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Arvidsson PM, Green PG, Watson WD, Shanmuganathan M, Heiberg E, De Maria GL, Arheden H, Herring N, Rider OJ. Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad035. [PMID: 37969333 PMCID: PMC10631830 DOI: 10.1093/ehjimp/qyad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023]
Abstract
Aims Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans. Methods and results Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R2 = 0.96, P < 0.0001, bias 4.6%), potential energy (R2 = 0.83, P = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R2 = 0.89, P = 0.0004, bias 5.8%), ventricular efficiency (R2 = 0.98, P < 0.0001, bias 0.8%), arterial elastance (R2 = 0.88, P = 0.0006, bias -8.0%), mean external power (R2 = 0.92, P = 0.0002, bias 4.4%), and energy per ejected volume (R2 = 0.89, P = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (P > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters. Conclusion Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.
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Affiliation(s)
- Per M Arvidsson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Peregrine G Green
- Oxford Heart Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - William D Watson
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Cardiovascular Medicine, Heart and Lung Research Institute, Papworth Road, Cambridge CB2 0AY, United Kingdom
| | - Mayooran Shanmuganathan
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
- Cardiology Department, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, Queen Alexandra Road, High Wycombe HP11 2TT, United Kingdom
- Heart Transplant Department, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Harefield UB9 6JH, United Kingdom
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Neil Herring
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Oliver J Rider
- Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, United Kingdom
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Lindsey ML, LeBlanc AJ, Ripplinger CM, Carter JR, Kirk JA, Hansell Keehan K, Brunt KR, Kleinbongard P, Kassiri Z. Reinforcing rigor and reproducibility expectations for use of sex and gender in cardiovascular research. Am J Physiol Heart Circ Physiol 2021; 321:H819-H824. [PMID: 34524922 DOI: 10.1152/ajpheart.00418.2021] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Merry L Lindsey
- Department of Cellular and Integrative Physiology, Center for Heart and Vascular Research, University of Nebraska Medical Center, Omaha, Nebraska.,Research Service, Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Amanda J LeBlanc
- Department of Physiology and Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky
| | | | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
| | - Jonathan A Kirk
- Department of Cell and Molecular Physiology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Kara Hansell Keehan
- Strategic Journal Development, American Physiological Society, Rockville, Maryland.,AJP-Heart and Circulatory Physiology, American Physiological Society, Rockville, Maryland
| | - Keith R Brunt
- Department of Pharmacology, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - Zamaneh Kassiri
- Department of Physiology, Cardiovascular Research Center, University of Alberta, Edmonton, Alberta, Canada
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