Defining end-systolic pressure for single-beat estimation of right ventricle–pulmonary artery coupling: simple… but not really

Singh, Inderjit; Oakland, Hannah; Elassal, Ahmed; Heerdt, Paul M.

doi:10.1183/23120541.00219-2021

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…15 Of these proposed surrogates for ESP, the latter two methods provided the best accuracy and precision when compared with a reference standard derived from simultaneous measurement of RV pressure and volume. 31 In the current study, a previously described approach for defining ESP as the point of maximal RV elastance was applied. 15,31 This method was developed using simultaneous RV pressure and volume measurements over a range of loading conditions in swine and regards the point of maximal RV pressure/RV volume ratio as endsystole 32 (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

“…31 In the current study, a previously described approach for defining ESP as the point of maximal RV elastance was applied. 15,31 This method was developed using simultaneous RV pressure and volume measurements over a range of loading conditions in swine and regards the point of maximal RV pressure/RV volume ratio as endsystole 32 (Figure 4). For the proof-of-concept evaluation of a simplified continuous beat-to-beat assessment of RVEF, we estimated ESP using the correction equation for mPAP [ESP = (mPAP*1.65) À 7.79].…”

Section: Discussionmentioning

confidence: 99%

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Pressure‐based estimation of right ventricular ejection fraction

et al. 2022

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Aims A method for estimating right ventricular ejection fraction (RVEF) from RV pressure waveforms was recently validated in an experimental model. Currently, cardiac magnetic resonance imaging (MRI) is the clinical reference standard for measurement of RVEF in pulmonary arterial hypertension (PAH). The present study was designed to test the hypothesis that the pressure-based method can detect clinically significant reductions in RVEF as determined by cardiac MRI in patients with PAH. Methods and results RVEF estimates derived from analysis of RV pressure waveforms recorded during right heart catheterization (RHC) in 25 patients were compared with cardiac MRI measurements of RVEF obtained within 24 h. Three investigators blinded to cardiac MRI results independently performed pressure-based RVEF estimation with the mean of their results used for comparison. Linear regression was used to assess correlation, and a receiver operator characteristic (ROC) curve was derived to define ability of the pressure-based method to detect a maladaptive RV response, defined as RVEF <35% on cardiac MRI. In 23 patients, an automated adaptation of the pressure-based RVEF method was also applied as proof of concept for beat-to-beat RVEF monitoring. The study cohort was comprised of 16 female and 9 male PAH patients with an average age of 53 ± 13 years. RVEF measured by cardiac MRI ranged from 16% to 57% (mean 37.7 ± 11.6%), and estimated RVEF from 15% to 54% (mean 36.2 ± 11.2%; P = 0.6). Measured and estimated RVEF were significantly correlated (r 2 = 0.78; P < 0.0001). ROC curve analysis demonstrated an area under the curve of 0.94 ± 0.04 with a sensitivity of 81% and specificity of 85% for predicting a maladaptive RV response. As a secondary outcome, with the recognized limitation of non-coincident measures, Bland-Altman analysis was performed and indicated minimal bias for estimated RVEF (À1.5%) with limits of agreement of ± 10.9%. Adaptation of the pressure-based estimation method to provide beat-to-beat RVEF also demonstrated significant correlation between the median beat-to-beat value over 10 s with cardiac MRI (r 2 = 0.66; P < 0.001), and an area under the ROC curve of 0.94 ± 0.04 (CI = 0.86 to 1.00) with sensitivity and specificity of 78% and 86%, respectively, for predicting a maladaptive RV response. Conclusions Pressure-based estimation of RVEF correlates with cardiac MRI and detects clinically significant reductions in RVEF. Study results support potential utility of pressure-based RVEF estimation for assessing the response to diagnostic or therapeutic interventions during RHC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pressure‐based estimation of right ventricular ejection fraction

et al. 2022

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“…The gold standard method to determine Pes is the multiple pressure‐volume (PV)‐loop analysis (multiple beat method) in which conductance and pressure catheterization are simultaneously applied 11 . However, in the present study, we did not conduct multiple PV‐loop analysis; contrariwise, we used three surrogate parameters for Pes, that is, mean PA pressure (MPAP), calculated pressure using MPAP (MPAPcalc, calculated as 1.65 × MPAP – 7.79), and SRVP, as reported in previous studies 6,8,17,20–24 . When MPAP was used for Pes, Ees was represented as Ees (MPAP); when MPAPcalc was used for Pes; Ees was represented as Ees (MPAPcalc); and when SRVP was used for Pes, Ees was represented as Ees (SRVP).…”

Section: Methodsmentioning

confidence: 96%

“…11 However, in the present study, we did not conduct multiple PV-loop analysis; contrariwise, we used three surrogate parameters for Pes, that is, mean PA pressure (MPAP), calculated pressure using MPAP (MPAPcalc, calculated as 1.65 × MPAP -7.79), and SRVP, as reported in previous studies. 6,8,17,[20][21][22][23][24] When MPAP was used for Pes, Ees was represented as Ees (MPAP); when MPAPcalc was used for Pes; Ees was represented as Ees (MPAPcalc); and when SRVP was used for Pes, Ees was represented as Ees (SRVP). SG-cath-derived MPAP was used in the calculations of Ees (MPAP) and Ees (MPAPcalc).…”

Section: Assessment Of Rv Functionmentioning

confidence: 99%

Accuracy of Swan‒Ganz catheterization‐based assessment of right ventricular function: Validation study using high‐fidelity micromanometry‐derived values as reference

et al. 2022

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Right ventricular (RV) function critically affects the outcomes of patients with pulmonary hypertension (PH). Pressure wave analysis using Swan-Ganz catheterization (SG-cath) allows for the calculation of indices of RV function. However, the accuracy of these indices has not been validated. In the present study, we calculated indices of systolic and diastolic RV functions using SG-cath-derived pressure recordings in patients with suspected or confirmed PH. We analyzed and validated the accuracies of three RV indices having proven prognostic values, that is, end-systolic elastance (Ees)/arterial elastance (Ea), β (stiffness constant), and end-diastolic elastance (Eed), using high-fidelity micromanometry-derived data as reference. We analyzed 73 participants who underwent SG-cath for the diagnosis or evaluation of PH. In this study, Ees/Ea was calculated via the single-beat pressure method using [1.65 × (mean pulmonary arterial pressure) − 7.79] as end-systolic pressure. SG-cath-derived Ees/Ea, β, and Eed were 0.89 ± 0.69 (mean ± standard deviation), 0.027 ± 0.002, and 0.16 ± 0.02 mmHg/ml, respectively. The mean differences (limits of agreement) between SG-cath and micromanometryderived data were 0.13 (0.99, −0.72), 0.002 (0.020, −0.013), and 0.04 (0.20, −0.12) for Ees/Ea, β, and Eed, respectively. The intraclass correlation coefficients of the indices derived from the two catheterizations were 0.76, 0.71, and 0.57 for Ees/Ea, β, and Eed, respectively. In patients with confirmed or suspected PH, SG-cath-derived RV indices, especially Ees/Ea and β, exhibited a good correlation with micromanometry-derived reference values.

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“…RV–PA coupling refers to the ability of RV systolic performance to face the afterload from pulmonary vascular system, 7,9–12 while RV–PA uncoupling is an early marker of RV dysfunction, 8 and studies on RV–PA coupling in HF have gained increasing attention over the past few years. RV–PA coupling assesses the right ventricle and pulmonary circulation (PC) as a complete functional component, 9,13 considering RV contractile performance at a specific afterload 14,15 . The gold standard for measuring RV–PA coupling is the ratio of RV end‐systolic elastance (Ees) to PA elastance (Ea), which was invasively evaluated using RV pressure–volume loops obtained via right heart catheterization (RHC) 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Application of an echocardiographic index to characterize right ventricular–pulmonary arterial coupling in heart failure

Chen,

Zhang,

Lou

et al. 2024

ESC Heart Failure

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Heart failure (HF), with its high morbidity and mortality, remains a global public health issue. Right ventricular (RV) dysfunction is a sign of deterioration in the natural history of HF, and a thorough evaluation of the relationship between RV contractility and its afterload through RV–pulmonary arterial (RV–PA) coupling can aid in accurately assessing overall RV function. The ratio of RV end‐systolic elastance (Ees) to pulmonary arterial elastance (Ea) invasively measured by right heart catheterization served as the gold standard for evaluating RV–PA coupling. An echocardiographic index termed tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) has been shown to correlate well with Ees/Ea. TAPSE/PASP is recognized as a non‐invasive surrogate of RV–PA coupling and has been extensively studied in patients with HF. This review briefly describes the methods of assessing RV–PA coupling, mainly discussing echocardiography, summarizes the clinical utility of TAPSE/PASP in patients with different HF types, and provides an overview of the available literature.

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Defining end-systolic pressure for single-beat estimation of right ventricle–pulmonary artery coupling: simple… but not really

Cited by 10 publications

References 14 publications

Pressure‐based estimation of right ventricular ejection fraction

Pressure‐based estimation of right ventricular ejection fraction

Accuracy of Swan‒Ganz catheterization‐based assessment of right ventricular function: Validation study using high‐fidelity micromanometry‐derived values as reference

Application of an echocardiographic index to characterize right ventricular–pulmonary arterial coupling in heart failure

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