scholarly journals Feasibility and accuracy of the automated software for dynamic quantification of left ventricular and atrial volumes and function in a large unselected population

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
G Italiano ◽  
G Tamborini ◽  
V Mantegazza ◽  
V Volpato ◽  
L Fusini ◽  
...  
Keyword(s):  
Machine Learning ◽  
Atrial Fibrillation ◽  
Image Quality ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Unselected Population ◽  
Lv Volumes ◽  
Time Required ◽  
2D Images

Abstract Funding Acknowledgements Type of funding sources: None. Objective. Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of machine learning based automated dynamic quantification of LV and LA volumes in an unselected population. Methods. We enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV and LA volumes were obtained from 2D images; 3D images were analysed using Dynamic Heart Model (DHM) software (Philips) resulting in LV and LA volume-time curves. A subgroup of 140 patients underwent also cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded and results were compared between 2DTTE, DHM and CMR. Results. The use of DHM was feasible in 522/600 cases (87%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n = 38) or minor (n = 149) borders corrections were needed. The overall time required for DHM datasets was approximately 40 seconds, resulting in physiologically appearing LV and LA volume–time curves in all cases. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173 ± 64 vs 142 ± 58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55%±12 vs 56%±14; LA volume 89 ± 36 vs 89 ± 38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r = 0.70 and r = 0.82, p < 0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r= 0.82, p < 0.001) and LA volumes. Conclusions. The DHM software is feasible, accurate and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation. Table 1 DHM quality Adjustment Feasibility Good Suboptimal Minor Major Total of patients (n, %) 522/600 (87%) 327/522 (62%) 195/522 (28%) 149/522 (29%) 38/522 (6%) Normal subjects (n, %) 39/40 (97%) 23/39 (57%) 16/39 (40%) 9/39 (21%) 1/39 (3%) Atrial Fibrillation (n, %) 59/73 (81%)* 28/59 (47%) 31/59 (53%) 15/59 (25%) 6/59 (10%) Valvular disease (n, %) 271/312 (87%) 120/271 (%) 151/271 (%) 65/271 (24%) 16/271 (6%) Coronary artery disease (n, %) 47/58 (81%)* 26/47 (46%) 21/47 (37%) 16/47 (34%) 5/47 (11%) Miscellaneous (n, %) 24/25 (96%) 18/24 (75%) 6/24 (25%) 5/24 (21%) 3/24 (12%) Feasibility of DHM, image quality and need to adjustments in global population and in each subgroup. Abstract Figure 1

scholarly journals Feasibility and Accuracy of the Automated Software for Dynamic Quantification of Left Ventricular and Atrial Volumes and Function in a Large Unselected Population

2021 ◽  
Author(s):  
Gianpiero Italiano ◽  
Gloria Tamborini ◽  
Laura Fusini ◽  
Valentina Mantegazza ◽  
Valentina Volpato ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Lv Volumes ◽  
Time Required ◽  
And Function ◽  
Automated Software ◽  
2D Images

Abstract PurposeWe aimed to evaluate the feasibility and accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes in an unselected population.MethodsWe enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV and LA volumes were obtained from 2D images; 3D images were analysed using Dynamic Heart Model (DHM) software resulting in LV and LA volume-time curves. A subgroup of 140 patients underwent also cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded and results were compared between 2DTTE, DHM and CMR.ResultsThe use of DHM was feasible in 529/600 cases (88%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n=43) or minor (n=156) borders corrections were needed. The overall time required for DHM datasets was approximately 40 seconds, resulting in physiologically appearing LV and LA volume–time curves in all cases. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173±64 vs 142±58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55%±12 vs 56%±14; LA volume 89±36 vs 89±38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r=0.70 and r=0.82, p<0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r= 0.82, p<0.001) and LA volumes.ConclusionsThe DHM software is feasible, accurate and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation.

scholarly journals P734 Feasibility and accuracy of the new automated software dynamic heart model in an unselected population

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Manfredonia ◽  
L Fusini ◽  
M Muratori ◽  
G Tamborini ◽  
P Gripari ◽  
...  
Keyword(s):  
Automated Analysis ◽  
Left Ventricular ◽  
Heart Model ◽  
Border Detection ◽  
Chamber View ◽  
Examination Time ◽  
Unselected Population ◽  
Time Required ◽  
Automated Software ◽  
2D Images

Abstract Objective Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of this new Dynamic Heart Model (DHM) software in an unselected population undergoing transthoracic echocardiography (TTE). Methods. We enrolled 91 consecutive unselected patients (80% in sinus rhythm) referred for clinically indicated 2D TTE, who also underwent single 3D TTE image acquisition from the apical 4-chamber view. 2D images were analyzed to measure ejection fraction, LV and LA volumes; 3D images were analyzed using Dynamic Heart Model (DHM) software (Philips Healthcare), which automatically measures chamber volumes throughout the cardiac cycle, resulting in LV and LA volume-time curves. Average time of analysis, feasibility, image quality were recorded and results compared between the 2D and 3D techniques. Results. Quality of the 91 2D TTE images was graded as poor (N = 13), satisfactory (N = 45) and good (N = 33). The use of DHM was feasible in 79/91 cases (87%). The remaining 12 datasets could not be analyzed because of poor images (N = 10) or incorrect automated border detection (N = 2): in these cases, the software did not accurately identify endocardial borders due to LV cavity near obliteration or extreme LA enlargement. When feasible, the boundary position was considered accurate in 61/79 patients (77%), while minor manual correction of the LV/LA borders was needed in the remaining cases. In only 1 case the reconstruction was considered unreliable because it needed major corrections. The overall time required to obtain DHM data was approximately 45 seconds. In all cases in which DHM was used, not only shapes of LV and LA were very well defined, but also functional curves were physiologically plausible. Even in the 13 patients in whom the 2D image was suboptimal, the DHM was not only feasible but also accurate endocardial boundaries in 8 cases, without (N = 5) or with only minimal manual corrections (N = 3). As expected, 3D LV volumes were slightly hige than 2D ones ( EDV 153.9 ± 59.8 vs 121.4 ± 47.3 mL, respectively), while LV EF and LA volumes were similar (EF 58.8 ± 11.8 vs 59 ± 11.8% and LA volume 92 ± 39.3 vs 83.4 ± 32.1 mL, respectively). Conclusions. The new DHM software is quick, feasible and accurate in the majority of unselected patients, including those with suboptimal 2D images or in atrial fibrillation. Introduction of this automated analysis into clinical practice can reduce examination time, while providing reliable information not only on volumes but also on function of the left heart chambers.

scholarly journals P353 Structural, functional, and electromechanical alterations in patients with paroxysmal atrial fibrillation compared to healthy controls

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
L Stefani ◽  
P Brown ◽  
E Kizana ◽  
S Kumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Inverse Correlation ◽  
Left Ventricular ◽  
P Value ◽  
Healthy Controls ◽  
Systolic Volume ◽  
Mechanical Dispersion ◽  
Lv Mass ◽  
Echocardiographic Parameters

Abstract Background and Methods We sought to evaluate the clinical and echocardiographic differences between healthy controls and paroxysmal atrial fibrillation (AF) patients. Clinical and echocardiographic parameters (performed in sinus rhythm) in 46 paroxysmal AF patients were compared with a departmental database of 83 health controls. Results AF patients were older and had increased body size (Table 1). 39/46 (84%) of AF patients had hypertension and 23/46 (50%) had diabetes mellitus. AF patients had increased left ventricular (LV) mass, and reduced diastolic function (lower e’ and increased E/e’ ratio) when compared to healthy controls. Left atrial (LA) volumes were significantly increased in the AF group. All strain parameters – reservoir, conduit, and contractile strain – were impaired in AF patients compared to controls. LA mechanical dispersion (MD) was significantly increased in AF patients. A ratio of indexed LA volume/LA reservoir strain was significantly higher in AF patients over controls. The duration of AF had an inverse correlation with LA reservoir strain (Fig 1) (r=–0.78; p &lt; 0.001). Conclusions Compared to healthy controls, patients with paroxysmal AF have significant structural, functional and electromechanical alterations. LA strain is significantly impaired in paroxysmal AF and correlates with AF duration. Table 1. Echocardiographic parameters Parameter Controls (mean ± SD) AF patients (mean ± SD) P value Age (years) 48 ± 18 58 ± 14 0.001 Body surface area (m2) 1.9 ± 0.2 2 ± 0.2 0.014 LV mass (g) 178 ± 48 223 ± 68 &lt;0.001 Average e’ velocity (cms-1) 10.3 ±2.7 8.1 ± 2.2 &lt;0.001 E/e’ 7.4 ± 1.9 9.3 ± 3.4 0.001 Indexed LA end systolic volume (ml/m2) 27.2 ± 7.1 39.0 ± 11.6 &lt;0.001 LA ejection fraction 55.2 ± 10.4 48.5 ± 14.0 0.007 LA functional index 43.7 ± 14.6 29.8 ± 14.3 &lt;0.001 LA reservoir strain (%) 34.3 ± 6.8 27.9± 8.1 &lt;0.001 LA conduit strain (%) 18.4 ± 6.2 13.5 ± 4.7 &lt;0.001 LA contractile strain (%) 15.9 ± 3.9 14.4 ± 5.5 0.007 LA mechanical dispersion (ms) 25.8 ± 9.6 30.9 ± 11.6 0.018 Indexed LA volume / Reservoir strain ratio 0.8 ± 0.3 1.6 ± 0.9 &lt;0.001 LV = left ventricular; LA = left atrium; SD = standard deviation Abstract P353 Figure. Fig 1. AF duration vs. Reservoir strain

scholarly journals Three Dimensional (3D) Echocardiography as a Tool of Left Ventricular Assessment in Children with Dilated Cardiomyopathy: Comparison to Cardiac MRI

2018 ◽  
Vol 6 (12) ◽  
pp. 2310-2315
Author(s):  
Nevin Mohamed Habeeb ◽  
Omneya Ibrahim Youssef ◽  
Waleed Mohamed Elguindy ◽  
Ahmed samir Ibrahim ◽  
Walaa Hamed Hussein
Keyword(s):  
Cardiac Mri ◽  
Systolic Function ◽  
Three Dimensional ◽  
Lateral Wall ◽  
Left Ventricular ◽  
3D Echocardiography ◽  
Prognostic Indicators ◽  
Systolic Volume ◽  
Significant Difference ◽  
Lv Volumes

BACKGROUND: Left ventricular (LV) volumes and ejection fraction (EF) is Strong prognostic indicators for DCM. Cardiac MRI (CMRI) is a preferred technique for LV volumes and EF assessment due to high spatial resolution and complete volumetric datasets. Three-dimensional echocardiography is a promising new technique under investigations. AIM: Evaluate 3D echocardiography as a tool in LV assessment in DCM children about CMRI. PATIENTS AND METHODS: A group of 20 DCM children (LVdiastolic diameter < 2 Z score, LVEF < 35%) at Children s Hospital, Ain-Shams University (gp1) (mean age 6.6 years) were compared to 20 age and sex-matched children as controls (gp2). Patients were subjected to: clinical examination, conventional echocardiography, automated 3D LV quantification, 3D speckle tracking echocardiography (3D-STE) (VIVID E9 Vingmed, Norway) and CMRI (Philips Achieva Nova, 1.5 Tesla scanner) for LV end systolic volume (LVESV), LVend diastolic volume (LVEDV) that were indexed to body surface area, EF% and wall motion abnormalities assessment. RESUTS: No statistically significant difference was found between automated 3D LV quantification echocardiography, 3D-STE, and CMRI in ESV/BSA and EDV/BSA assessment (p = 1, 0.99 respectively), between automated LV quantification echocardiography and CMRI in EF% assessment (p = 0.99) and between CMRI and 3D-STE in LV Global hypokinesia detection (P = 0.255). As for segmental hypokinesia CMRI was more sensitive [45% of patients vs. 40%, (P = 0,036), basal septal hypokinesia 85% vs. 75%, (p = 0.045), mid septal hypokinesia 80% vs. 65%, (p = 0.012) and lateral wall hypokinesia 75% vs. 65%, (p = 0.028)]. CONCLUSION: Automated 3D LV quantification echocardiography and 3D-STE are reliable tools in LV volumetric and systolic function assessment about CMRIas a standard method. 3D speckle echocardiography is comparable to CMRI in global wall hypokinesia detection but less sensitive in segmental wall hypokinesia which mandates further studies.

scholarly journals Assessment of Regional Left Ventricular Myocardial Strain in Patients with Left Anterior Descending Coronary Stenosis Using Computed Tomography Feature Tracking

2020 ◽  
Author(s):  
Xiaoyu Han ◽  
Yukun Cao ◽  
Zhiguo Ju ◽  
Jia Lu ◽  
Na Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Feature Tracking ◽  
Systolic Function ◽  
Myocardial Strain ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume ◽  
Group I

Abstract Background Computed Tomography feature tracking (CT-FT) has emerged as a valuable method for the assessment of cardiac function. However, there have been no study about the usefulness of CT-derived assessments of left ventricular strain on coronary artery disease (CAD). Our aim was to evaluate the regional left ventricular (LV) systolic deformation in patients with left anterior descending coronary (LAD) stenosis using CT-FT. Methods Seventy-six patients with LAD stenosis were enrolled. The patients were divided into four groups according to the percentage of LAD stenosis: ≤25% was defined as group I (24 patients), 26–49% as group II (17 patients), 50–74% as group III (21 patients), and ≥ 75% as group IV (14 patients).Thirty-two sex- and age-matched normal subjects were included as controls. Results No intergroup differences were found between groups I-IV and the controls in terms of the left ventricular ejection fraction, end-diastolic volume and end-systolic volume. However, the longitudinal strain (LS) of the LAD territory was significantly reduced in groups I-IV compared with the controls (-20.8% and − 18.5% and − 18.6% and − 17.0% vs -23.7%, respectively). The circumferential strain (CS) of the LAD territory was significantly reduced in groups III and IV compared with the controls and groups I and II (-22.4% and − 22.2% vs -25.4% and − 24.1% and − 25.3%, respectively). Compared with non-LAD territory, groups II-IV had significantly increased LS (-19.9% vs -21%; -18.6% vs -21.9%; -16.4% vs -20.1%). The severity of LAD stenosis had a positive correlation with the LS of the LAD territory (r = 0.438, p = 0.002). Conclusion CT‑FT can detect decreasing LV systolic function in patients with LAD stenosis. With the increasing severity of LAD stenosis, the LV regional systolic deformation of the LAD territory was reduced.

Abstract 12702: A Novel Human S10F-Hsp20 Mutation Induces Lethal Peripartum Cardiomyopathy (Best of Basic Science Abstract)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Guansheng Liu ◽  
Min Jiang ◽  
Wenfeng Cai ◽  
George Adly ◽  
George Gardner ◽  
...  
Keyword(s):  
Transgenic Mice ◽  
Functional Significance ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Heart Weight ◽  
Systolic Volume ◽  
The Third ◽  
End Diastolic Volume ◽  
Erk Phosphorylation ◽  
End Systolic Volume

Background: Heat shock protein 20 (Hsp20) has emerged as a novel cardioprotector against stress-induced injury. In this study, we investigated the functional significance of a novel human Hsp20 mutation (S10F) in peri-partum cardiomyopathy. Methods and Results: We identified a human S10F-Hsp20 mutant with a frequency of 2.8% in dilated cardiomyopathy patients (470 screened), while we did not find any normal subjects carrying this mutation (282 screened). To determine the functional significance of S10F-Hsp20, transgenic mice with cardiac-specific overexpression of this mutant were generated. We observed that female TGs were fertile, and delivered normal litter sizes, but they invariably died after 2, 3 or 4 pregnancies (Fig. 1a). However, overexpression of WT-Hsp20 to similar levels as S10F was not associated with any deaths following multiple pregnancies. Further histological examination of S10F females revealed significantly dilated hearts and increased heart weight/tibia length after the third delivery, compared to WT (non transgenic) mice. (Fig. 1b,c). Echocardiography assessment showed that this dilation (Fig. 1d) is associated with increased left ventricular end-systolic volume (Fig. 1e), increased left ventricular end-diastolic volume, depressed ejection fraction (Fig. 1f) and decreased fractional shortening. Further studies revealed that cardiomyocyte apoptosis was increased by 4 fold in S10F hearts after the third delivery(Fig. 1g,h). The mechanisms associated with the detrimental remodelling in S10F females included decreased Akt (Fig. 1i) and ERK phosphorylation under both baseline and pregnancy conditions. As a result, the activities of Akt and ERK were reduced, contributing to increased cell death in the S10F hearts of pregnant females. Conclusion: The human S10F mutation may compromise the heart’s coping with pregnancy induced stress conditions mainly through increased apoptosis by reduction of Akt and ERK activities.

Abstract 17335: Cluster Analysis of Cardiac Resynchronization Response Parameters Predicts Long-Term Survival With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kenneth C Bilchick ◽  
Xu Gao ◽  
Derek Bivona ◽  
Rohit Malhotra ◽  
Michael Mangrum ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Cluster Analysis ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Term Survival ◽  
Long Term Survival ◽  
Systolic Volume

Introduction: Machine learning methods such as cluster analysis can identify commonality in patterns of short-term response measures after cardiac resynchronization therapy (CRT) to predict classes of patients with distinct long-term prognoses. Hypothesis: Distinct response clusters identified within 6 months of CRT implantation would provide independent prognostic value relative to known pre-CRT patient characteristics. Methods: Patients with heart failure (HF) undergoing CRT had assessments of left ventricular end-systolic volume fractional change (LVESV-FC), peak VO 2 , and B-type natriuretic peptide (BNP) based on cardiac magnetic resonance (CMR), echocardiography, exercise testing, and blood tests before and 6 months after CRT. Statistical methods included multivariate multiple linear regression, cluster analysis based on a mixture model, survival analysis, and receiver operating characteristic (ROC) analysis. Results: During a median of 5.0 years of follow-up after CRT, the cohort of 146 patients (age 66.0 ± 11.3 years, 34.9% female) had a death rate of 28.1%. A significant correlation was observed for BNP response and LVESV-FC (r=0.42, p>0.01), but not for the other response comparisons. Three clusters of patients (1: n=27; 2: n=82; 3: n=37) were identified. Kaplan-Meier analysis (Figure) demonstrated the best long-term survival in cluster 2, intermediate survival in cluster 3, and the worst survival in cluster 1 (p<0.0001). ROC curve comparisons for 4-year survival based on pre-CRT findings with or without the 6-month response cluster showed that the cluster increased the AUC from 0.818 to 0.870 (p=0.069). Conclusions: Response clusters based on 6-month parameters were strongly associated with long-term survival and improved prognostication compared with just pre-CRT predictors alone. This response clustering approach based on machine learning promises to be very useful for clinical risk stratification in heart failure after CRT.

scholarly journals Machine learning based automated dynamic quantification of left heart chamber volumes

2018 ◽  
Vol 20 (5) ◽  
pp. 541-549 ◽  
Author(s):  
Akhil Narang ◽  
Victor Mor-Avi ◽  
Aldo Prado ◽  
Valentina Volpato ◽  
David Prater ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiac Cycle ◽  
Volumetric Analysis ◽  
Left Ventricular ◽  
Clinical Workflow ◽  
Limits Of Agreement ◽  
Heart Chamber ◽  
Automated Algorithm ◽  
Time Required ◽  
Manual Correction

Abstract Aims Studies have demonstrated the ability of a new automated algorithm for volumetric analysis of 3D echocardiographic (3DE) datasets to provide accurate and reproducible measurements of left ventricular and left atrial (LV, LA) volumes at end-systole and end-diastole. Recently, this methodology was expanded using a machine learning (ML) approach to automatically measure chamber volumes throughout the cardiac cycle, resulting in LV and LA volume–time curves. We aimed to validate ejection and filling parameters obtained from these curves by comparing them to independent well-validated reference techniques. Methods and results We studied 20 patients referred for cardiac magnetic resonance (CMR) examinations, who underwent 3DE imaging the same day. Volume–time curves were obtained for both LV and LA chambers using the ML algorithm (Philips HeartModel), and independently conventional 3DE volumetric analysis (TomTec), and CMR images (slice-by-slice, frame-by-frame manual tracing). Automatically derived LV and LA volumes and ejection/filling parameters were compared against both reference techniques. Minor manual correction of the automatically detected LV and LA borders was needed in 4/20 and 5/20 cases, respectively. Time required to generate volume–time curves was 35 ± 17 s using ML algorithm, 3.6 ± 0.9 min using conventional 3DE analysis, and 96 ± 14 min using CMR. Volume–time curves obtained by all three techniques were similar in shape and magnitude. In both comparisons, ejection/filling parameters showed no significant inter-technique differences. Bland–Altman analysis confirmed small biases, despite wide limits of agreement. Conclusion The automated ML algorithm can quickly measure dynamic LV and LA volumes and accurately analyse ejection/filling parameters. Incorporation of this algorithm into the clinical workflow may increase the utilization of 3DE imaging.

Effects of ibuprofen and pentoxifylline on the cardiovascular response of normal humans to endotoxin

1992 ◽  
Vol 73 (3) ◽  
pp. 925-931 ◽  
Author(s):  
G. D. Martich ◽  
M. M. Parker ◽  
R. E. Cunnion ◽  
A. F. Suffredini
Keyword(s):  
Cardiovascular Response ◽  
Resistance Index ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Oxygen Extraction Ratio ◽  
Ventricular Ejection Fraction ◽  
Endotoxin Administration ◽  
Systolic Volume ◽  
Hemodynamic Variables

Endotoxin is a major mediator of the life-threatening cardiovascular dysfunction that characterizes Gram-negative sepsis. In animal models of endotoxemia, pretreatment with ibuprofen or pentoxifylline attenuates some of these cardiovascular changes. To evaluate the effects of these agents on the human cardiovascular response to endotoxemia, hemodynamic variables were measured serially in 24 normal subjects who were given intravenous endotoxin. The subjects were randomized to receive oral ibuprofen (n = 9), pentoxifylline (n = 10), or no medication before endotoxin administration (n = 5). The subjects were volume loaded 3–5 h after endotoxin administration, and hemodynamic measurements were reassessed. Core temperature after endotoxin alone or endotoxin-pentoxifylline approached a maximum at 3 h (greater than or equal to 38.6 degrees C), while the endotoxin-ibuprofen group remained afebrile. At 3 and 5 h, all three groups had significant increases in heart rate, cardiac index, oxygen delivery, and oxygen consumption, while systemic vascular resistance index decreased significantly from baseline. The oxygen extraction ratio remained unchanged. After volume loading, the left ventricular ejection fraction and left ventricular end-diastolic and end-systolic volume indexes did not differ among the groups. The hyperdynamic cardiovascular response to endotoxin in humans occurs in the absence of fever and is not significantly ameliorated by oral cyclooxygenase or phosphodiesterase inhibition.

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