scholarly journals Validating Left Ventricular Filling Pressure Measurements in Patients with Congestive Heart Failure: CardioMEMS™ Pulmonary Arterial Diastolic Pressure versus Left Atrial Pressure Measurement by Transthoracic Echocardiography

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Sunit Tolia ◽  
Zubair Khan ◽  
Gunjan Gholkar ◽  
Marcel Zughaib
Keyword(s):  
Heart Failure ◽  
New York ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Systolic Dysfunction ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Atrial Pressure ◽  
Left Atrial Pressure

Background. Routine ambulatory echocardiographic estimates of left ventricular (LV) filling pressures are not cost-effective and are occasionally fraught with anatomic, physiologic as well as logistical limitations. The use of implantable hemodynamic devices such as CardioMEMS Heart Failure (HF) System has been shown to reduce HF-related readmission rates by remote monitoring of LV filling pressures. Little is known about the correlation between CardioMEMS and echocardiography-derived estimates of central hemodynamics. Methods. We performed a prospective, single-center study enrolling seventeen participants with New York Heart Association functional class II-III HF and preimplanted CardioMEMS sensor. Simultaneous CardioMEMS readings and a limited echocardiogram were performed at individual clinic visits. Estimated left atrial pressure (LAP) by echocardiogram was calculated by the Nagueh formula. Linear regression was used as a measure of agreement. Variability between methods was evaluated by Bland–Altman analysis. Results. Mean age was 74 ± 9 years; 59% (10/17) were males. LV systolic dysfunction was present in 76% (13/17) of subjects. Mean PAdP was 18 ± 4 mmHg and 19 ± 5 mmHg for CardioMEMS and echocardiographic-derived estimates, respectively, with a significant correlation between both methods (r2=0.798,  p≤0.001). Conclusions. Our study illustrates a direct linear correlation between PAdP measured by CardioMEMS and simultaneous measurement of LV filling pressures derived by echocardiography.

scholarly journals Monitoring of heart failure: comparison of left atrial pressure with intrathoracic impedance and natriuretic peptide measurements in an experimental model of ovine heart failure

2010 ◽  
Vol 120 (5) ◽  
pp. 207-217 ◽  
Author(s):  
Miriam T. Rademaker ◽  
Christopher J. Charles ◽  
Iain C. Melton ◽  
A. Mark Richards ◽  
Christopher M. Frampton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Cardiac Resynchronization ◽  
Delayed Response ◽  
Intrathoracic Impedance

Monitoring of HF (heart failure) with intracardiac pressure, intrathoracic impedance and/or natriuretic peptide levels has been advocated. We aimed to investigate possible differences in the response patterns of each of these monitoring modalities during HF decompensation that may have an impact on the potential for early therapeutic intervention. Six sheep were implanted with a LAP (left atrial pressure) sensor and a CRT-D (cardiac resynchronization therapy defibrillator) capable of monitoring impedance along six lead configuration vectors. An estimate of ALAP (LAP from admittance) was determined by linear regression. HF was induced by rapid ventricular pacing at 180 and 220 bpm (beats/min) for a week each, followed by a third week with daily pacing suspensions for increasing durations (1–5 h). Incremental pacing induced progressively severe HF reflected in increases in LAP (5.9 ± 0.4 to 24.5 ± 1.6 mmHg) and plasma atrial (20 ± 3 to 197 ± 36 pmol/l) and B-type natriuretic peptide (3.7 ± 0.7 to 32.7 ± 5.4 pmol/l) (all P<0.001) levels. All impedance vectors decreased in proportion to HF severity (all P<0.001), with the LVring (left ventricular)-case vector correlating best with LAP (r2=0.63, P<0.001). Natriuretic peptides closely paralleled rapid acute changes in LAP during alterations in pacing (P<0.001), whereas impedance changes were delayed relative to LAP. ALAP exhibited good agreement with LAP. In summary, impedance measured with an LV lead correlates significantly with changes in LAP, but exhibits a delayed response to acute alterations. Natriuretic peptides respond rapidly to acute LAP changes. Direct LAP, impedance and natriuretic peptide measurements all show promise as early indicators of worsening HF. ALAP provides an estimate of LAP that may be clinically useful.

scholarly journals Hemodynamics of the diastolic pressure gradients in acute heart failure: implications for the diagnosis of pre-capillary pulmonary hypertension in left heart disease

2018 ◽  
Vol 9 (1) ◽  
pp. 204589401881543 ◽  
Author(s):  
Doron Aronson ◽  
Emilia Hardak ◽  
Andrew J. Burger
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Acute Heart Failure ◽  
Left Atrial ◽  
Diastolic Pressure ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Left Heart ◽  
Left Heart Disease ◽  
Pulmonary Capillary

The diastolic pressure gradient (DPG) has been proposed as the metric of choice for the diagnosis of pulmonary vascular changes in left heart disease. We tested the hypothesis that this metric is less sensitive to changes in left atrial pressure and stroke volume (SV) than the transpulmonary gradient (TPG). We studied the effect of dynamic changes in pulmonary capillary wedge pressure (PCWP), SV, and pulmonary artery capacitance (PAC) on DPG and TPG in 242 patients with acute heart failure undergoing decongestive therapy with continuous hemodynamic monitoring. There was a close impact of PCWP reduction on TPG and DPG, with a 0.13 mmHg (95% confidence interval [CI] 0.07–0.19, P < 0.0001) and 0.21 mmHg (95% CI 0.16–0.25, P < 0.0001) increase for every 1 mmHg decrease in PCWP, respectively. Changes in SV had a negligible effect on TPG and DPG (0.19 and 0.13 mmHg increase, respectively, for every 10-mL increase in SV). Heart rate was positively associated with DPG (0.41-mmHg increase per 10 BPM [95% CI 0.22–0.60, P < 0.0001]). The resistance-compliance product was positively associated with both TPG and DPG (2.65 mmHg [95% CI 2.47–2.83] and 1.94 mmHg [95% CI 1.80–2.08] for each 0.1-s increase, respectively). In conclusion, DPG is not less sensitive to changes in left atrial pressure and SV compared with TPG. Although DPG was not affected by changes in PAC, the concomitant increase in the resistance-compliance product increases DPG.

scholarly journals The role of galectin-3 in the diagnosis and control of the effectiveness of pharmacotherapy of chronic heart failure

2017 ◽  
Vol 8 (4) ◽  
pp. 5-10
Author(s):  
K. A Giamdzhian ◽  
V. G Kukes
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chronic Heart Failure ◽  
Initial Level ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Clinical Value ◽  
Reduced Ejection Fraction ◽  
Galectin 3

Relevance. At present, it is urgent to develop new biomarkers that can serve as a tool for early diagnosis of the disease in order to select pharmacotherapy and further monitor its effectiveness. The goal is to evaluate the clinical value of the definition of galectin-3 in patients with chronic heart failure (CHF). Materials and methods. The study included 53 patients (31 women, 22 men) with CHF II-III functional class (FC) of the New York Heart Association (NYHA). The mean age of the patients was 71 years (95% confidence interval 68.99-74.37). A group of patients with NYHA FCh II CHF made up 14 people, a group of patients with NYHA-39 CHF III FC. The median of the initial level of the N-terminal brain natriuretic peptide (NT-proBNP) was 65.7 pmol/L, the median of the initial level of galectin-3 - 8.37 pmol/l. Results. The relationship of increased level of galectin-3 with reduced ejection fraction,% (r=-0.26, p=0.04), increased creatinine level (r=0.26, p=0.04) and increased level of NT-proBNP plasma (r=0.3, p=0.02). With other clinical indicators, such as systolic and diastolic blood pressure, heart rate, body mass index, 6-minute walk test, left ventricular mass index, glucose level, total cholesterol, glomerular filtration rate, no statistically significant association was found. A moderate correlation was obtained between the levels of NT-proBNP and galectin-3 plasma (r=0.3, p=0.02). Reduction in the level of galectin-3 after the treatment was detected in 84.3% of patients. The conclusion. Galectin-3 can serve as an additional diagnostic biomarker of CHF.

scholarly journals Direct Measurement of Left Atrial Pressure during Routine Transradial Catheterization

2016 ◽  
Vol 43 (6) ◽  
pp. 503-506
Author(s):  
Faisal Fa'ak ◽  
Bahaeddin Shabaneh ◽  
George Younis
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Direct Methods ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Coronary Catheterization ◽  
Diastolic Left Ventricular Dysfunction ◽  
Ventricular Filling Pressure ◽  
Ventricular Filling

Left atrial pressure indicates the left ventricular filling pressure in patients who have systolic or diastolic left ventricular dysfunction or valvular heart disease. The use of indirect surrogate methods to determine left atrial pressure has been essential in the modern evaluation and treatment of cardiovascular disease because of the difficulty and inherent risks associated with direct methods (typically the transseptal approach). One method that has been widely used to determine left atrial pressure indirectly is Swan-Ganz catheterization, in which a balloon-flotation technique is applied to measure pulmonary capillary wedge pressure; however, this approach has been associated with several limitations and potential risks. Measuring left ventricular end-diastolic pressure has also been widely used as a simple means to estimate filling pressures but remains a surrogate for the gold standard of directly measuring left atrial pressure. We describe a simple, low-risk method to directly measure left atrial pressure that involves the use of standard coronary catheterization techniques during a transradial procedure.

Hemodynamic effects of altering the timing of atrial systole

1963 ◽  
Vol 205 (3) ◽  
pp. 499-503 ◽  
Author(s):  
N. Sheldon Skinner ◽  
Jere H. Mitchell ◽  
Andrew G. Wallace ◽  
Stanley J. Sarnoff
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Hemodynamic Effects ◽  
Ventricular Systole ◽  
Ventricular Filling ◽  
Atrial Systole

The use of heart block dog preparations allowed an investigation at constant ventricular rates of the hemodynamic effects which resulted when the timing of atrial systole was altered relative to ventricular systole. Ganglionic blockade and vagotomy precluded sympathetic reflex compensation in these animals. Lengthening or shortening the interval between left atrial and left ventricular systole (As-Vs interval) produced a decrease in left ventricular end-diastolic pressure (LVEDP), mean aortic pressure, and aortic flow. Mean left atrial pressure (MLAP) increased as did the relation of MLAP to LVEDP. The absence of atrial systole produced similar changes. Lengthening or shortening the As-Vs interval while holding aortic pressure and stroke volume constant resulted in an increase in MLAP and the relation of MLAP to LVEDP. The changes observed in the left atrial pressure tracings suggested and a platinum electrode technique demonstrated that mitral regurgitation can occur with improper timing of atrial systole. The data indicate that properly timed, effective atrial activity can enhance ventricular filling and can preclose the atrioventricular valve.

scholarly journals Understanding preload and preload reserve within the conceptual framework of a limited range of possible left ventricular end-diastolic volumes

2020 ◽  
Vol 44 (3) ◽  
pp. 414-422
Author(s):  
Roger E. Peverill
Keyword(s):  
Left Atrial ◽  
Diastolic Pressure ◽  
Limited Range ◽  
Left Ventricular ◽  
Reciprocal Relationship ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Curvilinear Relationship ◽  
End Diastolic Volume ◽  
Intravenous Fluid Administration

Preload has been variously defined, but if there is to be a direct relationship with activity of the Frank-Starling mechanism in its action to increase the force and extent of contraction, preload must directly reflect myocardial stretch. The Frank-Starling mechanism is activated during any stretch of a cardiac chamber beyond its resting size, which is present immediately before contraction. Every left ventricle has an intrinsic and limited range of possible volumes at end diastole. There is a curvilinear relationship between left ventricular (LV) end-diastolic pressure (LVEDP) and LV end-diastolic volume (LVEDV), and, at maximal or near maximal LVEDV, there will be a high LVEDP. Within the possible range, the LVEDV will be determined by the extent of filling, any change in LVEDV will result in changed activity of the Frank-Starling mechanism, and change in LVEDV might, therefore, be considered to represent change in preload. On the other hand, it is the difference between the current and the maximal possible LVEDV (or the preload reserve) that may be of the most clinical relevance. There is a reciprocal relationship between preload and preload reserve, with minor or absent LV preload reserve indicating that there will be either minimal or no increase in stroke volume following intravenous fluid administration. As left atrial pressure can remain within the normal range when the LVEDP is elevated, it is LVEDP, and not left atrial pressure, that provides the most reliable guide to preload reserve in an individual at a specific period in time.

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