Ventricular stroke work indices to predict mortality after successful percutaneous edge-to-edge-repair for severe mitral valve regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Dierks ◽  
R Osteresch ◽  
K Diehl ◽  
A Ben Ammar ◽  
A Fach ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Mitral Valve ◽  
Stroke Volume ◽  
Stroke Volume Index ◽  
Right Atrial ◽  
Volume Index ◽  
Funding Source ◽  
Stroke Work ◽  
All Cause Mortality

Abstract Background Several studies identified predictors of worse clinical outcome despite successful transcatheter mitral valve repair (TMVR). The capability of invasively measured left and right ventricular stroke work indices (LVSWi, RVSWi) to predict mortality after successful TMVR is unclear. Purpose To assess the impact of LVSWi and RVSWi on mortality in patients with chronic heart failure (CHF) and severe mitral regurgitation (MR) undergoing TMVR. Methods Consecutive patients (pts.) with CHF (LV ejection fraction ≤50% from any cause) and severe MR who underwent successful TMVR (MR≤2+ at discharge) were included and followed prospectively. Primary endpoint was defined as all-cause mortality during a median follow-up period of 16±9 months. LVSWi was calculated as: Stroke volume index × (mean arterial pressure − postcapillary wedge pressure) × 0.0136 = g/m–1/m2. RVSWi was calculated as: Stroke volume index × (mean pulmonary artery pressure − right atrial pressure) × 0.0136 = g/m–1/m2. Receiver operator characteristic (ROC) analysis was used to determine discriminative capacity of LVSWi and RVSWi. Kaplan-Meier estimate was used for survival analysis. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for all-cause mortality. Results 140 patients (median age 74±9.9 years, 67.9% male) at high operative risk (LogEuro-SCORE 34.6±14.1%) were enrolled. Mean LVSWi and RVSWi were 22.3±10.7 g/m–1/m2 and 8.9±4.1 g/m–1/m2, respectively. 46 pts. died (33.1%). Pts. who died presented higher LogEuro-SCORE (27.8±16.6% vs. 20.1±13.7%; p=0.001), higher levels of NT-proBNP (12121±10602 ng/l vs. 6745±10820 ng/l; p=0.001), higher levels of creatinine (1.8±0.8 mg/dl vs. 1.4±0.8 mg/dl; p<0.001), lower LVSWi (18.9±8.1 g/m–1/m2 vs. 24.0±11.4 g/m–1/m2; p=0.01) and RVSWi (7.8±3.2 g/m–1/m2 vs. 9.4±4.4 g/m–1/m2; p=0.037), respectively. ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a threshold of 24.8 g/m–1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60–0.81]; p=0.001) and 8.3 g/m–1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56–0.78]; p=0.006), respectively. At long-term follow-up, a significantly lower survival rate was observed in pts. with LVSWi ≤24.8 g/m–1/m2 (20.0% vs. 39.4%; log-rank p=0.038) and in pts. with RVSWi ≤8.3 g/m–1/m2 (22.1% vs. 43.7%; log-rank p=0.026), respectively. In Cox regression analysis a LVSWi of ≤24.8 g/m–1/m2 and a RVSWi of ≤8.3 g/m–1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p=0.04; HR 2.52; 95% CI 1.04 to 6.1; p=0.041). Conclusions LVSWi and RVSWi are associated with mortality among pts. with CHF undergoing successful TMVR for severe MR. A LVSWi cut-off value of >24g/m–1/m2 and a RVSWi cut-off value of <8g/m–1/m2 seem to predict mortality independent of other clinical and echocardiographic factors. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Links der Weser, Bremen, Germany

scholarly journals Favorable course of tricuspid regurgitation after percutaneous mitral valve repair is associated with improved survival and clinical outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Meijerink ◽  
J Baan ◽  
B.J Bouma
Keyword(s):  
Mitral Valve ◽  
Clinical Outcome ◽  
Mitral Valve Repair ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Funding Source ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Tricuspid Regurgitation (TR) is often present in patients with mitral regurgitation (MR) and is associated with increased mortality and morbidity after percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular). It is unclear to what extent TR is reduced after PMVR and whether the reduction of TR is related to survival and functional outcome. Purpose The aim of this study was to determine (1) the TR course after PMVR and (2) if this was related to survival and clinical outcome. Methods Patients who underwent PMVR and had complete echocardiographic data at baseline and follow-up were included. TR severity was graded as none, mild, moderate or severe (according to current guidelines) and was determined before treatment and at 6-months of follow up. Favorable TR course was defined as improvement of ≥1 grade or ≤ mild TR at 6-months. Clinical endpoints were all-cause mortality during 1-year of follow-up and improvement in New York Heart Association (NYHA) functional class after 6 months. Results A total of 67 patients were included (mean age 76 years, 57% male, 81% NYHA class ≥3 and 69% baseline TR ≥ moderate). Favorable TR course was achieved in 31 patients (46%) (figure 1A). All-cause mortality at 1 year was 7.5%, and was lower in the favorable TR course group (0% vs. 13.9%, p=0.057) (figure 1B). Improvement in NYHA class at 6-months was seen in 45% of patients without vs. 81% of patients with favorable TR course (p=0.01) (figure 1C). Conclusion A favorable TR course is achieved in 46% of PMVR patients and is associated with improved survival and improvement of NYHA class. The relatively high rate of an unfavorable TR course at 6-months, indicates that interventional treatment of the tricuspid valve might benefit these patients. TR course (A) and NYHA improvement (B) Funding Acknowledgement Type of funding source: Other. Main funding source(s): Abbott

scholarly journals P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Barbier ◽  
O A Annoh ◽  
G Liu ◽  
M Scorsin ◽  
S Moriggia ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Myocardial Dysfunction ◽  
Stroke Volume Index ◽  
Volume Overload ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Maximum Strain

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p<.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p<.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p<.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p<.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p<.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p<.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Annone ◽  
P Omede' ◽  
F D'Ascenzo ◽  
A Montefusco ◽  
A Milan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrial ◽  
Stroke Work ◽  
Work Index ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Stroke Work Index

Abstract Introduction Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT). Purpose We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis. Methods A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters. Results In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not. Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001 Prognosis: different RV variables Discussion We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.

scholarly journals Nitric Oxide Stroke Volume Index as a New Hemodynamic Prognostic Parameter for Patients with Pulmonary Arterial Hypertension

2020 ◽  
Vol 9 (9) ◽  
pp. 2939
Author(s):  
Karolina Barańska-Pawełczak ◽  
Celina Wojciechowska ◽  
Mariusz Opara ◽  
Wojciech Jacheć
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Arterial Hypertension ◽  
Confidence Interval ◽  
Stroke Volume ◽  
Arterial Hypertension ◽  
Lung Transplantation ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Pulmonary Arterial

The aim of the study was to determine the prognostic value of hemodynamic parameters measured during initial diagnostic right heart catheterization (RHC) in standard conditions and using a nitric oxide reversibility test. A retrospective observational study of 62 patients with pulmonary arterial hypertension (PAH) was performed. Clinical, biochemical, echocardiographic, and hemodynamic data obtained at the time of the PAH diagnosis were precisely analyzed. Patients were followed for five years. Death or lung transplantation was considered as a primary endpoint. The mean follow-up period was 1090 ± 703 days and the median age was 46.84 years. In the studied group, 25 patients survived, 36 patients died, and one underwent a lung transplantation. From all the examined parameters, only stroke volume index during reversibility test with iNO (SVI(NO test)) (HR = 0.910; 95% confidence interval 0.878–0.944; p < 0.001) and initial arterial oxygen saturation (SaO2) (HR = 0.910; 95% confidence interval 0.843–0.982; p = 0.015) have been established as independent predictors of death or lung transplantation in the five-year follow–up. An SVI(NO test) value above 39.86 mL/m2 was associated with 100% five-year survival rate (AUC = 0.956; 95% confidence interval 0.899–1.000; p < 0.001; specificity/sensitivity: 100/84%). The results of the analysis suggest that the SVI(NO test) measured during the initial diagnostic RHC could be a very valuable prognostic factor in the PAH patients.

Determinants of aortic root dilatation over time in patients with essential hypertension: The Campania Salute Network

2020 ◽  
pp. 204748732093163
Author(s):  
Grazia Canciello ◽  
Costantino Mancusi ◽  
Raffaele Izzo ◽  
Carmine Morisco ◽  
Teresa Strisciuglio ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Stroke Volume ◽  
Diastolic Blood Pressure ◽  
Aortic Root ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Obese Women ◽  
Aortic Root Dilatation ◽  
Over Time

Background Determinants of changes of aortic root dimension over time are not well defined. Design We investigated whether specific phenotype and treatment exist predicting changes in aortic root dimension in hypertensive patients from the Campania Salute Network. Methods N = 4856 participants (age 53 ± 11 years, 44% women) were included. At first and last available echocardiograms, we measured aortic root and a z-score of aortic root (AOz) was generated as the difference between measured and predicted aortic root, derived from a healthy reference population. Aortic root dilatation (ARD) was defined as AOz >75th percentile of distribution. Results At baseline, 3642 patients (75%) exhibited normal aortic root, and 1214 (25%) ARD. After a follow-up of 6.1 years (interquartile range 3.0–8.8 years), 366 (11%) patients with initial normal aortic root exhibited ARD, whereas 457(38%) with initial ARD exhibited normal aortic root. At multivariate analysis patients with incident ARD were most likely to be women, obese, with left ventricular hypertrophy, lower systolic but higher diastolic blood pressure and stroke volume index at baseline, and higher average value of diastolic blood pressure during follow-up ( p < 0.05); whereas patients normalizing their ARD were non-obese women with lower baseline systolic blood pressure, stroke volume index, average diastolic blood pressure during follow-up and longer follow-up time ( p < 0.05). Anti-renin–angiotensin system (anti-RAS) was associated with 45% greater probability to normalize aortic root dimension. Conclusions Volume (stroke volume index) and pressure loads (diastolic blood pressure) influence aortic root dimension over time. Aortic root normalization, reflecting a more favourable haemodynamic load, is predictable in non-obese women with lower diastolic blood pressure, taking more anti-RAS therapy. This suggest that sex elicits a different response in aortic walls to pathological stimuli.

scholarly journals P1375 Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
U Annone ◽  
P Bocchino ◽  
W Grosso Marra ◽  
A Milan ◽  
F D"ascenzo ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Atrial ◽  
Stroke Work ◽  
Wall Tension ◽  
Work Index ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Stroke Work Index

Abstract Introduction Natural history of pulmonary hypertension (PH) is linked to right ventricle (RV) failure; in first phases of PH, coupling is preserved at the price of augmented RV wall tension (RVWT), which may represent an early sign of disease. Methods Patients with suspected PH, in absence of RV failure, underwent right heart catheterization and nearly-simultaneous echocardiography. We extrapolated RVWT from Laplace’s law as RV length × tricuspid regurgitation peak gradient (TRPG), and we correlated it with RV haemodynamic profile. Its impact on survival was tested. Results 190 patients were enrolled; RVWT correlated with invasive measure of RV telediastolic pressure, mean pulmonary artery (PA) pressure, PA compliance, transpulmonary gradient, pulmonary vascular resistance, right atrial pressure and RV stroke work index (all p &lt; 0.001). At a mean follow-up of five years and three months, RVWT predicted all-cause mortality at univariate and multivariate analysis (p 0.036, p 0,023); tricuspid annular plane systolic excursion (TAPSE) (p 0.536), RV fractional area change (p 0.383), RV S’ (p 0.076) and TAPSE/TRPG (p 0.181) did not. Conclusions We identified a novel echocardiographic predictor of precocious RV impairment, able to predict all-cause mortality at a long-term follow-up. Regression: RVWT and invasive parameters Characteristics R - R2 p value mPAP 0.742 - 0.550 &lt;0.001 PA pulsatory pressure 0.740 - 0.547 &lt;0.001 RV differential pressure 0.794 - 0.630 &lt;0.001 Mean RAP 0.326 - 0.106 &lt;0.001 CI/RAP 0.209 - 0.044 0.012 RVSWI 0.326 - 0.106 &lt;0.001 PA compliance 0.449 - .202 &lt;0.001 PVR 0.531 - 0.282 &lt;0.001 RV basal diameter 0.326 - 0.106 &lt;0.001 RV medium diameter 0.403 - 0.162 &lt;0.001 Right atrium area 0.204 - 0.042 0.013 RV FAC 0.382 - 0.146 &lt;0.001 RV telediastolic area 0.347 - 0.120 &lt;0.001 Correlation between RVWT and invasive haemodynamic parameters of RV function. mPAP, mean pulmonary artery pressure. RAP, right atrial pressure. CI, cardiac index. RVSWI, right ventricle stroke work index. PVR, pulmonary vascular resistance. RV, right ventricle. FAC, fractional area change. Abstract P1375 Figure. RVWT and invasive hemodynamic profile

Frequency and clinical impact of different definitions of moderate aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.U Du ◽  
G.O Hashimoto ◽  
J Cavalcante ◽  
M Goessl ◽  
S Garcia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume Index ◽  
High Rate ◽  
Volume Index ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Mortality And Morbidity ◽  
Patient Demographics

Abstract Background Current echocardiographic guidelines recommend five parameters to define severity of aortic stenosis (AS): peak velocity (PV), mean gradient (MG), aortic valve area (AVA), index AVA (AVAi), and dimensionless index (DI). However, the clinical utility of these parameters for patients with moderate AS largely remain unknown. Objective To investigate the clinical profiles and outcomes of patients with moderate AS according to five different definitions for severity. Methods Using standard echocardiographic definitions, we identified patients with moderate AS who were evaluated in our health care system from 2011 to 2012. Patient demographics, morbidities, and adverse events were reviewed, including death, heart failure (HF) admission, and aortic valve replacement (AVR). Results We enrolled 1,042 patients (age, 75±12 yrs; 40% women). Very few patients (4%) met all five criteria for moderate AS, while 49% had only one or two criteria met. DI was the most common parameter for defining moderate AS, employed in 93% of patients. Patients with area-based indices (i.e., AVA, AVAi, DI) had lower stroke volume index, lower mean gradients, lower peak velocities, and more morbidities in comparison to those flow-based definitions of severity (i.e., PV, MG). During a median follow-up of 5.7 years, overall survival was poor with all-cause mortality of 62.8%. Notably, there was no difference in the rates of mortality (range, 56.4 to 63.3%) or HF hospitalization (range, 28.9 to 32.2%) for groups defined by the five parameters, though patients with flow-based definitions more likely had AVR in follow-up. Conclusions Most patients with moderate AS meet the definition for severity with one or few criteria. Regardless of the method of definition for severity, a high rate of mortality and morbidity can occur in patients with moderate AS. Further study to optimize the clinical outcomes of patients with moderate AS is warranted. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Minneapolis Heart Institute Foundation

scholarly journals Right ventricular end-diastolic stiffness heralds right ventricular failure in monocrotaline-induced pulmonary hypertension

2016 ◽  
Vol 311 (4) ◽  
pp. H1004-H1013 ◽  
Author(s):  
Mohamed Alaa ◽  
Mahmoud Abdellatif ◽  
Marta Tavares-Silva ◽  
José Oliveira-Pinto ◽  
Lucas Lopes ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Diastolic Pressure ◽  
Stroke Volume Index ◽  
Volume Index ◽  
Positive Pressure ◽  
Stroke Work ◽  
Operating Characteristics ◽  
Diastolic Stiffness

Recent studies suggest right ventricular (RV) stiffness is important in pulmonary hypertension (PH) prognosis. Smaller stroke volume (SV) variation after a certain RV end-diastolic pressure (EDP) respiratory variation as assessed by spectral transfer function (STF) may identify RV stiffness. Our aim was to evaluate RV stiffness in monocrotaline (MCT)-induced PH progression and to validate STF gain between EDP and SV as marker of stiffness. Seven-week-old male Wistar rats randomly injected with 60 mg/kg MCT or vehicle were divided into three groups ( n = 12 each) according to cardiac index (CI): controls (Ctrl), preserved CI (MCT pCI), and reduced CI (MCT rCI). All underwent RV pressure-volume (PV) evaluation 24–34 days after MCT, under halogenate anesthesia and constant positive-pressure ventilation. End-diastolic stiffness (βi), end-systolic elastance (Eesi), arterial elastance for indexed volumes (Eai), and preload recruitable stroke work (PRSW) were obtained and beat-to-beat fluctuations during ventilation assessed by STF. Eai was the strongest determinant of CI, alongside βi but not PRSW. MCT rCI showed impaired ventricular-vascular coupling (VVC) and higher βi, along with low end-diastolic pressure (EDP) and stroke volume index (SVi) STF gain, denoting impaired preload reserve. On multivariate analysis βi and not Eesi correlated with EDP-SVi STF gain ( P < 0.001). Receiver-operating characteristics (ROC) curve analysis of EDP-SVi STF gain showed an area under curve of 0.84 for βi prediction ( P = 0.002). Afterload, impaired VVC and RV stiffness are major players in RV failure. RV stiffness can be assessed by STF gain analysis of respiratory fluctuations between EDP and SVi, which may constitute a prognostic tool in PH.

The respiratory change in preejection period: a new method to predict fluid responsiveness

2004 ◽  
Vol 96 (1) ◽  
pp. 337-342 ◽  
Author(s):  
Karim Bendjelid ◽  
Peter M. Suter ◽  
Jacques A. Romand
Keyword(s):  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Systolic Pressure ◽  
Fluid Challenge ◽  
Stroke Volume Index ◽  
Right Atrial ◽  
Volume Index ◽  
Predict Fluid Responsiveness ◽  
Respiratory Change

The accuracy and clinical utility of preload indexes as bedside indicators of fluid responsiveness in patients after cardiac surgery is controversial. This study evaluates whether respiratory changes (Δ) in the preejection period (PEP; ΔPEP) predict fluid responsiveness in mechanically ventilated patients. Sixteen postcoronary artery bypass surgery patients, deeply sedated under mechanical ventilation, were enrolled. PEP was defined as the time interval between the beginning of the Q wave on the electrocardiogram and the upstroke of the radial arterial pressure. ΔPEP (%) was defined as the difference between expiratory and inspiratory PEP measured over one respiratory cycle. We also measured cardiac output, stroke volume index, right atrial pressure, pulmonary arterial occlusion pressure, respiratory change in pulse pressure, systolic pressure variation, and the Δdown component of SPV. Data were measured without positive end-expiratory pressure (PEEP) and after application of a PEEP of 10 cmH2O (PEEP10). When PEEP10 induced a decrease of >15% in mean arterial pressure value, then measurements were re-performed before and after volume expansion. Volume loading was done in eight patients. Right atrial pressure and pulmonary arterial occlusion pressure before volume expansion did not correlate with the change in stroke volume index after the fluid challenge. Systolic pressure variation, ΔPEP, Δdown, and change in pulse pressure before volume expansion correlated with stroke volume index change after fluid challenge ( r2 = 0.52, 0.57, 0.68, and 0.83, respectively). In deeply sedated, mechanically ventilated patients after cardiac surgery, ΔPEP, a new method, can be used to predict fluid responsiveness and hemodynamic response to PEEP10.

Impact of age on the cardiovascular response to dynamic upright exercise in healthy men and women

1995 ◽  
Vol 78 (3) ◽  
pp. 890-900 ◽  
Author(s):  
J. L. Fleg ◽  
F. O'Connor ◽  
G. Gerstenblith ◽  
L. C. Becker ◽  
J. Clulow ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Cardiovascular Response ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Cardiac Response ◽  
Volume Index ◽  
Left Ventricular Volumes ◽  
Stroke Work ◽  
Cycle Exercise ◽  
Men And Women

To examine whether age differentially modifies the physiological response to exercise in men and women, we performed gated radionuclide ventriculography with measurement of left ventricular volumes at rest and during peak upright cycle exercise in 200 rigorously screened healthy sedentary volunteers (121 men and 79 women) aged 22–86 yr from the Baltimore Longitudinal Study of Aging. At rest in the sitting position, age-associated declines in heart rate (HR) and increases in systolic blood pressure occurred in both sexes. Whereas resting cardiac index (CI) and total systemic vascular resistance (TSVR) in men did not vary with age, in women resting CI decreased 16% and TSVR increased 46% over the six-decade age span. Men, but not women, demonstrated an age-associated increase of approximately 20% in sitting end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and stroke volume index over this age span. Peak cycle work rate declined with age approximately 40% in both sexes, but at any age it was greater in men than in women even after normalization for body weight. At peak effort, ejection fraction (EF), HR, and CI were reduced similarly with age while ESVI and TSVR were increased in both sexes; EDVI increased 35% with age and stroke work index (SWI) rose 19% in men, but neither was related to age in women; and stroke volume index did not vary with age in either sex. When hemodynamics were expressed as the change from rest to peak effort as an index of cardiovascular reserve function, both sexes demonstrated age-associated increases in EDVI and ESVI and reductions in EF, HR, and CI. However, the exercise-induced reduction in ESVI and the increases in EF, CI, and SWI from rest were greater in men than in women. Thus, age and gender each have a significant impact on the cardiac response to exhaustive upright cycle exercise.

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