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Heerdt PM, Kheyfets VO, Oakland HT, Joseph P, Singh I. Right Ventricular Pressure Waveform Analysis-Clinical Relevance and Future Directions. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00395-1. [PMID: 39025682 DOI: 10.1053/j.jvca.2024.06.022] [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: 05/11/2024] [Revised: 06/02/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024]
Abstract
Continuous measurement of pressure in the right atrium and pulmonary artery has commonly been used to monitor right ventricular function in critically ill and surgical patients. This approach is largely based upon the assumption that right atrial and pulmonary arterial pressures provide accurate surrogates for diastolic filling and peak right ventricular pressures, respectively. However, due to both technical and physiologic factors, this assumption is not always true. Accordingly, recent studies have begun to emphasize the potential clinical value of also measuring right ventricular pressure at the bedside. This has highlighted both past and emerging research demonstrating the utility of analyzing not only the amplitude of right ventricular pressure but also the shape of the pressure waveform. This brief review summarizes data demonstrating that combining conventional measurements of right ventricular pressure with variables derived from waveform shape allows for more comprehensive and ideally continuous bedside assessment of right ventricular function, particularly when combined with stroke volume measurement or 3D echocardiography, and discusses the potential use of right ventricular pressure analysis in computational models for evaluating cardiac function.
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Affiliation(s)
- Paul M Heerdt
- Department of Anesthesiology, Applied Hemodynamics, Yale School of Medicine, New Haven, CT.
| | - Vitaly O Kheyfets
- Department of Pediatrics-Critical Care Medicine, University of Colorado - Anschutz Medical Campus, Denver, CO
| | - Hannah T Oakland
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT
| | - Phillip Joseph
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT
| | - Inderjit Singh
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT
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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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3
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Gamarra A, Díez-Villanueva P, Salamanca J, Aguilar R, Mahía P, Alfonso F. Development and Clinical Application of Left Ventricular-Arterial Coupling Non-Invasive Assessment Methods. J Cardiovasc Dev Dis 2024; 11:141. [PMID: 38786963 PMCID: PMC11122267 DOI: 10.3390/jcdd11050141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
The constant and dynamic interaction between ventricular function and arterial afterload, known as ventricular-arterial coupling, is key to understanding cardiovascular pathophysiology. Ventricular-arterial coupling has traditionally been assessed invasively as the ratio of effective arterial elastance over end-systolic elastance (Ea/Ees), calculated from information derived from pressure-volume loops. Over the past few decades, numerous invasive and non-invasive simplified methods to estimate the elastance ratio have been developed and applied in clinical investigation and practice. The echocardiographic assessment of left ventricular Ea/Ees, as proposed by Chen and colleagues, is the most widely used method, but novel echocardiographic approaches for ventricular-arterial evaluation such as left ventricle outflow acceleration, pulse-wave velocity, and the global longitudinal strain or global work index have arisen since the former was first published. Moreover, multimodal imaging or artificial intelligence also seems to be useful in this matter. This review depicts the progressive development of these methods along with their academic and clinical application. The left ventricular-arterial coupling assessment may help both identify patients at risk and tailor specific pharmacological or interventional treatments.
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Affiliation(s)
- Alvaro Gamarra
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Jorge Salamanca
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Rio Aguilar
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
| | - Patricia Mahía
- Cardiology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de la Princesa, 28006 Madrid, Spain; (A.G.); (J.S.); (R.A.); (F.A.)
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4
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Forbes LM, Bull TM, Lahm T, Sisson T, O'Gean K, Lawley JS, Hunter K, Levine BD, Lovering A, Roach RC, Subudhi AW, Cornwell WK. Right ventricular performance during acute hypoxic exercise. J Physiol 2024. [PMID: 38409819 DOI: 10.1113/jp284943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
Acute hypoxia increases pulmonary arterial (PA) pressures, though its effect on right ventricular (RV) function is controversial. The objective of this study was to characterize exertional RV performance during acute hypoxia. Ten healthy participants (34 ± 10 years, 7 males) completed three visits: visits 1 and 2 included non-invasive normoxic (fraction of inspired oxygen (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) = 0.21) and isobaric hypoxic (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12) cardiopulmonary exercise testing (CPET) to determine normoxic/hypoxic maximal oxygen uptake (V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ). Visit 3 involved invasive haemodynamic assessments where participants were randomized 1:1 to either Swan-Ganz or conductance catheterization to quantify RV performance via pressure-volume analysis. Arterial oxygen saturation was determined by blood gas analysis from radial arterial catheterization. During visit 3, participants completed invasive submaximal CPET testing at 50% normoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ and again at 50% hypoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ (F i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12). Median (interquartile range) values for non-invasiveV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ values during normoxic and hypoxic testing were 2.98 (2.43, 3.66) l/min and 1.84 (1.62, 2.25) l/min, respectively (P < 0.0001). Mean PA pressure increased significantly when transitioning from rest to submaximal exercise during normoxic and hypoxic conditions (P = 0.0014). Metrics of RV contractility including preload recruitable stroke work, dP/dtmax , and end-systolic pressure increased significantly during the transition from rest to exercise under normoxic and hypoxic conditions. Ventricular-arterial coupling was maintained during normoxic exercise at 50%V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ . During submaximal exercise at 50% of hypoxicV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , ventricular-arterial coupling declined but remained within normal limits. In conclusion, resting and exertional RV functions are preserved in response to acute exposure to hypoxia at anF i O 2 ${F_{{\mathrm{i}}{{\mathrm{O}}_{\mathrm{2}}}}}$ = 0.12 and the associated increase in PA pressures. KEY POINTS: The healthy right ventricle augments contractility, lusitropy and energetics during periods of increased metabolic demand (e.g. exercise) in acute hypoxic conditions. During submaximal exercise, ventricular-arterial coupling decreases but remains within normal limits, ensuring that cardiac output and systemic perfusion are maintained. These data describe right ventricular physiological responses during submaximal exercise under conditions of acute hypoxia, such as occurs during exposure to high altitude and/or acute hypoxic respiratory failure.
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Affiliation(s)
- Lindsay M Forbes
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA
| | - Todd M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA
| | - Tim Lahm
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Tyler Sisson
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katie O'Gean
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Justin S Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin D Levine
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Andrew Lovering
- Department of Physiology, University of Oregon, Eugene, OR, USA
| | - Robert C Roach
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA
| | - Andrew W Subudhi
- Department of Physiology, University of Colorado, Colorado Springs, CO, USA
| | - William K Cornwell
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, USA
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5
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Grinstein J, Houston BA, Nguyen AB, Smith BA, Chinco A, Pinney SP, Tedford RJ, Belkin MN. Standardization of the Right Heart Catheterization and the Emerging Role of Advanced Hemodynamics in Heart Failure. J Card Fail 2023; 29:1543-1555. [PMID: 37633442 DOI: 10.1016/j.cardfail.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
The accurate assessment of hemodynamics is paramount to providing timely and efficacious care for patients presenting in cardiogenic shock. Recently, the regular use of the pulmonary artery catheter in cardiogenic shock has had a resurgence with emerging data indicating improved survival in the modern era. Optimal multidisciplinary management of advanced heart failure and cardiogenic shock relies on our ability to effectively communicate and understand the complete hemodynamic assessment. Standardization of data acquisition and a renewed focus on the physiological processes, and thresholds driving disease progression, including the coupling ratio and myocardial reserve, are needed to fully understand and interpret the hemodynamic assessment. This State-of-the-Art review discusses best practices in the cardiac catheterization laboratory as well as emerging data on the prognostic role of emerging advanced hemodynamic parameters.
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Affiliation(s)
- Jonathan Grinstein
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois.
| | - Brian A Houston
- Medical University of South Carolina, Department of Medicine, Section of Heart Failure, Charleston, South Carolina
| | - Ann B Nguyen
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
| | - Bryan A Smith
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
| | - Annalyse Chinco
- University of Chicago, Department of Surgery, Chicago, Illinois
| | - Sean P Pinney
- Mount Sinai Hospital, Department of Medicine, Section of Cardiology, New York, New York
| | - Ryan J Tedford
- Medical University of South Carolina, Department of Medicine, Section of Heart Failure, Charleston, South Carolina
| | - Mark N Belkin
- University of Chicago, Department of Medicine, Section of Cardiology, Chicago, Illinois
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Isotani Y, Amiya E, Hatano M, Kiriyama H, Uehara M, Ishida J, Tsuji M, Bujo C, Narita K, Ishii S, Kakuda N, Minatsuki S, Yagi H, Saito A, Numata G, Yamada T, Kurihara T, Suzuki T, Komuro I. A new assessment method for right ventricular diastolic function using right heart catheterization by pressure-volume loop. Physiol Rep 2023; 11:e15751. [PMID: 37394657 PMCID: PMC10315326 DOI: 10.14814/phy2.15751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Diastolic stiffness coefficient (β) and end-diastolic elastance (Eed) are ventricular-specific diastolic parameters. However, the diastolic function of right ventricle had not been investigated sufficiently due to the lack of established evaluation method. We evaluated the validity of these parameters calculated using only data of right heart catheterization (RHC) and assessed it in patients with restrictive cardiomyopathy (RCM) and cardiac amyloidosis. We retrospectively analyzed 46 patients with heart failure who underwent RHC within 10 days of cardiac magnetic resonance (CMR). Right ventricular end-diastolic volume and end-systolic volume were calculated using only RHC data, which were found to be finely correlated with those obtained from CMR. β and Eed calculated by this method were also significantly correlated with those derived from conventional method using CMR. By this method, β and Eed were significantly higher in RCM with amyloidosis group than dilated cardiomyopathy group. In addition, the β and Eed calculated by our method were finely correlated with E/A ratio on echocardiography. We established an easy method to estimate β and Eed of right ventricle from only RHC. The method finely demonstrated right ventricular diastolic dysfunction in patients with RCM and amyloidosis.
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Affiliation(s)
- Yoshitaka Isotani
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Advanced Medical Center for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
- Department of Therapeutic Strategy for Heart Failure, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Satoshi Ishii
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Nobutaka Kakuda
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroki Yagi
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Genri Numata
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Takanobu Yamada
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Takahiro Kurihara
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Tatsuya Suzuki
- Electrical Engineering Program, Graduate School of Science and TechnologyMeiji UniversityKawasakiJapan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of MedicineThe University of TokyoBunkyo‐kuJapan
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7
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Edward JA, Cerbin LP, Groves DW, Quaife RA, Hunter KS, Levine BD, Cornwell WK. Right Ventricular Dysfunction During Endurance Exercise as Determined by Pressure-Volume Analysis. JACC Case Rep 2022; 4:1435-1438. [PMID: 36388707 PMCID: PMC9664012 DOI: 10.1016/j.jaccas.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/12/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
A 37-year-old athlete completed invasive endurance (90 km) bicycle exercise testing for right ventricular pressure-volume analysis. Increased right ventricular afterload caused declines in ventricular-arterial coupling and cardiac output, causing increased arteriovenous oxygen difference to maintain oxygen uptake. These findings demonstrate effects of changes in right ventricular performance on exercise capacity. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Justin A. Edward
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lukasz P. Cerbin
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel W. Groves
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology–Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Radiology–Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benjamin D. Levine
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Campus, Dallas, Texas, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas, USA
| | - William K. Cornwell
- Department of Medicine–Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Ahmadian M, Williams AM, Mannozzi J, Konecny F, Hoiland RL, Wainman L, Erskine E, Duffy J, Manouchehri N, So K, Tauh K, Sala-Mercado JA, Shortt K, Fisk S, Kim KT, Streijger F, Foster GE, Kwon BK, O’Leary DS, West CR. A cross-species validation of single-beat metrics of cardiac contractility. J Physiol 2022; 600:4779-4806. [PMID: 36121759 PMCID: PMC9669232 DOI: 10.1113/jp283319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
Abstract
The assessment of left ventricular (LV) contractility in animal models is useful in various experimental paradigms, yet obtaining such measures is inherently challenging and surgically invasive. In a cross-species study using small and large animals, we comprehensively tested the agreement and validity of multiple single-beat surrogate metrics of LV contractility against the field-standard metrics derived from inferior vena cava occlusion (IVCO). Fifty-six rats, 27 minipigs and 11 conscious dogs underwent LV and arterial catheterization and were assessed for a range of single-beat metrics of LV contractility. All single-beat metrics were tested for the various underlying assumptions required to be considered a valid metric of cardiac contractility, including load-independency, sensitivity to inotropic stimulation, and ability to diagnose contractile dysfunction in cardiac disease. Of all examined single-beat metrics, only LV maximal pressure normalized to end-diastolic volume (EDV), end-systolic pressure normalized to EDV, and the maximal rate of rise of the LV pressure normalized to EDV showed a moderate-to-excellent agreement with their IVCO-derived reference measure and met all the underlying assumptions required to be considered as a valid cardiac contractile metric in both rodents and large-animal models. Our findings demonstrate that single-beat metrics can be used as a valid, reliable method to quantify cardiac contractile function in basic/preclinical experiments utilizing small- and large-animal models KEY POINTS: Validating and comparing indices of cardiac contractility that avoid caval occlusion would offer considerable advantages for the field of cardiovascular physiology. We comprehensively test the underlying assumptions of multiple single-beat indices of cardiac contractility in rodents and translate these findings to pigs and conscious dogs. We show that when performing caval occlusion is unfeasible, single-beat metrics can be utilized to accurately quantify cardiac inotropic function in basic and preclinical research employing various small and large animal species. We report that maximal left-ventricular (LV)-pressure normalized to end-diastolic volume (EDV), LV end-systolic pressure normalized to EDV and the maximal rate of rise of the LV pressure waveform normalized to EDV are the best three single-beat metrics to measure cardiac inotropic function in both small- and large-animal models.
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Affiliation(s)
- Mehdi Ahmadian
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Alexandra M. Williams
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Mannozzi
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI 48009
| | - Filip Konecny
- Transonic Scisense Inc., London, ON, Canada
- MaRS Centre Toronto Medical Discovery Tower, 3rd Floor, 101 College Street, M5G 1L7, Toronto, Ontario, Canada
| | - Ryan L. Hoiland
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, Vancouver General Hospital, 899 West 12th Avenue, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Liisa Wainman
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Erin Erskine
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Duffy
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Kitty So
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Keerit Tauh
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | | | - Katelyn Shortt
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Shera Fisk
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Kyoung-Tae Kim
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Neurosurgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Femke Streijger
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Glen E. Foster
- Centre for Heart, Lung, & Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC, V1V1V7
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Donal S. O’Leary
- Department of Physiology, School of Medicine, Wayne State University, Detroit, MI 48009
| | - Christopher R. West
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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9
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Dong Y, Li Y, Song L. Evaluation of right ventricular function in patients with pulmonary arterial hypertension by different right ventricular-pulmonary artery coupling methods. Medicine (Baltimore) 2022; 101:e30873. [PMID: 36181031 PMCID: PMC9524992 DOI: 10.1097/md.0000000000030873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To compare the accuracy of end-systolic elasticity (Ees)/arterial elasticity (Ea) ratio measured by single beat estimation, pressure-volume loop and cardiac magnetic resonance (CMR) combined volume method in patients with pulmonary artery hypertension, and to find a feasible and reliable method to quantitatively evaluate the function of right ventricle in patients with pulmonary artery hypertension. Forty-nine pulmonary artery hypertension patients enrolled between May 2017 and May 2018 in our hospital were retrospectively analyzed. Firstly, measure Ees/Ea ratio by single beat estimation, pressure-volume loop and CMR combined volume method, then, compare Ees/Ea ratio with New York Heart Association (NYHA) classification and NT-proBNP value respectively to evaluate the accuracy of the 3 methods. Ees/Ea ratio measured by single beat estimation is 2.07 ± 1.01, correlation analysis is not statistically significant when compare with NYHA classification and NT-proBNP value (P > .05). Ees/Ea ratio measured by pressure-volume loop is 2.64 ± 1.48, correlation analysis is not statistically significant when compare with NYHA classification and NT-proBNP value (P > .05). Ees/Ea ratio measured by CMR combined volume method is 0.72 ± 0.43, correlation analysis is statistically significant when compare with NYHA classification and NT-proBNP with negative correlation (P < .05). Ees/Ea ratio decrease according to the increase of NT-proBNP value and the NYHA classification. There is linear regression equation between Ees/Ea ratio measured by CMR combined volume method and log (NT-proBNP) value: Y = -0.257X + 1.45, and the linear regression equation is statistically significant (P = .001). Ees/Ea ratio measured by CMR combined volume method is a feasible and reliable method to quantitatively evaluate the function of right ventricule in patients with pulmonary artery hypertension, which might be further verified in a larger patient population.
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Affiliation(s)
- Yaling Dong
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, PR China
| | - Yu Li
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, PR China
| | - Laichun Song
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, PR China
- *Correspondence: Laichun Song, Department of Cardiac Surgery, Asia Heart Hospital, Wuhan University of Science and Technology, No. 753 Jinghan Road, Hankou District, Wuhan 430022, PR China (e-mail: )
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10
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Ventriculo-arterial coupling in the intensive cardiac care unit: A non-invasive prognostic parameter. Int J Cardiol 2021; 348:85-89. [PMID: 34933063 DOI: 10.1016/j.ijcard.2021.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 11/29/2021] [Accepted: 12/14/2021] [Indexed: 12/22/2022]
Abstract
AIMS The aim of this study was to investigate the relationship between ventriculo-arterial coupling (VAC) and in-hospital outcomes and to assess the prognostic value of VAC in critically ill patients. METHODS AND RESULTS A total of 329 consecutive patients (mean age 66,7 ± 15.5 years, 66.9% male) admitted to the intensive cardiac care unit of the Sandro Pertini Hospital, Rome (Italy) between January 2019 and December 2019, were included in the study. All patients underwent blood pressure measurement and non-invasive, echocardiography-derived estimates of left ventricular end-systolic elastance (Ees), arterial elastance (Ea) and VAC in a single-beat determination using the iElastance© application. In-hospital events related to acute heart failure and hypoperfusion were recorded and need for invasive ventilation, intra-aortic balloon pump, renal replacement therapy and death were considered as composite. Overall, 39 patients (11,8%) experienced in-hospital complications (group C), and 290 (88,2%) did not (group NoC). Ea and VAC were found to be significantly higher in group C than in group NoC, and a trend toward decreased Ees was observed in group C. VAC was a strong and independent predictor of in-hospital clinical outcome both at univariable and multivariable analysis adjusted for comorbidities [OR (95% CI): 1.868 (1.141-3.059); P = 0.013] and hemodynamic parameters [OR (95% CI): 1674 (1018-2755); P = 0.042]. CONCLUSION VAC might be an additional non-invasive prognosticator of outcome in critically ill patients.
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11
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Travers G, González-Alonso J, Riding N, Nichols D, Shaw A, Périard JD. Exercise Heat Acclimation With Dehydration Does Not Affect Vascular and Cardiac Volumes or Systemic Hemodynamics During Endurance Exercise. Front Physiol 2021; 12:740121. [PMID: 34867447 PMCID: PMC8633441 DOI: 10.3389/fphys.2021.740121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
Permissive dehydration during exercise heat acclimation (HA) may enhance hematological and cardiovascular adaptations and thus acute responses to prolonged exercise. However, the independent role of permissive dehydration on vascular and cardiac volumes, ventricular-arterial (VA) coupling and systemic hemodynamics has not been systematically investigated. Seven males completed two 10-day exercise HA interventions with controlled heart rate (HR) where euhydration was maintained or permissive dehydration (-2.9 ± 0.5% body mass) occurred. Two experimental trials were conducted before and after each HA intervention where euhydration was maintained (-0.5 ± 0.4%) or dehydration was induced (-3.6 ± 0.6%) via prescribed fluid intakes. Rectal (Tre) and skin temperatures, HR, blood (BV) and left ventricular (LV) volumes, and systemic hemodynamics were measured at rest and during bouts of semi-recumbent cycling (55% V̇O2peak) in 33°C at 20, 100, and 180 min. Throughout HA sweat rate (12 ± 9%) and power output (18 ± 7 W) increased (P < 0.05), whereas Tre was 38.4 ± 0.2°C during the 75 min of HR controlled exercise (P = 1.00). Neither HA intervention altered resting and euhydrated exercising Tre, BV, LV diastolic and systolic volumes, systemic hemodynamics, and VA coupling (P > 0.05). Furthermore, the thermal and cardiovascular strain during exercise with acute dehydration post-HA was not influenced by HA hydration strategy. Instead, elevations in Tre and HR and reductions in BV and cardiac output matched pre-HA levels (P > 0.05). These findings indicate that permissive dehydration during exercise HA with controlled HR and maintained thermal stimulus does not affect hematological or cardiovascular responses during acute endurance exercise under moderate heat stress with maintained euhydration or moderate dehydration.
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Affiliation(s)
- Gavin Travers
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Centre for Human Performance and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - José González-Alonso
- Centre for Human Performance and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Nathan Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David Nichols
- Sport Development Centre, Loughborough University, Loughborough, United Kingdom
| | - Anthony Shaw
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julien D Périard
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Research Institute for Sport and Exercise, University of Canberra, Bruce, ACT, Australia
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12
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Dufva MJ, Ivy D, Campbell K, Lam A, Rauff A, Breeman KTN, Douwes JM, Berger RMF, Kheyfets VO, Hunter K. Ventricular-vascular coupling is predictive of adverse clinical outcome in paediatric pulmonary arterial hypertension. Open Heart 2021; 8:openhrt-2021-001611. [PMID: 34583983 PMCID: PMC8479945 DOI: 10.1136/openhrt-2021-001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Ventricular–vascular coupling, the ratio between the right ventricle’s contractile state (Ees) and its afterload (Ea), may be a useful metric in the management of paediatric pulmonary arterial hypertension (PAH). In this study we assess the prognostic capacity of the ventricular–vascular coupling ratio (Ees/Ea) derived using right ventricular (RV) pressure alone in children with PAH. Methods One hundred and thirty paediatric patients who were diagnosed with PAH via right heart catheterisation were retrospectively reviewed over a 10-year period. Maximum RV isovolumic pressure and end-systolic pressure were estimated using two single-beat methods from Takeuchi et al (Ees/Ea_(Takeuchi)) and from Kind et al (Ees/Ea_(Kind)) and used with an estimate of end-systolic pressure to compute ventricular–vascular coupling from pressure alone. Patients were identified as either idiopathic/hereditary PAH or associated PAH (IPAH/HPAH and APAH, respectively). Haemodynamic data, clinical functional class and clinical worsening outcomes—separated into soft (mild) and hard (severe) event categories—were assessed. Adverse soft events included functional class worsening, syncopal event, hospitalisation due to a proportional hazard-related event and haemoptysis. Hard events included death, transplantation, initiation of prostanoid therapy and hospitalisation for atrial septostomy and Pott’s shunt. Cox proportional hazard modelling was used to assess whether Ees/Ea was predictive of time-to-event. Results In patients with IPAH/HPAH, Ees/Ea_(Kind) and Ees/Ea_(Takeuchi) were both independently associated with time to hard event (p=0.003 and p=0.001, respectively) and when adjusted for indexed pulmonary vascular resistance (p=0.032 and p=0.013, respectively). Neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to soft event. In patients with APAH, neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to hard event or soft event. Conclusions Ees/Ea derived from pressure alone is a strong independent predictor of adverse outcome and could be a potential powerful prognostic tool for paediatric PAH.
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Affiliation(s)
- Melanie J Dufva
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA .,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Dunbar Ivy
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Kristen Campbell
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Aimee Lam
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Adam Rauff
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Bioengineering, University of Utah Health, Salt Lake City, Utah, USA
| | - Karel T N Breeman
- Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Johannes M Douwes
- Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Rolf M F Berger
- Paediatric Cardiology, University Medical Center Groningen Department of Cardiology, Groningen, The Netherlands
| | - Vitaly Oleg Kheyfets
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Kendall Hunter
- Bioengineering, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA.,Cardiology, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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13
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Sensitivity Analysis of Single Beat Left Ventricular Elastance Estimation by Chen Method. Cardiovasc Eng Technol 2021; 13:139-146. [PMID: 34159533 DOI: 10.1007/s13239-021-00556-5] [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: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Left ventricular (LV) end-systolic elastance (Ees) can be estimated using single-beat (Ees(sb)) Chen method, employing systolic and diastolic arm-cuff pressures, stroke volume (SV), ejection fraction and estimated normalized ventricular elastance at arterial end-diastole. This work aims to conduct a sensitivity analysis of Chen formula to verify its reliability and applicability in clinical scenario. METHODS Starting from a baseline condition, we evaluated the sensitivity of Ees(sb) to the parameters contained in the formula. Moreover, a mathematical model of the cardiovascular system was used to evaluate the sensitivity of Ees(sb) to end-diastolic LV elastance (Eed), Ees, arterial systemic resistance (Ras) and heart rate (HR). RESULTS In accordance with Ees definition, Ees(sb) increases by increasing aortic pressure and pre-ejection time, reaching the highest value for a pre-ejection time = 40 ms, and then decreases. In contrast with Ees definition, Ees(sb) increases (from 3.21 mmHg/mL to 12.15 mmHg/mL) by increasing the LV end-systolic volume and decreases by increasing the SV. In the majority of the analysis with the mathematical model, Ees was underestimated using the Chen method: by increasing Ees (from 0.5 to 2.5 mmHg/mL), Ees(sb) passes only from 0.56 to 1.54 mmHg/mL. Ees(sb) increases for higher Eed (from 1.03 to 2.33 mmHg/mL). Finally, Ees(sb) decreases (increases) for HR < 50 bpm (< 50 bpm), and for Ras < 1100 mmHg/gcm4 (> 1100 mmHg/gcm4). CONCLUSION Unexpectedly Ees(sb) increases for higher LV end-systolic volume and decreases for higher SV. These results contrast with Ees definition, which is the ratio between the LV end-systolic pressure and the LV end-systolic volume. Moreover, Ees(sb) is influenced by cardiocirculatory parameters such as LV Eed, HR, Ras, ejection time, and pre-ejection time. Finally, Ees(sb) computed with the model output often underestimates model Ees.
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14
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Dufva MJ, Boehm M, Ichimura K, Truong U, Qin X, Tabakh J, Hunter KS, Ivy D, Spiekerkoetter E, Kheyfets VO. Pulmonary arterial banding in mice may be a suitable model for studies on ventricular mechanics in pediatric pulmonary arterial hypertension. J Cardiovasc Magn Reson 2021; 23:66. [PMID: 34078382 PMCID: PMC8173855 DOI: 10.1186/s12968-021-00759-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of interventricular mechanics in pediatric pulmonary arterial hypertension (PAH) and its relation to right ventricular (RV) dysfunction has been largely overlooked. Here, we characterize the impact of maintained pressure overload in the RV-pulmonary artery (PA) axis on myocardial strain and left ventricular (LV) mechanics in pediatric PAH patients in comparison to a preclinical PA-banding (PAB) mouse model. We hypothesize that the PAB mouse model mimics important aspects of interventricular mechanics of pediatric PAH and may be beneficial as a surrogate model for some longitudinal and interventional studies not possible in children. METHODS Balanced steady-state free precession (bSSFP) cardiovascular magnetic resonance (CMR) images of 18 PAH and 17 healthy (control) pediatric subjects were retrospectively analyzed using CMR feature-tracking (FT) software to compute measurements of myocardial strain. Furthermore, myocardial tagged-CMR images were also analyzed for each subject using harmonic phase flow analysis to derive LV torsion rate. Within 48 h of CMR, PAH patients underwent right heart catheterization (RHC) for measurement of PA/RV pressures, and to compute RV end-systolic elastance (RV_Ees, a measure of load-independent contractility). Surgical PAB was performed on mice to induce RV pressure overload and myocardial remodeling. bSSFP-CMR, tagged CMR, and intra-cardiac catheterization were performed on 12 PAB and 9 control mice (Sham) 7 weeks after surgery with identical post-processing as in the aforementioned patient studies. RV_Ees was assessed via the single beat method. RESULTS LV torsion rate was significantly reduced under hypertensive conditions in both PAB mice (p = 0.004) and pediatric PAH patients (p < 0.001). This decrease in LV torsion rate correlated significantly with a decrease in RV_Ees in PAB (r = 0.91, p = 0.05) and PAH subjects (r = 0.51, p = 0.04). In order to compare combined metrics of LV torsion rate and strain parameters principal component analysis (PCA) was used. PCA revealed grouping of PAH patients with PAB mice and control subjects with Sham mice. Similar to LV torsion rate, LV global peak circumferential, radial, and longitudinal strain were significantly (p < 0.05) reduced under hypertensive conditions in both PAB mice and children with PAH. CONCLUSIONS The PAB mouse model resembles PAH-associated myocardial mechanics and may provide a potential model to study mechanisms of RV/LV interdependency.
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Affiliation(s)
- Melanie J Dufva
- Department of Bioengineering, University of Colorado Denver, Denver, CO, USA.
- Department of Pediatrics, Section of Cardiology, Childrens Hospital Colorado, Aurora, CO, USA.
- Department of Bioengineering, University of Colorado Denver, 12700 E. 19th Ave, Aurora, CO, 80045-2560, USA.
| | - Mario Boehm
- Universities of Giessen and Marburg Lung Center (UGMLC), Justus-Liebig University Giessen, German Center for Lung Research (DZL), Giessen, Germany
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, USA
| | - Kenzo Ichimura
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, USA
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Uyen Truong
- Department of Pediatrics, Section of Cardiology, Childrens Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA
| | - Xulei Qin
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Jennifer Tabakh
- Department of Bioengineering, University of Colorado Denver, Denver, CO, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Denver, Denver, CO, USA
- Department of Pediatrics, Section of Cardiology, Childrens Hospital Colorado, Aurora, CO, USA
| | - Dunbar Ivy
- Department of Pediatrics, Section of Cardiology, Childrens Hospital Colorado, Aurora, CO, USA
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, USA
- Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University, Stanford, CA, USA
- Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Vitaly O Kheyfets
- Department of Bioengineering, University of Colorado Denver, Denver, CO, USA
- Department of Pediatrics, Section of Cardiology, Childrens Hospital Colorado, Aurora, CO, USA
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Pecchiari M, Pontikis K, Alevrakis E, Vasileiadis I, Kompoti M, Koutsoukou A. Cardiovascular Responses During Sepsis. Compr Physiol 2021; 11:1605-1652. [PMID: 33792902 DOI: 10.1002/cphy.c190044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection. Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection, and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer, and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro- and the microcirculation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however, our defective diagnostic tools preclude its clinical recognition. © 2021 American Physiological Society. Compr Physiol 11:1605-1652, 2021.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Konstantinos Pontikis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Emmanouil Alevrakis
- 4th Department of Pulmonary Medicine, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Maria Kompoti
- Intensive Care Unit, Thriassio General Hospital of Eleusis, Magoula, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
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Pereyra KV, Schwarz KG, Andrade DC, Toledo C, Rios-Gallardo A, Díaz-Jara E, Bastías SS, Ortiz FC, Ortolani D, Del Rio R. Paraquat herbicide diminishes chemoreflex sensitivity, induces cardiac autonomic imbalance and impair cardiac function in rats. Am J Physiol Heart Circ Physiol 2021; 320:H1498-H1509. [PMID: 33513085 DOI: 10.1152/ajpheart.00710.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/21/2021] [Indexed: 11/22/2022]
Abstract
Paraquat (PQT) herbicide is widely used in agricultural practices despite being highly toxic to humans. It has been proposed that PQT exposure may promote cardiorespiratory impairment. However, the physiological mechanisms involved in cardiorespiratory dysfunction following PQT exposure are poorly known. We aimed to determine the effects of PQT on ventilatory chemoreflex control, cardiac autonomic control, and cardiac function in rats. Male Sprague-Dawley rats received two injections/week of PQT (5 mg·kg-1 ip) for 4 wk. Cardiac function was assessed through echocardiography and pressure-volume loops. Ventilatory function was evaluated using whole body plethysmography. Autonomic control was indirectly evaluated by heart rate variability (HRV). Cardiac electrophysiology (EKG) and exercise capacity were also measured. Four weeks of PQT administration markedly enlarged the heart as evidenced by increases in ventricular volumes and induced cardiac diastolic dysfunction. Indeed, end-diastolic pressure was significantly higher in PQT rats compared with control (2.42 ± 0.90 vs. 4.01 ± 0.92 mmHg, PQT vs. control, P < 0.05). In addition, PQT significantly reduced both the hypercapnic and hypoxic ventilatory chemoreflex response and induced irregular breathing. Also, PQT induced autonomic imbalance and reductions in the amplitude of EKG waves. Finally, PQT administration impaired exercise capacity in rats as evidenced by a ∼2-fold decrease in times-to-fatigue compared with control rats. Our results showed that 4 wk of PQT treatment induces cardiorespiratory dysfunction in rats and suggests that repetitive exposure to PQT may induce harmful mid/long-term cardiovascular, respiratory, and cardiac consequences.NEW & NOREWORTHY Paraquat herbicide is still employed in agricultural practices in several countries. Here, we showed for the first time that 1 mo paraquat administration results in cardiac adverse remodeling, blunts ventilatory chemoreflex drive, and promotes irregular breathing at rest in previously healthy rats. In addition, paraquat exposure induced cardiac autonomic imbalance and cardiac electrophysiology alterations. Lastly, cardiac diastolic dysfunction was overt in rats following 1 mo of paraquat treatment.
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Affiliation(s)
- Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Envejecimiento y Regeneración, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Fisiología y Medicina de Altura, Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Excelencia en Biomedicina de Magallanes, Universidad de Magallanes, Punta Arenas, Chile
| | - Angélica Rios-Gallardo
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Díaz-Jara
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sussy S Bastías
- Centro de Excelencia en Biomedicina de Magallanes, Universidad de Magallanes, Punta Arenas, Chile
| | - Fernando C Ortiz
- Mechanism of Myelin Formation and Repair Laboratory, Instituto de Ciencias Biomédicas, Facultad de Ciencias de Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Domiziana Ortolani
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Envejecimiento y Regeneración, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Excelencia en Biomedicina de Magallanes, Universidad de Magallanes, Punta Arenas, Chile
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Tran T, Muralidhar A, Hunter K, Buchanan C, Coe G, Hieda M, Tompkins C, Zipse M, Spotts MJ, Laing SG, Fosmark K, Hoffman J, Ambardekar AV, Wolfel EE, Lawley J, Levine B, Kohrt WM, Pal J, Cornwell WK. Right ventricular function and cardiopulmonary performance among patients with heart failure supported by durable mechanical circulatory support devices. J Heart Lung Transplant 2021; 40:128-137. [PMID: 33281029 DOI: 10.1016/j.healun.2020.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Patients with continuous-flow left ventricular assist devices (CF-LVADs) experience limitations in functional capacity and frequently, right ventricular (RV) dysfunction. We sought to characterize RV function in the context of global cardiopulmonary performance during exercise in this population. METHODS A total of 26 patients with CF-LVAD (aged 58 ± 11 years, 23 males) completed a hemodynamic assessment with either conductance catheters (Group 1, n = 13) inserted into the right ventricle to generate RV pressure‒volume loops or traditional Swan‒Ganz catheters (Group 2, n = 13) during invasive cardiopulmonary exercise testing. Hemodynamics were collected at rest, 2 sub-maximal levels of exercise, and peak effort. Breath-by-breath gas exchange parameters were collected by indirect calorimetry. Group 1 participants also completed an invasive ramp test during supine rest to determine the impact of varying levels of CF-LVAD support on RV function. RESULTS In Group 1, pump speed modulations minimally influenced RV function. During upright exercise, there were modest increases in RV contractility during sub-maximal exercise, but there were no appreciable increases at peak effort. Ventricular‒arterial coupling was preserved throughout the exercise. In Group 2, there were large increases in pulmonary arterial, left-sided filling, and right-sided filling pressures during sub-maximal and peak exercises. Among all participants, the cardiac output‒oxygen uptake relationship was preserved at 5.8:1. Ventilatory efficiency was severely abnormal at 42.3 ± 11.6. CONCLUSIONS Patients with CF-LVAD suffer from limited RV contractile reserve; marked elevations in pulmonary, left-sided filling, and right-sided filling pressures during exercise; and severe ventilatory inefficiency. These findings explain mechanisms for persistent reductions in functional capacity in this patient population.
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Affiliation(s)
- Tomio Tran
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Akshay Muralidhar
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kendall Hunter
- Department of Bioengineering, Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cullen Buchanan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Greg Coe
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michinari Hieda
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas
| | - Christine Tompkins
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Matthew Zipse
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melanie J Spotts
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie G Laing
- Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristina Fosmark
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jordan Hoffman
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee
| | - Amrut V Ambardekar
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eugene E Wolfel
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Justin Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Benjamin Levine
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Campus, Dallas, Texas; Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas Texas
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jay Pal
- Department of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - William K Cornwell
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Xiao W, Xin L, Gao S, Peng Y, Luo J, Yao W, Ribeiro R, Xu Z, Zhang Z, Liu Y, Li J, Badiwala M, Sun Y. Single-Beat Measurement of Left Ventricular Contractility in Normothermic Ex Situ Perfused Porcine Hearts. IEEE Trans Biomed Eng 2020; 67:3288-3295. [DOI: 10.1109/tbme.2020.2982655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
PURPOSE OF REVIEW We will highlight the role of ventriculoarterial coupling in the pathophysiology of sepsis and how to assess it. RECENT FINDINGS Most septic patients show a ventriculoarterial uncoupling at the time of diagnosis with arterial elastance (Ea) greater than left ventricle (LV) end-systolic elastance (Ees), often despite arterial hypotension. Ventriculoarterial coupling levels predict the cardiovascular response to resuscitation in this heterogeneously responding population. SUMMARY Ventriculoarterial coupling is quantified as the ratio of Ea to Ees. The efficiency of the cardiovascular function is optimal when Ea/Ees is near one. When the hydraulic load of the arterial system is excessive either from increased vasomotor tone, decreased LV contractility or both, Ea/Ees becomes greater than 1 (i.e. ventriculoarterial decoupling), and cardiac efficiency decreases leading to heart failure, loss of volume responsiveness, and if sustained, increased mortality. Noninvasive echocardiographic techniques when linked with arterial pressure monitoring allow for the bedside estimates of both Ea and Ees. Studies using this approach have documented the key role ventriculoarterial coupling has defining initial cardiovascular state, response to therapy and outcome from critical illness. Sequential monitoring of ventriculoarterial coupling at the bedside offers a unique opportunity to assess relevant cardiovascular determinants in septic patients requiring resuscitation.
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Travers G, González-Alonso J, Riding N, Nichols D, Shaw A, Périard JD. Exercise heat acclimation has minimal effects on left ventricular volumes, function and systemic hemodynamics in euhydrated and dehydrated trained humans. Am J Physiol Heart Circ Physiol 2020; 319:H965-H979. [DOI: 10.1152/ajpheart.00466.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study demonstrates that 10 days of exercise heat acclimation has minimal effects on left ventricular volumes, intrinsic cardiac function, and systemic hemodynamics during prolonged, repeated semirecumbent exercise in moderate heat, where heart rate and blood volume are similar to preacclimation levels. However, progressive dehydration is consistently associated with similar degrees of hyperthermia and tachycardia and reductions in blood volume, diastolic filling of the left ventricle, stroke volume, and cardiac output, regardless of acclimation state.
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Affiliation(s)
- Gavin Travers
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Centre for Human Performance, Exercise and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - José González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Nathan Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - David Nichols
- Sport Development Centre, Loughborough University, Loughborough, United Kingdom
| | - Anthony Shaw
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Julien D. Périard
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
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21
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Cornwell WK, Tran T, Cerbin L, Coe G, Muralidhar A, Hunter K, Altman N, Ambardekar AV, Tompkins C, Zipse M, Schulte M, O'Gean K, Ostertag M, Hoffman J, Pal JD, Lawley JS, Levine BD, Wolfel E, Kohrt WM, Buttrick P. New insights into resting and exertional right ventricular performance in the healthy heart through real-time pressure-volume analysis. J Physiol 2020; 598:2575-2587. [PMID: 32347547 DOI: 10.1113/jp279759] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/20/2020] [Indexed: 02/02/2024] Open
Abstract
KEY POINTS Despite growing interest in right ventricular form and function in diseased states, there is a paucity of data regarding characteristics of right ventricular function - namely contractile and lusitropic reserve, as well as ventricular-arterial coupling, in the healthy heart during rest, as well as submaximal and peak exercise. Pressure-volume analysis of the right ventricle, during invasive cardiopulmonary exercise testing, demonstrates that that the right heart has enormous contractile reserve, with a three- or fourfold increase in all metrics of contractility, as well as myocardial energy production and utilization. The healthy right ventricle also demonstrates marked augmentation in lusitropy, indicating that diastolic filling of the right heart is not passive. Rather, the right ventricle actively contributes to venous return during exercise, along with the muscle pump. Ventricular-arterial coupling is preserved during submaximal and peak exercise in the healthy heart. ABSTRACT Knowledge of right ventricular (RV) function has lagged behind that of the left ventricle and historically, the RV has even been referred to as a 'passive conduit' of lesser importance than its left-sided counterpart. Pressure-volume (PV) analysis is the gold standard metric of assessing ventricular performance. We recruited nine healthy sedentary individuals free of any cardiopulmonary disease (42 ± 12 years, 78 ± 11 kg), who completed invasive cardiopulmonary exercise testing during upright ergometry, while using conductance catheters inserted into the RV to generate real-time PV loops. Data were obtained at rest, two submaximal levels of exercise below ventilatory threshold, to simulate real-world scenarios/activities of daily living, and maximal effort. Breath-by-breath oxygen uptake was determined by indirect calorimetry. During submaximal and peak exercise, there were significant increases in all metrics of systolic function by three- to fourfold, including cardiac output, preload recruitable stroke work, and maximum rate of pressure change in the ventricle (dP/dtmax ), as well as energy utilization as determined by stroke work and pressure-volume area. Similarly, the RV demonstrated a significant, threefold increase in lusitropic reserve throughout exercise. Ventricular-arterial coupling, defined by the quotient of end-systolic elastance and effective arterial elastance, was preserved throughout all stages of exercise. Maximal pressures increased significantly during exercise, while end-diastolic volumes were essentially unchanged. Overall, these findings demonstrate that the healthy RV is not merely a passive conduit, but actively participates in cardiopulmonary performance during exercise by accessing an enormous amount of contractile and lusitropic reserve, ensuring that VA coupling is preserved throughout all stages of exercise.
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Affiliation(s)
- William K Cornwell
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Clinical and Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tomio Tran
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lukasz Cerbin
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Greg Coe
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Akshay Muralidhar
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kendall Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Natasha Altman
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amrut V Ambardekar
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christine Tompkins
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Zipse
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Margaret Schulte
- Clinical and Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katie O'Gean
- Clinical and Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Morgan Ostertag
- Clinical and Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jordan Hoffman
- Department of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jay D Pal
- Department of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Justin S Lawley
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Benjamin D Levine
- University of Texas Southwestern Medical Campus, Dallas, TX, USA
- Texas Health Presbyterian Hospital, Institute for Exercise and Environmental Medicine, Dallas, TX, USA
| | - Eugene Wolfel
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Wendy M Kohrt
- Clinical and Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Medicine, Division of Geriatric Medicine and Eastern Colorado VA Geriatric Research Education and Clinical Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter Buttrick
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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23
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Lucero CM, Andrade DC, Toledo C, Díaz HS, Pereyra KV, Diaz-Jara E, Schwarz KG, Marcus NJ, Retamal MA, Quintanilla RA, Del Rio R. Cardiac remodeling and arrhythmogenesis are ameliorated by administration of Cx43 mimetic peptide Gap27 in heart failure rats. Sci Rep 2020; 10:6878. [PMID: 32327677 PMCID: PMC7181683 DOI: 10.1038/s41598-020-63336-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
Alterations in connexins and specifically in 43 isoform (Cx43) in the heart have been associated with a high incidence of arrhythmogenesis and sudden death in several cardiac diseases. We propose to determine salutary effect of Cx43 mimetic peptide Gap27 in the progression of heart failure. High-output heart failure was induced by volume overload using the arterio-venous fistula model (AV-Shunt) in adult male rats. Four weeks after AV-Shunt surgery, the Cx43 mimetic peptide Gap27 or scrambled peptide, were administered via osmotic minipumps (AV-ShuntGap27 or AV-ShuntScr) for 4 weeks. Cardiac volumes, arrhythmias, function and remodeling were determined at 8 weeks after AV-Shunt surgeries. At 8th week, AV-ShuntGap27 showed a marked decrease in the progression of cardiac deterioration and showed a significant improvement in cardiac functions measured by intraventricular pressure-volume loops. Furthermore, AV-ShuntGap27 showed less cardiac arrhythmogenesis and cardiac hypertrophy index compared to AV-ShuntScr. Gap27 treatment results in no change Cx43 expression in the heart of AV-Shunt rats. Our results strongly suggest that Cx43 play a pivotal role in the progression of cardiac dysfunction and arrhythmogenesis in high-output heart failure; furthermore, support the use of Cx43 mimetic peptide Gap27 as an effective therapeutic tool to reduce the progression of cardiac dysfunction in high-output heart failure.
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Affiliation(s)
- Claudia M Lucero
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Diaz-Jara
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noah J Marcus
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA, USA
| | - Mauricio A Retamal
- Universidad del Desarrollo, Centro de Fisiología Celular e Integrativa, Clínica Alemana Facultad de Medicina, Santiago, Chile
| | | | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia de Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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24
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Zhao X, Zhang JM, Bryant JA, Yap J, Ong CC, Singh D, Lim ST, Yip JW, Chen Y, Zhong L, Tan RS, Tan JL, Chai P, Teo L, Fortier MV, Hong Tan T, Leng S, Ruan W. Elevated Right Atrial Pressure Associated with Alteration of Left Ventricular Contractility and Ventricular-Arterial Coupling in Pulmonary Artery Hypertension. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:820-823. [PMID: 31946021 DOI: 10.1109/embc.2019.8856814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary artery hypertension (PAH) is a progressive disorder which leads to heart failure and death. Development of dilated right ventricle (RV), progressive RV dysfunction and increased right atrial (RA) pressure make the RV transition from a compensated to a decompensated phase and eventually leads to heart failure. However, the relationship between elevated RA pressure and left ventricular contractility and ventricular arterial coupling (VAC) has not been well studied. 36 patients were recruited and underwent both right heart catheterization (RHC) and cardiac magnetic resonance (CMR). Left ventricular (LV) pressure-volume loops were reconstructed from RHC and CMR. LV contractility was assessed by end-systolic elastance (Ees) using single-beat method and arterial elastance (Ea) was estimated as the ratio of end-systolic pressure and stroke volume (SV). The VAC was calculated as the ratio of Ees and Ea (i.e. Ees/Ea). The results demonstrated a nonlinear relationship between RA pressure and Ees, RA pressure and VAC. Ees increased when RA pressure increased to 7 mmHg and then decreased when RA pressure exceeded 7 mmHg. Ees were 2.79 ± 1.61 mmHg/ml, 4.27 ±1 33 mmHg/ml, 2.69 ± 0.89 mmHg/ml and 2.36± 1.10 mmHg/ml at ascending quartiles of RA pressure, respectively (quartile 1: RAP≤5 mmHg; quartile 2: 5<; RAP≤7 mmHg; quartile 3: 7<; RAP 10 mmHg and quartile 4: RAP>10 mmHg). Similarly, VAC were 1.36 ± 0.61, 1.93±0.86, 1.16 ± 0.55 and 0.95± 0.27 the four quartiles (both ANOVA P <; 0.05). We found that there was a nonlinear relationship between RA pressure and LV contractility, and between RA pressure and ventricular-arterial coupling. A cut-off value of 7 mmHg of RAP may indicate a decompensated LV hemodynamics.
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25
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Parameters of Right Ventricular Function Reveal Ventricular-Vascular Mismatch as Determined by Right Ventricular Stroke Work versus Pulmonary Vascular Resistance in Children with Pulmonary Hypertension. J Am Soc Echocardiogr 2020; 33:218-225. [DOI: 10.1016/j.echo.2019.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
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26
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Tello K, Seeger W, Naeije R, Vanderpool R, Ghofrani HA, Richter M, Tedford RJ, Bogaard HJ. Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment. Br J Pharmacol 2019; 178:90-107. [PMID: 31517994 DOI: 10.1111/bph.14866] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Adaptation of right ventricular (RV) function to increased afterload-known as RV-arterial coupling-is a key determinant of prognosis in pulmonary hypertension. However, measurement of RV-arterial coupling is a complex, invasive process involving analysis of the RV pressure-volume relationship during preload reduction over multiple cardiac cycles. Simplified methods have therefore been proposed, including echocardiographic and cardiac MRI approaches. This review describes the available methods for assessment of RV function and RV-arterial coupling and the effects of pharmacotherapy on these variables. Overall, pharmacotherapies for pulmonary hypertension have shown beneficial effects on various measures of RV function, but it is often unclear if these are direct RV effects or indirect results of afterload reduction. Studies of the effects of pharmacotherapies on RV-arterial coupling are limited and mostly restricted to experimental models. Simplified methods to assess RV-arterial coupling should be validated and incorporated into routine clinical follow-up and future clinical trials. LINKED ARTICLES: This article is part of a themed issue on Risk factors, comorbidities, and comedications in cardioprotection. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.1/issuetoc.
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Affiliation(s)
- Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Robert Naeije
- Physiology, Erasme University Hospital, Brussels, Belgium
| | | | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Manuel Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Giessen, Germany
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Harm J Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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27
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Welt FGP, Fang JC. Pressure Volume System for Management of Heart Failure and Valvular Heart Disease. Curr Cardiol Rep 2019; 21:153. [PMID: 31768659 DOI: 10.1007/s11886-019-1247-0] [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] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To introduce the reader to the basics of pressure-volume (PV) analysis, its current role in management of heart failure and valvular disease, and the possibilities for future use. RECENT FINDINGS The recent introduction of FDA-approved miniaturized conductance catheters that can produce PV loops in the clinical setting has set the stage for the translation of this important research technique into clinical practice. The use of these catheters has shed important insights into the pathophysiology of many common conditions associated with heart failure including heart failure with preserved ejection fraction and right heart failure and has been utilized to assist in optimization of lead placement during cardiac resynchronization therapy. The use of PV loops has enhanced our understanding and diagnosis of common conditions associated with heart failure. In addition, it has shown promise as an adjunct to therapeutic procedures. Future directions may include the use of PV loops in the management of patients with heart failure requiring mechanical circulatory support and to help predict the utility of percutaneous valvular interventions.
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Affiliation(s)
- Frederick G P Welt
- Division of Cardiovascular Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, Utah, 84132, USA.
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah Health, 30 North 1900 East, Room 4A100, Salt Lake City, Utah, 84132, USA
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Nguyen M, Berhoud V, Bartamian L, Martin A, Ellouze O, Bouhemad B, Guinot PG. Agreement between different non-invasive methods of ventricular elastance assessment for the monitoring of ventricular-arterial coupling in intensive care. J Clin Monit Comput 2019; 34:893-901. [PMID: 31599374 DOI: 10.1007/s10877-019-00397-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/01/2019] [Indexed: 01/03/2023]
Abstract
Ventricular-arterial coupling is calculated as the arterial elastance to end systolic elastance ratio (EA/Ees). Although the gold standard is invasive pressure volume loop analysis, Chen method is the clinical reference non-invasive method for estimating end systolic elastance (Ees). Several simplified methods calculate Ees from the end systolic pressure to volume ratio (ESP/ESV). The objective of the present study was to determine whether ESP/ESV simplification can be used instead of the Chen formula to measure ventricular-arterial coupling and to monitor changes following therapeutic intervention. In this retrospective, single-center study, 3 non-invasive EA/Ees calculation methods were applied to 86 cardiac ICU patients. The Chen method was used as the reference method. Ees was also calculated according to method 1: Ees1 = 0.9 × SAP/ESV and method 2: Ees2= EA/(1/LVEF) - 1. EA was estimated as 0.9 × SAP/SV (mmHg ml-1). After simplification: EA/Ees1 = EA/Ees2 = (1/LVEF) - 1, with the stroke volume estimated as the product of the aortic velocity-time integral (VTIAo) and the aortic area or as the difference between the end diastolic volume (EDV) and the ESV. All patients received fluid infusion, norepinephrine, or dobutamine. At baseline, the concordance correlation coefficient with EA/EesChen was 0.13 [- 0.07; 0.31] for EA/Ees1 and 0.32 [0.19; 0.44] for EA/Ees2. Bias and limit of agreement were 0.28 [- 0.02; 0.36] and [- 5.8; 2.6] for EA/Ees1 and of 0.44 [0.31; 0.53] and [- 3.2; 2.6] for EA/Ees2. When used to follow variations in EA/Ees following therapeutic interventions, only 65% (for EA/Ees1) and 70% (for EA/Ees2) of measures followed the same trend as EA/EesChen. Our results do not support the use of ESP/ESV based method as substitute for Chen method to measure and assess changes in ventriculo-arterial coupling (EA/Ees) in cardiac intensive care patients. Further investigations are needed to establish the most reliable non-invasive method.
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Affiliation(s)
- Maxime Nguyen
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France. .,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.
| | - Vivien Berhoud
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Loïc Bartamian
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Audrey Martin
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Omar Ellouze
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Bélaïd Bouhemad
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
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29
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Nie L, Li J, Zhang S, Dong Y, Xu M, Yan M, Zhang G, Song L. Correlation between right ventricular-pulmonary artery coupling and the prognosis of patients with pulmonary arterial hypertension. Medicine (Baltimore) 2019; 98:e17369. [PMID: 31577738 PMCID: PMC6783205 DOI: 10.1097/md.0000000000017369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the correlation between the efficiency coefficient of right ventricular-pulmonary artery coupling (ηvv) and the prognosis of patients with pulmonary arterial hypertension (PAH).A total of 64 patients who underwent right heart catheterization (RHC) were enrolled and divided into PAH and control groups depending on the RHC results. Pressure and volumetric methods were adopted to analyze the results of RHC and cardiac magnetic resonance imaging examination. The ηvv of patients in 2 groups were calculated, and the relationship between ηvv calculated by the 2 methods and the 2-year prognosis of patients with PAH was evaluated.The hemodynamic index and right ventricular-pulmonary artery coupling parameter of patients with PAH were significantly higher than those in the control group (P < .05). The right ventricular volume parameter in the PAH group was significantly different from that in the control group (P < .05). For patients with PAH, the end-systolic elastance/effective arterial elastance (Ees/Ea) calculated by the volumetric method was significantly related to the prognosis of patients (odds ratio = 0.192, 95% confidence interval: 0.042-0.868, P = .032). When Ees/Ea <0.67 was calculated by the volumetric method, the adverse prognosis of patients with PAH increased significantly (P < .05).The Ees/Ea calculated by the volumetric method may be better an independent factor for the prognosis of patients with PAH.
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Affiliation(s)
- Lin Nie
- Department of Cardiac Surgery
| | - Jun Li
- Department of Anaesthesiology, Wuhan Asia Heart Hospital, Wuhan
| | - Sanping Zhang
- Department of Cardiology, Third People's Hospital of Xining, Qinghai
| | - Yaling Dong
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, P.R. China
| | - Ming Xu
- Department of Cardiac Surgery
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Philip JL, Chesler NC. Know Your Limitations: Assumptions in the Single-Beat Method for Estimating Right Ventricular-Pulmonary Vascular Coupling. Am J Respir Crit Care Med 2019; 198:707-709. [PMID: 29979607 DOI: 10.1164/rccm.201805-1000ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jennifer L Philip
- 1 Department of Biomedical Engineering University of Wisconsin-Madison College of Engineering Madison, Wisconsin.,2 Department of Surgery University of Wisconsin-Madison Madison, Wisconsin and
| | - Naomi C Chesler
- 1 Department of Biomedical Engineering University of Wisconsin-Madison College of Engineering Madison, Wisconsin.,3 Department of Medicine University of Wisconsin-Madison Madison, Wisconsin
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Ventricular-Arterial Coupling in Children and Infants With Congenital Heart Disease After Cardiopulmonary Bypass Surgery: Observational Study. Pediatr Crit Care Med 2019; 20:753-758. [PMID: 31169761 DOI: 10.1097/pcc.0000000000001982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Ventricular-arterial coupling represents the interaction between the left ventricle and the arterial system. Ventricular-arterial coupling is measured as the ratio between arterial elastance and ventricular end-systolic elastance. Scant information is available in critically ill children about these variables. The aim of this study was to prospectively assess ventricular-arterial coupling after pediatric cardiac surgery and evaluate its association with other commonly recorded hemodynamic parameters. DESIGN Single-center retrospective observational study. SETTING Pediatric cardiac surgery operating room. PATIENTS Children undergoing corrective cardiac surgery. INTERVENTIONS Hemodynamic monitoring with transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS Twenty-seven patients with biventricular congenital heart disease, who underwent elective cardiac surgery with cardiopulmonary bypass, were enrolled before operating room discharge. Chen single-beat modified method was applied to calculate ventricular-arterial coupling. The median arterial elastance and end-systolic elastance values were 5.9 mm Hg/mL (2.2-9.3 mm Hg/mL) and 4.3 mm Hg/mL (1.9-8.3 mm Hg/mL), respectively. The median ventricular- arterial coupling was 1.2 (1.1-1.6). End-systolic elastance differences between patients with a ventricular-arterial coupling below (low ventricular-arterial coupling) and above (high ventricular-arterial coupling) the median value were -5.2 (95% CI, -6.28 to -0.7; p = 0.008). Differently, arterial elastance differences were -2.1 (95% CI, -5.7 to 1.6; p = 0.19). Ventricular-arterial coupling showed a significant association with pre-ejection time (r, 0.44; p = 0.02), total ejection time (r, -0.41; p = 0.003), cardiac cycle efficiency (r, -0.46; p = 0.02), maximal delta pressure over delta time (r, -0.44; p = 0.02), ejection fraction (r, -0.57; p = 0.01), and systemic vascular resistances indexed (0.56; p = 0.003). After adjustment, total ejection time (p = 0.001), pre-ejection time (p = 0.02), and ejection fraction (p = 0.001) remained independently associated with ventricular-arterial coupling. CONCLUSIONS Median ventricular-arterial coupling values in children after cardiac surgery appear high (above 1). Uncoupling was particularly evident in high ventricular-arterial coupling patients who showed the lowest end-systolic elastance values (but not significantly different arterial elastance values) compared with low ventricular-arterial coupling. Ventricular-arterial coupling appears to be inversely proportional to pre-ejection time, total ejection time, and ejection fraction.
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Right ventricular-vascular coupling ratio in pediatric pulmonary arterial hypertension: A comparison between cardiac magnetic resonance and right heart catheterization measurements. Int J Cardiol 2019; 293:211-217. [PMID: 31109778 DOI: 10.1016/j.ijcard.2019.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/25/2019] [Accepted: 05/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH), right ventricular (RV) failure is the main cause of mortality. Non-invasive estimation of ventricular-vascular coupling ratio (VVCR), describing contractile response to afterload, could be a valuable tool for monitoring clinical course in children with PAH. This study aimed to test two hypotheses: VVCR by cardiac magnetic resonance (VVCRCMR) correlates with conventional VVCR by right heart catheterization (VVCRRHC) and both correlate with disease severity. METHODS AND RESULTS Twenty-seven patients diagnosed with idiopathic and associated PAH without post-tricuspid shunt, who underwent RHC and CMR within 17 days at two specialized centers for pediatric PAH were retrospectively studied. Clinical functional status and hemodynamic data were collected. Median age at time of MRI was 14.3 years (IQR: 11.1-16.8), median PVRi 7.6 WU × m2 (IQR: 4.1-12.2), median mPAP 40 mm Hg (IQR: 28-55) and median WHO-FC 2 (IQR: 2-3). VVCRCMR, defined as stroke volume/end-systolic volume ratio was compared to VVCRRHC by single-beat pressure method using correlation and Bland-Altman plots. VVCRCMR and VVCRRHC showed a strong correlation (r = 0.83, p < 0.001). VVCRCMR and VVCRRHC both correlated with clinical measures of disease severity (pulmonary vascular resistance index [PVRi], mean pulmonary artery pressure [mPAP], mean right atrial pressure [mRAP], and World Health Organization functional class [WHO-FC]; all p ≤ 0.02). CONCLUSIONS Non-invasively measured VVCRCMR is feasible in pediatric PAH and comparable to invasively assessed VVCRRHC. Both correlate with functional and hemodynamic measures of disease severity. The role of VVCR assessed by CMR and RHC in clinical decision-making and follow-up in pediatric PAH warrants further clinical investigation.
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Wang CH, Chang RW, Wu ET, Chang CY, Kao HL, Wu MS, Cheng YJ, Chen YS, Chang KC. Quantification of cardiac pumping mechanics in rats by using the elastance-resistance model based solely on the measured left ventricular pressure and cardiac output. Pflugers Arch 2019; 471:935-947. [PMID: 30904932 PMCID: PMC6591189 DOI: 10.1007/s00424-019-02270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 11/28/2022]
Abstract
The cardiac pumping mechanics can be characterized by both the maximal systolic elastance (Emax) and theoretical maximum flow (Qmax), which are generated using an elastance–resistance model. The signals required to fit the elastance–resistance model are the simultaneously recorded left ventricular (LV) pressure and aortic flow (Qm), followed by the isovolumic LV pressure. In this study, we evaluated a single-beat estimation technique for determining the Emax and Qmax by using the elastance–resistance model based solely on the measured LV pressure and cardiac output. The isovolumic LV pressure was estimated from the measured LV pressure by using a non-linear least-squares approximation technique. The measured Qm was approximated by an unknown triangular flow (Qtri), which was generated by using a fourth-order derivative of the LV pressure. The Qtri scale was calibrated using the cardiac output. Values of EmaxtriQ and QmaxtriQ obtained using Qtri were compared with those of EmaxmQ and QmaxmQ obtained from the measured Qm. Healthy rats and rats with chronic kidney disease or diabetes mellitus were examined. We found that the LV Emax and Qmax can be approximately calculated using the assumed Qtri, and they strongly correlated with the corresponding values derived from Qm (P < 0.0001; n = 78): EmaxtriQ = 51.9133 + 0.8992 × EmaxmQ (r2 = 0.8257; P < 0.0001); QmaxtriQ = 2.4053 + 0.9767 × QmaxmQ (r2 = 0.7798; P < 0.0001). Our findings suggest that the proposed technique can be a useful tool for determining Emax and Qmax by using a single LV pressure pulse together with cardiac output.
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Affiliation(s)
- Chih-Hsien Wang
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Ru-Wen Chang
- Department of Physiology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan
| | - En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Chun-Yi Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Chu-Tung Branch, Hsin-Chu, 310, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Ming-Shiou Wu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Kuo-Chu Chang
- Department of Physiology, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan.
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Wo N, Rajagopal V, Cheung MMH, Smolich JJ, Mynard JP. Assessment of single beat end-systolic elastance methods for quantifying ventricular contractility. Heart Vessels 2018; 34:716-723. [PMID: 30430293 DOI: 10.1007/s00380-018-1303-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/09/2018] [Indexed: 11/25/2022]
Abstract
Multi-beat end-systolic elastance (EMB) is considered a gold-standard index of ventricular contractility. However, it is difficult to measure clinically due to the need for transient manipulation of ventricular preload or afterload. We compared the performance of 5 'single-beat' methods that do not require loading interventions, for estimating the equivalent of EMB. In 7 sheep instrumented with a micromanometer/conductance catheter, single-beat methods were compared with EMB, obtained after transiently decreasing preload or increasing afterload under a broad range of heart rates and inotropic conditions. The single-beat elastance (ESB) method described by Shishido et al. (Circulation 102(16):1983-1989, 2000) had the highest correlation (R = 0.69, y = 0.52x + 0.43) with EMB, although the absolute accuracy was poor. Interestingly, for all methods tested, a higher correlation was observed when EMB was obtained with an afterload increase (R = 0.47 - 0.78) rather than a preload reduction (R = 0.07-0.57). Within-animal regression coefficients were higher than those obtained from pooled data, with excellent within-animal correlation observed for Shishido et al. method (0.73 ≤ R ≤ 0.96) when using afterload increase as the loading intervention. We conclude that (1) current methods perform better when using an afterload increase to obtain reference EMB, (2) intra-individual ESB comparisons may be more reliable than inter-individual comparisons and (3) Shishido et al.'s method demonstrated the strongest correlation with EMB. Current ESB methods have limited and variable accuracy, but may hold promise for tracking relative changes in ventricular contractility in individuals.
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Affiliation(s)
- Naomi Wo
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
| | - Vijay Rajagopal
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - Michael M H Cheung
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Joseph J Smolich
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Jonathan P Mynard
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia.
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia.
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van Loon LM, van der Hoeven JG, Veltink PH, Lemson J. The influence of esmolol on right ventricular function in early experimental endotoxic shock. Physiol Rep 2018; 6:e13882. [PMID: 30318855 PMCID: PMC6186817 DOI: 10.14814/phy2.13882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022] Open
Abstract
The mechanism by which heart rate (HR) control with esmolol improves hemodynamics during septic shock remains unclear. Improved right ventricular (RV) function, thereby reducing venous congestion, may play a role. We assessed the effect of HR control with esmolol during sepsis on RV function, macrocirculation, microcirculation, end-organ-perfusion, and ventricular-arterial coupling. Sepsis was induced in 10 healthy anesthetized and mechanically ventilated sheep by continuous IV administration of lipopolysaccharide (LPS). Esmolol was infused after successful resuscitation of the septic shock, to reduce HR and stopped 30-min after reaching targeted HR reduction of 30%. Venous and arterial blood gases were sampled and the small intestines' microcirculation was assessed by using a hand-held video microscope (CytoCam-IDF). Arterial and venous pressures, and cardiac output (CO) were recorded continuously. An intraventricular micromanometer was used to assess the RV function. Ventricular-arterial coupling ratio (VACR) was estimated by catheterization-derived single beat estimation. The targeted HR reduction of >30% by esmolol infusion, after controlled resuscitation of the LPS induced septic shock, led to a deteriorated RV-function and macrocirculation, while the microcirculation remained depressed. Esmolol improved VACR by decreasing the RV end-systolic pressure. Stopping esmolol showed the reversibility of these effects on the RV and the macrocirculation. In this animal model of acute severe endotoxic septic shock, early administration of esmolol decreased RV-function resulting in venous congestion and an unimproved poor microcirculation despite improved cardiac mechanical efficiency.
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Affiliation(s)
- Lex M. van Loon
- Biomedical Signals and SystemsFaculty of Electrical Engineering, Mathematics and Computer ScienceTechnical Medical CentreUniversity of TwenteEnschedethe Netherlands
- Department of Critical Care Medicine (707)Radboud university medical centerNijmegenthe Netherlands
| | | | - Peter H. Veltink
- Biomedical Signals and SystemsFaculty of Electrical Engineering, Mathematics and Computer ScienceTechnical Medical CentreUniversity of TwenteEnschedethe Netherlands
| | - Joris Lemson
- Department of Critical Care Medicine (707)Radboud university medical centerNijmegenthe Netherlands
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Tabima DM, Philip JL, Chesler NC. Right Ventricular-Pulmonary Vascular Interactions. Physiology (Bethesda) 2018; 32:346-356. [PMID: 28814495 DOI: 10.1152/physiol.00040.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022] Open
Abstract
Accurate and comprehensive evaluation of right ventricular (RV)-pulmonary vascular (PV) interactions is critical to the assessment of cardiopulmonary function, dysfunction, and failure. Here, we review methods of quantifying RV-PV interactions and experimental results from clinical trials as well as large- and small-animal models based on pressure-volume analysis. We conclude by outlining critical gaps in knowledge that should drive future studies.
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Affiliation(s)
- Diana M Tabima
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin; and
| | - Jennifer L Philip
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin; and.,Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Naomi C Chesler
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, Madison, Wisconsin; and
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Inuzuka R, Hsu S, Tedford RJ, Senzaki H. Single-Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension. J Am Heart Assoc 2018; 7:JAHA.117.007929. [PMID: 29739798 PMCID: PMC6015338 DOI: 10.1161/jaha.117.007929] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background An accurate assessment of intrinsic right ventricular (RV) contractility and its relation to pulmonary arterial load is essential for the management of pulmonary hypertension. The pressure‐volume relationship with load manipulation is the gold standard assessment used for this purpose, but its clinical application has been hindered by the lack of a single‐beat method that is valid for the human RV. In the present study, we sought to validate a novel single‐beat method to estimate the preload recruitable stroke work (PRSW) and its derivative for ventriculoarterial coupling in the human RV. Methods and Results A novel single‐beat slope of the PRSW relationship (Msw) was derived by calculating the mean ejection pressure when the end‐systolic volume was equal to volume‐axis intercept of the PRSW relationship. In addition, by using a mathematical transformation of the equation representing the linearity of the PRSW relationship, a novel index for ventriculoarterial coupling, Msw/mean ejection pressure, was developed. RV pressure‐volume relationships were measured in 31 patients (including 23 patients with pulmonary hypertension) who were referred for right‐sided heart catheterization. In this cohort, the single‐beat Msw was strongly correlated with the multiple‐beat Msw (r=0.91, P<0.0001). Moreover, a significant correlation was observed between the single‐ and multiple‐beat Msw/mean ejection pressure (r=0.53, P=0.002), with a stronger correlation in those with greater RV systolic pressure (r=0.70, P=0.003). Conclusions The novel single‐beat approach provided an accurate estimation of indexes for the PRSW relationship and ventriculoarterial coupling. It may be particularly useful in assessing RV adaptation to increased pressure overload.
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Affiliation(s)
- Ryo Inuzuka
- Department of Pediatrics, University of Tokyo, Tokyo, Japan
| | - Steven Hsu
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Hideaki Senzaki
- Department of Pediatric Cardiology, Saitama Medical Center, Saitama Medical University, Saitama, Japan .,Department of Pediatrics and Pediatric Cardiology, Kitasato University, Sagamihara, Kanagawa, Japan
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Bonadei I, Sciatti E, Vizzardi E, Fabbricatore D, Pagnoni M, Rossi L, Carubelli V, Lombardi CM, Metra M. Effects of ivabradine on endothelial function, aortic properties and ventricular-arterial coupling in chronic systolic heart failure patients. Cardiovasc Ther 2018; 36:e12323. [PMID: 29460403 DOI: 10.1111/1755-5922.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/30/2017] [Accepted: 02/15/2018] [Indexed: 12/28/2022] Open
Abstract
AIM Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. METHODS We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months. RESULTS At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VAC value (ΔVAC -0.10 ± 0.18, P = .021), mainly linked to Ea (ΔEa -0.40 ± 0.23 mm Hg/mL; P = .003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82 ± 1.43 cm² × dyn- ¹, P = .004; ΔASI -4.73 ± 6.07, P = .033; ΔSAS -7.98 ± 4.37%, P = .003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35 ± 0.35; P < .001). At follow-up 40% of patients had impaired VAC (P = .018) and 33% endothelial dysfunction (P = .038). CONCLUSION In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.
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Affiliation(s)
- Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Laura Rossi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Carlo M Lombardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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Wang CH, Chang RW, Chang CY, Wu MS, Kao HL, Lai LC, Young TH, Yu HY, Chen YS, Chang KC. Quantification of contractile mechanics in the rat heart from ventricular pressure alone. Oncotarget 2017; 8:96161-96170. [PMID: 29221195 PMCID: PMC5707089 DOI: 10.18632/oncotarget.21815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022] Open
Abstract
To quantitate the contractile mechanics of the heart, the ventricle is considered an elastic chamber with known end-systolic elastance (Ees). Ees can be calculated from a single pressure-ejected volume curve, which requires simultaneous records of left ventricular (LV) pressure and the aortic flow (Qm). In clinical settings, it is helpful to evaluate patients’ cardiac contractile status by using a minimally invasive approach to physiological signal monitoring, wherever possible, such as by using LV pressure alone. In this study, we evaluated a method for determining Ees on the basis of the measured LV pressure and an assumed aortic flow with a triangular wave shape (Qtri). Qtri was derived using a fourth-order derivative of the LV pressure to approximate its corresponding Qm. Values of EestriQ obtained using Qtri were compared with those of EesmQ obtained from the measured Qm. Healthy rats (NC; n = 28) and rats with type 1 diabetes (DM; n = 26) and chronic kidney disease (CKD; n = 20) were examined. The cardiodynamic conditions in both the DM and CKD groups were characterized by a decline in EesmQ and EestriQ. A significant regression line for Ees was observed (P < 0.0001): EestriQ = 2.6214 + 1.0209 × EesmQ (r2 = 0.9870; n = 74). Our finding indicates that the systolic pumping mechanics of the heart can be derived from a single LV pressure recording together with the assumed Qtri.
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Affiliation(s)
- Chih-Hsien Wang
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan.,Department of Surgery, National Taiwan University Hospital, Hsinchu Branch, Hsinchu 300, Taiwan
| | - Ru-Wen Chang
- Department of Physiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chun-Yi Chang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Chu-Tung Branch, Hsinchu 310, Taiwan
| | - Ming-Shiou Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsien-Li Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Liang-Chuan Lai
- Department of Physiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and Engineering, National Taiwan University, Taipei 100, Taiwan
| | - Hsi-Yu Yu
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Kuo-Chu Chang
- Department of Physiology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
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Shigemi K, Fuke S, Une D, Saku K, Shimizu S, Kawada T, Shishido T, Sunagawa K, Sugimachi M. Physiological insights of recent clinical diagnostic and therapeutic technologies for cardiovascular diseases. J Physiol Sci 2017; 67:655-672. [PMID: 28681363 PMCID: PMC5698391 DOI: 10.1007/s12576-017-0554-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/22/2017] [Indexed: 12/21/2022]
Abstract
Diagnostic and therapeutic methods for cardiovascular diseases continue to be developed in the 21st century. Clinicians should consider the physiological characteristics of the cardiovascular system to ensure successful diagnosis and treatment. In this review, we focus on the roles of cardiovascular physiology in recent diagnostic and therapeutic technologies for cardiovascular diseases. In the first section, we discuss how to evaluate and utilize left ventricular arterial coupling in the clinical settings. In the second section, we review unique characteristics of pulmonary circulation in the diagnosis and treatment of pulmonary hypertension. In the third section, we discuss physiological and anatomical factors associated with graft patency after coronary artery bypass grafting. In the last section, we discuss the usefulness of mechanical ventricular unloading after acute myocardial infarction. Clinical development of diagnostic methods and therapies for cardiovascular diseases should be based on physiological insights of the cardiovascular system.
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Affiliation(s)
- Kenji Shigemi
- Department of Anesthesiology and Reanimatology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Soichiro Fuke
- Department of Cardiology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Dai Une
- Division of Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, Kanagawa, Japan
| | - Keita Saku
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Toshiaki Shishido
- Department of Research Promotion, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kenji Sunagawa
- Department of Therapeutic Regulation of Cardiovascular Homeostasis, Center for Disruptive Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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Moza A, Gesenhues J, Autschbach R, Abel D, Rossaint R, Schmitz-Rode T, Goetzenich A. Parametrization of an in-silico circulatory simulation by clinical datasets - towards prediction of ventricular function following assist device implantation. BIOMED ENG-BIOMED TE 2017; 62:123-130. [PMID: 28259865 DOI: 10.1515/bmt-2016-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) therapy has revolutionized the way end stage heart failure is treated today. Analysis of LVAD interaction with the whole cardiovascular system and its biological feedback loops is often conducted by means of computer models. Generating real time pressure volume loops (PV-loops) in patients, not using conductance catheters but routine diagnostics to feed an in-silico model could help to predict postoperative complications. METHODS Routinely obtained hemodynamic measurements to evaluate myocardial function prior to LVAD implantation like pressure readings in the aorta, the left atrium and the left ventricle and simultaneous three-dimensional (3D) echocardiography recordings were assessed to parametrize a reduced computational model of the cardiovascular system. An automatic parameter identification procedure has been developed. RESULTS The results constitute a patient-individual computational simulation model. An exemplary in-silico study focusing on the effect of different ventricular assist device (VAD) speeds has been conducted. Results allow for estimation of the resulting hemodynamic parameters and changes of the PV-loops. CONCLUSION The model improves understanding and prediction of the interaction between pump and ventricles. Future modifications in exporting and merging routinely assessed real time hemodynamic patient data are necessary to investigate various clinical and pathological conditions of LVAD recipients.
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Affiliation(s)
- Ajay Moza
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen
| | - Jonas Gesenhues
- Institute of Automatic Control, RWTH Aachen University, Aachen
| | - Rüdiger Autschbach
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen
| | - Dirk Abel
- Institute of Automatic Control, RWTH Aachen University, Aachen
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital RWTH Aachen
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen
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Systolic and diastolic unloading by mechanical support of the acute vs the chronic pressure overloaded right ventricle. J Heart Lung Transplant 2017; 36:457-465. [DOI: 10.1016/j.healun.2016.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/07/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022] Open
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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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Chowdhury SM, Butts RJ, Taylor CL, Bandisode VM, Chessa KS, Hlavacek AM, Shirali GS, Baker GH. Validation of Noninvasive Measures of Left Ventricular Mechanics in Children: A Simultaneous Echocardiographic and Conductance Catheterization Study. J Am Soc Echocardiogr 2016; 29:640-7. [PMID: 27025669 DOI: 10.1016/j.echo.2016.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The accuracy of echocardiography in evaluating left ventricular contractility has not been validated in children. The objective of this study was to compare echocardiographic measures of contractility with those derived from pressure-volume loop (PVL) analysis in children. METHODS Patients with relatively normal loading conditions undergoing routine left heart catheterization were prospectively enrolled. PVLs were obtained via conductance catheters. The gold-standard measure of contractility, end-systolic elastance (Ees), was obtained via balloon occlusion of one or both vena cavae. Echocardiograms were performed immediately after PVL analysis under the same anesthetic conditions. Single-beat estimations of echocardiographic Ees were calculated using four different methods. These estimates were calculated using a combination of noninvasive blood pressure readings, ventricular volumes derived from three-dimensional echocardiography, and Doppler time intervals. RESULTS Of 24 patients, 18 patients were heart transplant recipients, and six patients had small patent ductus arteriosus or small coronary fistulae. The mean age was 9.1 ± 5.6 years. The average invasive Ees was 3.04 ± 1.65 mm Hg/mL. Invasive Ees correlated best with echocardiographic Ees by the method of Tanoue (r = 0.85, P < .01), with a mean difference of -0.07 mm Hg/mL (95% limits of agreement, -2.0 to 1.4 mm Hg/mL). CONCLUSIONS Echocardiographic estimates of Ees correlate well with gold-standard measures obtained via conductance catheters in children with relatively normal loading conditions. The use of these noninvasive measures in accurately assessing left ventricular contractility appears promising and merits further study in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S Shirali
- The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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Ko YH, Tsai MS, Chang RW, Chang CY, Wang CH, Wu MS, Liang JT, Chang KC. Methylprednisolone Protects Cardiac Pumping Mechanics from Deteriorating in Lipopolysaccharide-Treated Rats. Front Physiol 2015; 6:348. [PMID: 26635633 PMCID: PMC4659924 DOI: 10.3389/fphys.2015.00348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/09/2015] [Indexed: 11/13/2022] Open
Abstract
It has been shown that a prolonged low-dose corticosteroid treatment attenuates the severity of inflammation and the intensity and duration of organ system failure. In the present study, we determined whether low-dose methylprednisolone (a synthetic glucocorticoid) can protect male Wistar rats against cardiac pumping defects caused by lipopolysaccharide-induced chronic inflammation. For the induction of chronic inflammation, a slow-release ALZET osmotic pump was subcutaneously implanted to infuse lipopolysaccharide (1 mg kg(-1) d(-1)) for 2 weeks. The lipopolysaccharide-challenged rats were treated on a daily basis with intraperitoneal injection of methylprednisolone (5 mg kg(-1) d(-1)) for 2 weeks. Under conditions of anesthesia and open chest, we recorded left ventricular (LV) pressure and ascending aortic flow signals to calculate the maximal systolic elastance (E max) and the theoretical maximum flow (Q max), using the elastance-resistance model. Physically, E max reflects the contractility of the myocardium as an intact heart, whereas Q max has an inverse relationship with the LV internal resistance. Compared with the sham rats, the cardiodynamic condition was characterized by a decline in E max associated with the increased Q max in the lipopolysaccharide-treated rats. Methylprednisolone therapy increased E max, which suggests that the drug may have protected the contractile status from deteriorating in the inflamed heart. By contrast, methylprednisolone therapy considerably reduced Q max, indicating that the drug may have normalized the LV internal resistance. In parallel, the benefits of methylprednisolone on the LV systolic pumping mechanics were associated with the reduced cardiac levels of negative inotropic molecules such as peroxynitrite, malondialdehyde, and high-mobility group box 1 protein. Based on these data, we suggested that low-dose methylprednisolone might prevent lipopolysaccharide-induced decline in cardiac intrinsic contractility and LV internal resistance, possibly through its ability to reduce the aforementioned myocardial depressant substances. However, since our results were obtained in anesthetized open-chest rats, extrapolation to what may occur in conscious intact animals should be done with caution.
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Affiliation(s)
- Ya-Hui Ko
- Department of Physiology, College of Medicine, National Taiwan University Taipei, Taiwan
| | | | - Ru-Wen Chang
- Department of Physiology, College of Medicine, National Taiwan University Taipei, Taiwan
| | - Chun-Yi Chang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu, Taiwan
| | - Chih-Hsien Wang
- Department of Surgery, National Taiwan University Hospital Taipei, Taiwan
| | - Ming-Shiou Wu
- Department of Internal Medicine, National Taiwan University Hospital Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University Hospital Taipei, Taiwan
| | - Kuo-Chu Chang
- Department of Physiology, College of Medicine, National Taiwan University Taipei, Taiwan
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Gerges M, Gerges C, Pistritto AM, Lang MB, Trip P, Jakowitsch J, Binder T, Lang IM. Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival. Am J Respir Crit Care Med 2015; 192:1234-46. [DOI: 10.1164/rccm.201503-0529oc] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Truong U, Patel S, Kheyfets V, Dunning J, Fonseca B, Barker AJ, Ivy D, Shandas R, Hunter K. Non-invasive determination by cardiovascular magnetic resonance of right ventricular-vascular coupling in children and adolescents with pulmonary hypertension. J Cardiovasc Magn Reson 2015; 17:81. [PMID: 26376972 PMCID: PMC4574020 DOI: 10.1186/s12968-015-0186-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/21/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric pulmonary hypertension (PH) remains a disease with high morbidity and mortality in children. Understanding ventricular-vascular coupling, a measure of how well matched the ventricular and vascular function are, may elucidate pathway leading to right heart failure. Ventricular vascular coupling ratio (VVCR), comprised of effective elastance (Ea, index of arterial load) and right ventricular maximal end-systolic elastance (Ees, index of contractility), is conventionally determined by catheterization. Here, we apply a non-invasive approach to determining VVCR in pediatric subjects with PH. METHODS This retrospective study included PH subjects who had a cardiovascular magnetic resonance (CMR) study within 14 days of cardiac catheterization. PH was defined as mean pulmonary artery pressure (mPAP) ≥ 25 mmHg on prior or current catheterization. A non-invasive measure of VVCR was derived from CMR-only (VVCRm) and compared to VVCR estimated by catheterization-derived single beat estimation (VVCRs). Indexed pulmonary vascular resistance (PVRi) and pulmonary vascular reactivity were determined during the catheterization procedure. Pearson correlation coefficients were calculated between PVRi and VVCRm. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of VVCRm in predicting vascular reactivity. RESULTS Seventeen subjects (3 months-23 years; mean 11.3 ± 7.4 years) were identified between January 2009-August 2013 for inclusion with equal gender distributions. Mean mPAP was 35 mmHg ± 15 and PVRi was 8.5 Woods unit x m2 ± 7.8. VVCRm (range 0.43-2.82) increased with increasing severity as defined by PVRi (p < 0.001), and was highly correlated with PVRi (r = 0.92, 95 % CI 0.79-0.97, p < 0.0001). Regression of VVCRm and PVRi demonstrated differing lines when separated by reactivity. VVCRm was significantly correlated with VVCRs (r = 0.79, CI 0.48-0.99, p <0.0001). ROC curve analysis showed high accuracy of VVCRm in determining vascular reactivity (VVCR = 0.85 had a sensitivity of 100 % and a specificity of 80 %) with an area under the curve of 0.89 (p = 0.008). CONCLUSION Measurement of VVCRm in pediatrics is feasible. Pulmonary vascular non-reactivity may be contribute to ventricular-vascular decoupling in severe PH. Therapeutic intervention to maintain a low vascular afterload in reactive patients may preserve right ventricular functional reserve and delay the onset of RV-PA decoupling. Use of VVCRm may have significant prognostic implication.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department for Pediatrics, Division of Cardiology, Children's Hospital Colorado, University of Colorado Anschultz Medical Center, 13123 E. 16th Avenue, B100, Aurora, CO, 80045, USA.
| | - Sonali Patel
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Vitaly Kheyfets
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Jamie Dunning
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Brian Fonseca
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Alex J Barker
- Department of Radiology, Northwestern University, Chicago, IL, USA.
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Robin Shandas
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
| | - Kendall Hunter
- Division of Pediatric Cardiology, Children's Hospital Colorado, Aurora, CO, 80045, USA.
- Department of Bioengineering, University of Colorado Denver Medical Campus, Aurora, CO, 80045, USA.
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Verbelen T, Verhoeven J, Goda M, Burkhoff D, Delcroix M, Rega F, Meyns B. Mechanical support of the pressure overloaded right ventricle: an acute feasibility study comparing low and high flow support. Am J Physiol Heart Circ Physiol 2015; 309:H615-24. [DOI: 10.1152/ajpheart.00246.2015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/11/2015] [Indexed: 11/22/2022]
Abstract
The objectives of this study were to assess the feasibility of low flow right ventricular support and to describe the hemodynamic effects of low versus high flow support in an animal model of acute right ventricular pressure overload. A Synergy Pocket Micro-pump (HeartWare International, Framingham, MA) was implanted in seven sheep. Blood was withdrawn from the right atrium to the pulmonary artery. Hemodynamics and pressure-volume loops were recorded in baseline conditions, after banding the pulmonary artery, and after ligating the right coronary artery in these banded sheep. End-organ perfusion (reflected by total cardiac output and arterial blood pressure) improved in all conditions. Intrinsic right ventricular contractility was not significantly impacted by support. Diastolic unloading of the pressure overloaded right ventricle (reflected by decreases in central venous pressure, end-diastolic pressure and volume, and ventricular capacitance) was successful, but with a concomitant and flow-dependent increase of the systolic afterload. This unloading diminished with right ventricular ischemia. Right ventricular mechanical support improves arterial blood pressure and cardiac output. It provides diastolic unloading of the right ventricle, but with a concomitant and right ventricular assist device flow-dependent increase of systolic afterload. These effects are most distinct in the pressure overloaded right ventricle without profound ischemic damage. We advocate the low flow strategy, which is potentially beneficial for the afterload sensitive right ventricle and has the advantage of avoiding excessive increases in pulmonary artery pressure when pulmonary hypertension exists. This might protect against the development of pulmonary edema and hemorrhage.
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Affiliation(s)
- Tom Verbelen
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jelle Verhoeven
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Motohiko Goda
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Marion Delcroix
- Respiratory Division, University Hospitals Leuven and Department of Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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Kerkhof PLM. Characterizing heart failure in the ventricular volume domain. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:11-31. [PMID: 25780344 PMCID: PMC4345934 DOI: 10.4137/cmc.s18744] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/11/2015] [Accepted: 01/17/2015] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) may be accompanied by considerable alterations of left ventricular (LV) volume, depending on the particular phenotype. Two major types of HF have been identified, although heterogeneity within each category may be considerable. All variants of HF show substantially elevated LV filling pressures, which tend to induce changes in LV size and shape. Yet, one type of HF is characterized by near-normal values for LV end-diastolic volume (EDV) and even a smaller end-systolic volume (ESV) than in matched groups of persons without cardiac disease. Furthermore, accumulating evidence indicates that, both in terms of shape and size, in men and women, the heart reacts differently to adaptive stimuli as well as to certain pharmacological interventions. Adjustments of ESV and EDV such as in HF patients are associated with (reverse) remodeling mechanisms. Therefore, it is logical to analyze HF subtypes in a graphical representation that relates ESV to EDV. Following this route, one may expect that the two major phenotypes of HF are identified as distinct entities localized in different areas of the LV volume domain. The precise coordinates of this position imply unique characteristics in terms of the actual operating point for LV volume regulation. Evidently, ejection fraction (EF; equal to 1 minus the ratio of ESV and EDV) carries little information within the LV volume representation. Thus far, classification of HF is based on information regarding EF combined with EDV. Our analysis shows that ESV in the two HF groups follows different patterns in dependency of EDV. This observation suggests that a superior HF classification system should primarily be founded on information embodied by ESV.
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Affiliation(s)
- Peter LM Kerkhof
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
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