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Berboth L, Zirngast B, Manninger M, Steendijk P, Tschöpe C, Scherr D, Hinghofer-Szalkay HG, Goswami N, Petersen LG, Mächler H, Alogna A. Graded lower body negative pressure induces intraventricular negative pressures and incremental diastolic suction: a pressure volume study in a porcine model. J Appl Physiol (1985) 2022; 133:20-26. [PMID: 35546125 DOI: 10.1152/japplphysiol.00110.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Lower body negative pressure (LBNP) has been a tool to study compensatory mechanisms to central hypovolemia for decades. However, underlying hemodynamic mechanisms were mostly assessed non-invasively and remain unclear. We hypothesized that incremental LBNP reduces diastolic filling and thereby affects left ventricular (LV) diastolic suction (DS). Here, we investigated the impact of graded LBNP at 3 different levels of seal as well as during beta-adrenergic stimulation by invasive pressure-volume (PV) analysis. Eight Landrace pigs were instrumented closed-chest for PV assessment. LBNP was applied at three consecutive locations: I) cranial, 10cm below xiphoid process; II) medial, half-way between cranial and caudal; III) caudal, at the iliac spine. Level III) was repeated under dobutamine infusion. At each level, baseline measurements were followed by application of incremental LBNP of -15, -30 and -45 mmHg. LBNP induced varying degrees of preload-dependent hemodynamic changes, with cranial LBNP inducing more pronounced effects than caudal. According to the Frank-Starling mechanism, graded LBNP progressively reduced LV stroke volume (LV SV) following a decrease in LV end-diastolic volume. Negative intraventricular minimal pressures were observed during dobutamine-infusion as well as higher levels of LBNP. Of note, incremental LV negative pressures were accompanied by increasing DS volumes, derived by extrapolating the volume at zero transmural pressure, the so-called equilibrium volume (V0), related to LV SV. In conclusion, graded preload reduction shifts the PV loop to smaller volumes and end-systolic volume below V0, which induces negative LV pressures and increases LV suction. Accordingly, LBNP induced central hypovolemia is associated with increased DS.
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Affiliation(s)
- Leonhard Berboth
- Department of Internal Medicine and Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Zirngast
- Department of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Martin Manninger
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Scherr
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Nandu Goswami
- Institute of Physiology, Medical University of Graz, Graz, Austria, Austria
| | - Lonnie G Petersen
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States.,Mechanical and Aerospace Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Heinrich Mächler
- Department of Cardiac Surgery, Medical University of Graz, Graz, Austria
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Charité, Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
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Noninvasive assessment of intraventricular pressure difference in left ventricular dyssynchrony using vector flow mapping. Heart Vessels 2020; 36:92-98. [PMID: 32632552 DOI: 10.1007/s00380-020-01664-3] [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: 04/17/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Diastolic intraventricular pressure difference (IVPD) reflects left ventricular (LV) diastolic function. The relative pressure imaging (RPI) enables the noninvasive quantification of IVPD based on vector flow mapping (VFM) and visualization of regional pressure distribution. LV dyssynchrony causes deterioration of cardiac performance. However, it remains unclear how IVPD is modulated by LV dyssynchrony. LV dyssynchrony was created in ten open-chest dogs by right ventricular (RV) pacing. The other ten dogs undergoing right atrial (RA) pacing set at the similar heart rate with RV pacing were used as controls. Echocardiographic images were acquired at baseline and during pacing simultaneously with LV pressure measurement by a micromanometer. Pressure difference (ΔP) was computed between the apex and the base of the LV inflow tract during a cardiac cycle by RPI and ΔP during isovolumic relaxation time (ΔPIRT), a parameter of diastolic suction, and that during early filling phase (ΔPE) were measured. During RV pacing, stroke volume (SV) and ΔPIRT decreased significantly, while ΔPE did not change compared to the baseline. During RA pacing, SV, ΔPIRT and ΔPE did not change significantly. ΔPIRT tended to correlate with -dP/dtmin and end-systolic volume, and significantly correlated with ejection fraction. IVPD during isovolumic relaxation time was decreased by LV dyssynchrony, while IVPD during early filling phase was not. A reduction of diastolic suction is observed in LV dyssynchrony and is significantly related to a decrease in SV.
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Liu R, Cui C, Li Y, Qiu Z, Hu Y, Wang Y, Cui M, Yin S, Liu L. Analysis of left ventricular diastolic energy loss in patients with aortic stenosis with preserved ejection fraction by using vector flow mapping. Echocardiography 2019; 36:2216-2226. [PMID: 31876982 DOI: 10.1111/echo.14555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ruijie Liu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Cunying Cui
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Yanan Li
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Zhaoying Qiu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Yanbin Hu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Ying Wang
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Mingxia Cui
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Shanshan Yin
- Henan Academy of Medical Sciences Zhengzhou China
| | - Lin Liu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
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Wang W, Wang Y, Chen X, Yuan L, Bai H. Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction. Echocardiography 2019; 36:567-576. [PMID: 30677176 DOI: 10.1111/echo.14264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Wei Wang
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Yueheng Wang
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Xiaoxue Chen
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Lijun Yuan
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
| | - Hui Bai
- Department of Cardiac Ultrasound; The Second Hospital of He bei Medical University; Shijiazuhang China
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Li M, Lu Y, Fang C, Zhang X. Correlation between myocardial deformation on three-dimensional speckle tracking echocardiography and cardiopulmonary exercise testing. Echocardiography 2017; 34:1640-1648. [PMID: 28929529 DOI: 10.1111/echo.13675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Mei Li
- Ultrasound Department; Beijing Haidian Hospital; Peking University Third Hospital Haidian District; Haidian District, Beijing China
| | - Yaran Lu
- Ultrasound Department; Beijing Haidian Hospital; Peking University Third Hospital Haidian District; Haidian District, Beijing China
| | - Cui Fang
- Ultrasound Department; Beijing Haidian Hospital; Peking University Third Hospital Haidian District; Haidian District, Beijing China
| | - Xiaorong Zhang
- Ultrasound Department; Beijing Haidian Hospital; Peking University Third Hospital Haidian District; Haidian District, Beijing China
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