Non-invasive evaluation of left ventricular filling pressures in patients with abnormal relaxation

2004 ◽  
Vol 106 (5) ◽  
pp. 485-494 ◽  
Author(s):  
Tudor C. POERNER ◽  
Björn GOEBEL ◽  
Petra UNGLAUB ◽  
Tim SÜSELBECK ◽  
Jens J. KADEN ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Predictive Accuracy ◽  
Diastolic Pressure ◽  
Characteristic Curve ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Heart Catheterization ◽  
Time Interval ◽  
Non Invasive

The aim of the present study was to assess the ability of several echocardiographic and TDI (tissue Doppler imaging) parameters to predict an elevated LVEDP (left ventricular end-diastolic pressure) in patients with abnormal relaxation. Eighty-two consecutive patients presenting with an E/A ratio (ratio of early-to-late diastolic peak transmitral velocity) <0.9 scheduled for left heart catheterization underwent echocardiography, including TDI, and measurement of LVEDP using fluid-filled catheters. The difference in duration between PVR (retrograde peak in the pulmonary veins) and A (ΔPVR-A) was calculated from pulsed Doppler recordings. VP (propagation velocity of the early mitral inflow) was determined by colour M-mode. TDI measurements included E´ (early diastolic peak myocardial velocities near the lateral mitral annulus), MVG (the early diastolic transmyocardial velocity gradient of the posterior basal wall) and the PRT (peak relaxation time), determined as the time interval between aortic valve closure and peak E´. Fifty-six patients presented with LVEDP values <15 mmHg, whereas an LVEDP >15 mmHg was found in 26 patients. The index ΔPVR-A showed a significant linear correlation with LVEDP (r=0.7, P<0.001) and provided the highest predictive accuracy for the identification of LVEDP >15 mmHg [AUC (area under receiver operating characteristic curve)=0.83], followed by PRT (AUC=0.67), whereas other TDI-derived parameters failed to reach significance. In conclusion, ΔPVR-A enabled the most accurate non-invasive estimation of LVEDP. A prolonged peak relaxation time was the only TDI-derived index that differed significantly between patient groups.

Abstract 10878: Validation of Non-invasive Measures of Diastolic Function in Children: A Simultaneous Echocardiography and Conductance Catheterization Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shahryar M Chowdhury ◽  
Ryan J Butts ◽  
Anthony M Hlavacek ◽  
Carolyn L Taylor ◽  
Varsha M Bandisode ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Diastolic Pressure ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Balloon Occlusion ◽  
Heart Catheterization ◽  
Active Relaxation ◽  
Non Invasive ◽  
Stiffness Constant ◽  
Lv Diastolic Function

Introduction: The accuracy of echocardiography in evaluating left ventricular (LV) diastolic function has not been validated in children. The objective of this study was to compare echocardiographic and gold-standard measures of LV diastolic function in children. Methods: Patients undergoing routine left heart catheterization were prospectively enrolled. Pressure-volume loops (PVL) were obtained via conductance catheters. The end-diastolic pressure-volume relationship was obtained via balloon occlusion of the vena cavae. PVL measures of diastolic function were divided into early active relaxation (the isovolumic relaxation time constant, tau), and ventricular stiffness (the chamber stiffness constant, β). End-diastolic pressure (EDP) was also recorded. Echocardiographic measures of diastolic function were derived from spectral Doppler, tissue Doppler, and 2D speckle-tracking. The relationships between PVL and echocardiographic measures were determined using Spearman’s correlation. Results: Of 24 patients, 18 patients were s/p heart transplant, 5 patients had a small patent ductus arteriosus or coronary fistula. Mean age was 9.1 ± 5.6 years. The median τ was 24.9 ms (IQR 22.8 - 28.4 ms), median β was 0.094 (IQR 0.035 - 0.154), and median EDP was 9 mmHg (IQR 8 - 13 mmHg). Statistically significant correlations between invasive and echocardiographic measures of diastolic function are reported in the Table. No echocardiographic measures correlated with β. Conclusion: Early diastolic echocardiographic measures correlate with tau and may accurately represent early active relaxation in children. Modest associations exist between echocardiographic measures and EDP. The use of these non-invasive measures in accurately assessing LV diastolic function appears promising in children. However, no echocardiographic measures correlate with chamber stiffness. The development of such measures merits further study.

scholarly journals Determination of Left Ventricular End Diastolic Pressure Utilizing Non-Invasive Techniques: A Computer Simulation Study

2016 ◽  
Vol 22 (8) ◽  
pp. S43-S44
Author(s):  
Ying Sun ◽  
Toby Steinberg ◽  
Jeremy Rier ◽  
Stewart Benton ◽  
Daniel Steinberg ◽  
...  
Keyword(s):  
Computer Simulation ◽  
Simulation Study ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Computer Simulation Study ◽  
Non Invasive ◽  
Invasive Techniques

A novel index combining diastolic and systolic Tissue Doppler parameters for the non-invasive assessment of left ventricular end-diastolic pressure

2009 ◽  
Vol 136 (2) ◽  
pp. 120-129 ◽  
Author(s):  
Cristian Mornos ◽  
Dragos Cozma ◽  
Dan Rusinaru ◽  
Adina Ionac ◽  
Daniela Maximov ◽  
...  
Keyword(s):  
Diastolic Pressure ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Non Invasive

scholarly journals Cardiac Triangle Mapping: A New Systems Approach for Noninvasive Evaluation of Left Ventricular End Diastolic Pressure

Fluids ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 16
Author(s):  
Niema M Pahlevan ◽  
Ray V Matthews
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Systems Approach ◽  
Diastolic Pressure ◽  
Unmet Need ◽  
Left Ventricular ◽  
Time Interval ◽  
Chronic Congestive Heart Failure ◽  
Intrinsic Frequency ◽  
Future Design

Noninvasive and practical assessment of hemodynamics is a critical unmet need in the treatment of both chronic and acute cardiovascular diseases. Particularly, the ability to monitor left ventricular end-diastolic pressure (LVEDP) noninvasively offers enormous benefit for managing patients with chronic congestive heart failure. Recently, we provided proof of concept that a new cardiac metric, intrinsic frequency (IF), derived from mathematical analysis of non-invasively captured arterial waveforms, can be used to accurately compute cardiovascular hemodynamic measures, such as left ventricle ejection fraction (LVEF), by using a smartphone. In this manuscript, we propose a new systems-based method called cardiac triangle mapping (CTM) for hemodynamics evaluation of the left ventricle. This method is based on intrinsic frequency (IF) and systolic time interval (STI) methods that allows computation of LVEDP from noninvasive measurements. Since the CTM method only requires arterial waveform and electrocardiogram (ECG), it can eventually be adopted as a simple smartphone-based device, an inexpensive hand-held device, or perhaps (with future design modifications) a wearable sensor. Such devices, combined with this method, would allow for remote monitoring of heart failure patients.

scholarly journals Diastolic dysfunction is associated with cardiac fibrosis in the senescence-accelerated mouse

2011 ◽  
Vol 301 (3) ◽  
pp. H824-H831 ◽  
Author(s):  
Alana L. Reed ◽  
Atsuko Tanaka ◽  
Dan Sorescu ◽  
Hong Liu ◽  
Euy-Myoung Jeong ◽  
...  
Keyword(s):  
Growth Factor ◽  
Diastolic Dysfunction ◽  
Transforming Growth Factor ◽  
Diastolic Pressure ◽  
Diastolic Heart Failure ◽  
Left Ventricular ◽  
Tissue Growth ◽  
Doppler Imaging ◽  
Suitable Model ◽  
Samp8 Mice

Diastolic heart failure is a major cause of mortality in the elderly population. It is often preceded by diastolic dysfunction, which is characterized by impaired active relaxation and increased stiffness. We tested the hypothesis that senescence-prone (SAMP8) mice would develop diastolic dysfunction compared with senescence-resistant controls (SAMR1). Pulsed-wave Doppler imaging of the ratio of blood flow velocity through the mitral valve during early (E) vs. late (A) diastole was reduced from 1.3 ± 0.03 in SAMR1 mice to 1.2 ± 0.03 in SAMP8 mice ( P < 0.05). Tissue Doppler imaging of the early (E') and late (A') diastolic mitral annulus velocities found E' reduced from 25.7 ± 0.9 mm/s in SAMR1 to 21.1 ± 0.8 mm/s in SAMP8 mice and E'/A' similarly reduced from 1.1 ± 0.02 to 0.8 ± 0.03 in SAMR1 vs. SAMP8 mice, respectively ( P < 0.05). Invasive hemodynamics revealed an increased slope of the end-diastolic pressure-volume relationship (0.5 ± 0.05 vs. 0.8 ± 0.14; P < 0.05), indicating increased left ventricular chamber stiffness. There were no differences in systolic function or mean arterial pressure; however, diastolic dysfunction was accompanied by increased fibrosis in the hearts of SAMP8 mice. In SAMR1 vs. SAMP8 mice, interstitial collagen area increased from 0.3 ± 0.04 to 0.8 ± 0.09% and perivascular collagen area increased from 1.0 ± 0.11 to 1.6 ± 0.14%. Transforming growth factor-β and connective tissue growth factor gene expression were increased in the hearts of SAMP8 mice ( P < 0.05 for all data). In summary, SAMP8 mice show increased fibrosis and diastolic dysfunction similar to those seen in humans with aging and may represent a suitable model for future mechanistic studies.

Search for non-invasive load-independent indices of left ventricular relaxation

2003 ◽  
Vol 105 (4) ◽  
pp. 395-397 ◽  
Author(s):  
Sherif F. NAGUEH
Keyword(s):  
Mitral Annulus ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Left Ventricular Relaxation ◽  
Non Invasive ◽  
Ventricular Relaxation ◽  
Invaluable Tool ◽  
Flow Propagation Velocity ◽  
Flow Propagation

Echocardiography is an invaluable tool for the routine evaluation of patients with congestive heart failure. A number of Doppler modalities are now available. In this comment, the haemodynamic determinants and the clinical application of the more recent indices of left ventricular relaxation, namely tissue Doppler imaging of the mitral annulus and the flow propagation velocity by colour M-mode, and the importance of the study by Graham et al. in this issue of Clinical Science are discussed.

Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study

2015 ◽  
Vol 308 (12) ◽  
pp. H1556-H1563 ◽  
Author(s):  
Sara Leite ◽  
José Oliveira-Pinto ◽  
Marta Tavares-Silva ◽  
Mahmoud Abdellatif ◽  
Dulce Fontoura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Pressure ◽  
Characteristic Curve ◽  
Left Ventricular ◽  
Doppler Velocity ◽  
Preserved Ejection Fraction ◽  
Hemodynamic Stress ◽  
Effort Testing ◽  
Obese Rats

Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old Wistar-Kyoto, ZSF1 lean, and obese rats ( n = 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30°), 5 μg·Kg−1·min−1 dobutamine, and 7.5 μg·Kg−1·min−1 phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V̇o2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V̇o2 max along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E′) ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC = 0.95) but not higher than that of E/E′ (AUC = 0.77, P = 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing.

Effects of insulin on ventricular function in diabetic lambs with acidosis

1981 ◽  
Vol 241 (3) ◽  
pp. H401-H407
Author(s):  
S. E. Downing ◽  
J. C. Lee ◽  
J. C. Werner
Keyword(s):  
No Reduction ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Time Interval ◽  
Inotropic Action ◽  
Mean Values ◽  
Chronic Group ◽  
Acute Group ◽  
Group Data ◽  
Arterial Ph

Diabetes mellitus (DM) was induced in 10 lambs by giving alloxan (150 mg/kg). Two to 4 days later, mean values for glucose were 748 mg/dl, and for arterial pH 7.25 (acute group). Two additional lambs were studied after 3 mo of DM (chronic group). Data were compared with 7 controls (glucose 128 mg/dl, pH 7.36). Left ventricular (LV) performance was assessed from function curves and measurements of LV dP/dtmax. Stroke volume ejected at LV end-diastolic pressure of 5 cmH2O (SV5) was calculated from regression analysis of each curve. SV5 averaged 2.83 +/- 0.34 ml in controls and 2.90 +/- 0.23 ml in the acute diabetics (not significant). Mean values for LV dP/dtmax also did not differ. A significant correlation was found between SV5 and LV weight (P less than 0.001). SV5 was normalized as ml/100 g LV, and average values for the three groups were identical. Insulin (10 U/kg) caused a progressive fall in SV5 in diabetics with severe acidosis (pH 7.00), but not in those with less acidosis (pH 7.28). In nondiabetics given lactic acid (pH 7.01), SV5 fell to 60% of initial values 1 h after insulin. Acidemic animals not given insulin showed no reduction in LV performance in the same time interval. Adrenergic support is necessary to prevent cardiac failure associated with acidosis. The present findings are ascribed to inhibition by insulin of catecholamine inotropic action on myocardium.

scholarly journals Room for improvement in pulmonary capillary wedge pressure reporting: a review of hemodynamic tracings at a large academic medical center

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402092915 ◽  
Author(s):  
Shelsey W. Johnson ◽  
Alison Witkin ◽  
Josanna Rodriguez-Lopez ◽  
Richard Channick
Keyword(s):  
Pulmonary Capillary Wedge Pressure ◽  
Diastolic Pressure ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Left Heart ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Left Heart Catheterization ◽  
Wedge Pressure

To describe the frequency with which pulmonary capillary wedge pressure measurements, obtained during right heart catheterization, are falsely elevated and to educate operators on techniques to improve accuracy of pulmonary capillary wedge pressure reporting. Failure to completely occlude pulmonary artery branch vessels during balloon inflation can lead to falsely elevated, “incomplete” pulmonary capillary wedge pressures. Balloon deflation prior to catheter retraction may result in catheter advancement into smaller branch vessels, yielding an inadvertent but more accurate alternative pulmonary capillary wedge pressure. We hypothesized that this phenomenon can be identified on retrospective review of right heart catheterization tracings, which occurs commonly and goes unrecognized by operators. We conducted a retrospective study of patients undergoing right heart catheterization or right heart catheterization and left heart catheterization with computer-generated pulmonary capillary wedge pressure ≥20 from January 2015 to June 2017. Alternative pulmonary capillary wedge pressures were defined as a pulmonary capillary wedge pressure trace during balloon deflation ≥3 mmHg lower than the reported pulmonary capillary wedge pressure. Inter-rater reliability of tracing reviewers was also evaluated. Results showed that, of the 182 tracings reviewed, an alternative pulmonary capillary wedge pressure was identified in 26 or 14.3% of cases. Eleven of these alternative pulmonary capillary wedge pressures were ≤15 mmHg with a calculated pulmonary vascular resistance ≥3 Wood units in 10 patients, re-classifying the etiology of pulmonary hypertension from post-capillary to pre-capillary in 38.5% of cases. For the eight patients for whom left heart catheterization data were available, left ventricular end-diastolic pressure aligned with the alternative pulmonary capillary wedge pressure. In conclusion, inadvertently obtained, but likely more accurate, alternative pulmonary capillary wedge pressures were identified in almost 15% of procedures reviewed from a busy academic institution. As wedge pressures often drive diagnosis and treatment decisions for patients with cardiac and pulmonary pathology, operators should be attuned to balloon deflation as a time when alternative pulmonary capillary wedge pressures may be identified as they are likely more reflective of left ventricular end-diastolic pressure. Additional tools to ensure accuracy of pulmonary capillary wedge pressure reporting are reviewed.

Sign in / Sign up

Export Citation Format

Share Document