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Ventriculo-arterial coupling in patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Int J Cardiovasc Imaging 2021; 38:571-577. [PMID: 34655349 DOI: 10.1007/s10554-021-02437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
To investigate ventriculo-arterial coupling (VAC) and its components (Ea, Ees) in patients with stable ischemic heart disease and changes following percutaneous coronary intervention (PCI). 129 patients with stable ischemic heart disease (SIHD) undergoing PCI (study group) and 40 individuals without IHD (control group) were enrolled. VAC was calculated using echocardiography method at baseline and 1, 3, and 6 months after PCI. A linear mixed-effects models with restricted maximum likelihood were used to assess the impact of PCI on Ea, Ees, VAC over 6-month follow-up. Mean age of the SIHD group was 67.8 ± 8.1 (years), and predominantly men (73.6%). In the SIHD group, baseline median Ea, Ees and VAC were 2.52 (IQR 1.89-3.28) (mmHg/ml), 3.87 (IQR 2.90-4.95) (mmHg/ml), and 0.64 (IQR 0.54-0.79), respectively. Patients with SIHD had significantly lower Ees and higher VAC when compared to the control group (p < 0.05). Ees (p = 0.01) and VAC (p < 0.001) were significantly improved over 6 month follow-up after PCI. Notably, the degree of VAC improvement appears to be related to stented artery (Table 3). VAC obtained from echocardiographic methodology demonstrated a significant increase in patients with SIHD at baseline. This observation may represent a plausible mechanism for the benefit of PCI in SIHD. Hence, VAC may be a feasible parameter in the assessment of patients with SIHD.
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Li JKJ, Kaya M, Kerkhof PL. Quantitative cardiology and computer modeling analysis of heart failure in systole and in diastole. Comput Biol Med 2018; 103:252-261. [DOI: 10.1016/j.compbiomed.2018.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Vasopressors induce passive pulmonary hypertension by blood redistribution from systemic to pulmonary circulation. Basic Res Cardiol 2017; 112:21. [PMID: 28258299 DOI: 10.1007/s00395-017-0611-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/28/2017] [Indexed: 02/05/2023]
Abstract
Vasopressors are widely used in resuscitation, ventricular failure, and sepsis, and often induce pulmonary hypertension with undefined mechanisms. We hypothesize that vasopressor-induced pulmonary hypertension is caused by increased pulmonary blood volume and tested this hypothesis in dogs under general anesthesia. In normal hearts (model 1), phenylephrine (2.5 μg/kg/min) transiently increased right but decreased left cardiac output, associated with increased pulmonary blood volume (63% ± 11.8, P = 0.007) and pressures in the left atrium, pulmonary capillary, and pulmonary artery. However, the trans-pulmonary gradient and pulmonary vascular resistance remained stable. These changes were absent after decreasing blood volume or during right cardiac dysfunction to reduce pulmonary blood volume (model 2). During double-ventricle bypass (model 3), phenylephrine (1, 2.5 and 10 μg/kg/min) only slightly induced pulmonary vasoconstriction. Vasopressin (1U and 2U) dose-dependently increased pulmonary artery pressure (52 ± 8.4 and 71 ± 10.3%), but did not cause pulmonary vasoconstriction in normally beating hearts (model 1). Pulmonary artery and left atrial pressures increased during left ventricle dysfunction (model 4), and further increased after phenylephrine injection by 31 ± 5.6 and 43 ± 7.5%, respectively. In conclusion, vasopressors increased blood volume in the lung with minimal pulmonary vasoconstriction. Thus, this pulmonary hypertension is similar to the hemodynamic pattern observed in left heart diseases and is passive, due to redistribution of blood from systemic to pulmonary circulation. Understanding the underlying mechanisms may improve clinical management of patients who are taking vasopressors, especially those with coexisting heart disease.
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Kerkhof PLM, Li JKJ, Heyndrickx GR. Effective arterial elastance and arterial compliance in heart failure patients with preserved ejection fraction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:691-4. [PMID: 24109781 DOI: 10.1109/embc.2013.6609594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Heart failure (HF) patients have often been observed to have their ejection fractions somewhat preserved (HFpEF). Since left ventricular (LV) ejection is dependent on the coupled arterial load, the preserved ejection may be dependent on the effective arterial elastance (Ea). Whether this is indeed the case is subject to further analysis. We investigated this aspect in 67 patients with cardiac disease; 34 of them met the matching criteria for HFpEF. Both Ea, an arterial system (ASy) property, and aortic compliance (C), a physical property, were obtained in an attempt to differentiate the LV-ASy interaction in HFpEF and HFrEF (reduced ejection fraction) patients. Outcome of the study allowed us to conclude that Ea does not parallel changes in C. While Ea may be useful in assessing the severity of HFrEF, it is a weak indicator of EF dependence in HFpEF patients.
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Li JKJ, Atlas G. Left Ventricle-Arterial System Interaction in Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:93-9. [PMID: 26124691 PMCID: PMC4479180 DOI: 10.4137/cmc.s18742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 11/20/2022]
Abstract
Ejection fraction (EF) has been viewed as an important index in assessing the contractile state of the left ventricle (LV). However, it is frequently inadequate for the diagnosis and management of heart failure (HF), as a significant subset of HF patients have been found to have reduced EF (HFrEF) whereas others have preserved EF (HFpEF). It should be noted that the function of the LV is dependent on both preload and afterload, as well as its intrinsic contractile state. Furthermore, stroke volume (SV) is dependent on the properties of the arterial system (AS). Thus, the LV-arterial system interaction plays an important role in those patients with HF. This aspect is investigated through the analysis of the specific parameters involved in the coupling of the LV and AS. This includes contractility and the systolic/diastolic indices of the LV. Furthermore, AS afterload parameters such as vascular stiffness and arterial compliance, and their derived coupling coefficient, are also investigated. We conclude that those parameters, which relate to LV structural changes, are most appropriate in quantifying the LV-AS interaction.
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Affiliation(s)
- John K-J Li
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, USA
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Glen Atlas
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ, USA
- Department of Chemistry, Chemical Biology, and Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
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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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Diakos NA, Pozios I, Katsaros L, Vakrou S, Sventzouri S, Michelinakis N, Tseliou E, Bonios M, Malliaras K, Papalois A, Anastasiou-Nana M, Terrovitis JV. Afterload-induced left ventricular diastolic dysfunction during myocardial ischaemia and reperfusion. Exp Physiol 2015; 100:288-301. [DOI: 10.1113/expphysiol.2014.082131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/12/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Nikolaos A. Diakos
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Iraklis Pozios
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Lampros Katsaros
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Styliani Vakrou
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Stefania Sventzouri
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Nikolaos Michelinakis
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Eleni Tseliou
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Michael Bonios
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | | | - Apostolos Papalois
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - Maria Anastasiou-Nana
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
| | - John V. Terrovitis
- The 3rd Department of Cardiology; University of Athens; ‘Laiko’ Hospital; Athens Greece
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Kerkhof PLM, Yasha Kresh J, Li JKJ, Heyndrickx GR. Left ventricular volume regulation in heart failure with preserved ejection fraction. Physiol Rep 2013; 1:e0007. [PMID: 24303121 PMCID: PMC3831907 DOI: 10.1002/phy2.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/23/2022] Open
Abstract
Ejection Fraction (EF) has attained the recognition as indicator of global ventricular performance. Remarkably, precise historical origins promoting the apparent importance of EF are scant. During early utilization EF has been declared a gold standard for the evaluation of the heart as a pump. In contrast, during the last two decades, clinicians have developed a measure of doubt in the universal applicability of EF. This reluctance lead to the introduction of a new and prevalent syndrome in which heart failure (HF) is diagnosed as having a preserved EF (pEF). We examine the existing criticism regarding EF, and describe a novel avenue to characterize ventricular function within the unifying framework of cardiac input–output volume regulation. This approach relates end-systolic volume (ESV) to end-diastolic volume (EDV), and derives for a subgroup matching pEF criteria a distinct pattern in the ESV–EDV domain. In patients with pEF (n = 34), a clear difference (P < 0.0004) in the slope of the regression line for ESV versus EDV was demonstrated compared to control patients with EF < 50% (n = 29). These findings are confirmed by analysis of data presented in two independent publications. The volume regulation approach proposed employs primary end-point determinants (such as ESV and EDV) rather than derived quantities (e.g., the ratio EF or its differential parameter, that is, stroke volume) and confirms a distinct advantage over the classical Starling curve. Application of the ESV-EDV-construct provides the basis and clarifies why some patients present as HFpEF, while others have reduced EF.
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Affiliation(s)
- Peter L M Kerkhof
- Department Physics & Medical Technology, VU University Medical Center Amsterdam, The Netherlands
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Asemu G, O'Connell KA, Cox JW, Dabkowski ER, Xu W, Ribeiro RF, Shekar KC, Hecker PA, Rastogi S, Sabbah HN, Hoppel CL, Stanley WC. Enhanced resistance to permeability transition in interfibrillar cardiac mitochondria in dogs: effects of aging and long-term aldosterone infusion. Am J Physiol Heart Circ Physiol 2012; 304:H514-28. [PMID: 23241318 DOI: 10.1152/ajpheart.00674.2012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Functional differences between subsarcolemmal and interfibrillar cardiac mitochondria (SSM and IFM) have been observed with aging and pathological conditions in rodents. Results are contradictory, and there is little information from large animal models. We assessed the respiratory function and resistance to mitochondrial permeability transition (MPT) in SSM and IFM from healthy young (1 yr) and old (8 yr) female beagles and in old beagles with hypertension and left ventricular (LV) wall thickening induced by 16 wk of aldosterone infusion. MPT was assessed in SSM and IFM by Ca(2+) retention and swelling. Healthy young and old beagles had similar mitochondrial structure, respiratory function, and Ca(2+)-induced MPT within SSM and IFM subpopulations. On the other hand, oxidative capacity and resistance to Ca(2+)-induced MPT were significantly greater in IFM compared with SSM in all groups. Old beagles treated with aldosterone had greater LV wall thickness and worse diastolic filling but normal LV chamber volume and systolic function. Treatment with aldosterone did not alter mitochondrial respiratory function but accelerated Ca(2+)-induced MPT in SSM, but not IFM, compared with healthy old and young beagles. In conclusion, in a large animal model, oxidative capacity and resistance to MPT were greater in IFM than in SSM. Furthermore, aldosterone infusion increased susceptibility to MPT in SSM, but not IFM. Together this suggests that SSM are less resilient to acute stress than IFM in the healthy heart and are more susceptible to the development of pathology with chronic stress.
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Affiliation(s)
- Girma Asemu
- Division of Cardiology, Department of Medicine, University of Maryland, Baltimore, MD, USA
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Strik M, van Middendorp LB, Vernooy K. Animal models of dyssynchrony. J Cardiovasc Transl Res 2011; 5:135-45. [PMID: 22130900 PMCID: PMC3306020 DOI: 10.1007/s12265-011-9336-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/17/2011] [Indexed: 02/01/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an important therapy for patients with heart failure and conduction pathology, but the benefits are heterogeneous between patients and approximately a third of patients do not show signs of clinical or echocardiographic response. This calls for a better understanding of the underlying conduction disease and resynchronization. In this review, we discuss to what extent established and novel animal models can help to better understand the pathophysiology of dyssynchrony and the benefits of CRT.
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Affiliation(s)
- Marc Strik
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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