateral blood flow in conjunction with global ventricular pump function, myocontractility (end-systolic pressure-volume relation), and diastolic compliance (end-diastolic pressure-volume relation) in 10 patients with a Fontan circulation at rest and during dobutamine stress. Pulmonary and ventricular pressures were measured invasively and synchronized with velocity-encoded MRI-derived pulmonary and aortic blood flows and cine MRI-derived ventricular volumes. Pulmonary vascular resistance and end-systolic and end-diastolic pressure-volume relations were then determined. Aortopulmonary collateral flow was calculated as the difference between aortic and pulmonary flow. Compared to rest, dobutamine caused a small increase in mean pulmonary pressures (P<0.05). Collateral flow was significantly augmented (P<0.001) and contributed importantly to an increase in pulmonary flow (P<0.01). Pulmonary vascular resistance decreased significantly (P<0.01). Dobutamine did not increase stroke volumes significantly despite slightly enhanced contractility (end-systolic pressure-volume relation). Active early relaxation (τ) was inconspicuous, but the end-diastolic pressure-volume relation shifted upward, indicating reduced compliance. CONCLUSIONS In patients with a Fontan circulation, aortopulmonary collateral flow contributes substantially to enhanced pulmonary flow during stress. Our data indicate that pulmonary vascular response to augmented cardiac output was adequate, but decreased diastolic compliance was identified as an important component of ventricular dysfunction.
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Affiliation(s)
- Boris Schmitt
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin and The Charité, Medical University Berlin, Berlin, Germany
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Manolas J. Combining Volumetry With External Pressure Transducer. JACC Cardiovasc Imaging 2010; 3:328; author reply 328-9. [DOI: 10.1016/j.jcmg.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 12/17/2009] [Indexed: 11/29/2022]
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Schmitt B, Steendijk P, Lunze K, Ovroutski S, Falkenberg J, Rahmanzadeh P, Maarouf N, Ewert P, Berger F, Kuehne T. Reply. JACC Cardiovasc Imaging 2010. [DOI: 10.1016/j.jcmg.2010.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Burkhoff D. Chasing the elusive pressure-volume relationships. JACC Cardiovasc Imaging 2009; 2:1282-4. [PMID: 19909931 DOI: 10.1016/j.jcmg.2009.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 11/26/2022]
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Kramer CM, Narula J. Interventional CMR: Great Promise, but a Long Road Ahead. JACC Cardiovasc Imaging 2009; 2:1337-8. [DOI: 10.1016/j.jcmg.2009.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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