Instantaneous measurement of left and right ventricular stroke volume and pressure-volume relationships with an impedance catheter.

McKay, Raymond G.; Spears, Jenna; Aroesty, Julian M.; Baim, D S; Royal, Henry D.; Heller, Gary V.; Lincoln, William C.; Salo, Rodney W.; Braunwald, Eugene; Grossman, William

doi:10.1161/01.cir.69.4.703

Cited by 120 publications

(33 citation statements)

References 7 publications

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“…IVC occlusion, unlike pharmacologic loading Adjustment used in nearly all prior human studies , can be readily repeated before and after drug administration and during atrial or ventricular pacing. Although previous reports have shown some of the capabilities and safety of these techniques [ 12,15,24], demonstration of their combined use for assessment of calibrated left ventricular pressure-volume relationhips in man has not been made. Only one prior study, in animals, has shown the potential of this approach using calibrated volumes [ …”

Section: Introductionmentioning

confidence: 99%

Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure‐volume relationships in man

Kass

Midei

Graves

et al. 1988

Cathet. Cardiovasc. Diagn.

208

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Determination of left ventricular pressure-volume relationships in situ ideally requires both a method for easy measurement of multiple pressure-volume loops and a rapid and reversible means of altering load. We report a technique, previously used in animals, that combines conductance catheter volumes and rapid inferior vena caval occlusion to permit routine measurement of calibrated P-V relationships in man for the first time. An 8F volume catheter with a 3F micromanometer tipped pressure catheter placed through its lumen was advanced to the left ventricular apex through a femoral artery. A thermodilution output catheter was placed through a 9F femoral venous sheath and later replaced with an IVC balloon occlusion catheter, through which a 2.5F bipolar wire was advanced for atrial pacing. A specialized data system facilitated collection, editing, and data analysis at the time of cardiac catheterization. Absolute volume calibration required cardiac output measurement and injection of hypertonic saline. IVC occlusion decreased peak left ventricular pressure by 42 +/- 17 (SD) (P less than .001) mm Hg in 15 patients. Endsystolic pressure-volume relationships (ESPVR) were determined with 5-8 cardiac cycles with an average of r2 of 0.94 +/- 0.05 and were generally reproducible. The slope of the ESPVR demonstrated consistency among a group of normal patients (n = 6), and was significantly lower than the slope derived from a group of patients with ventricular hypertrophy (n = 9). We conclude that left ventricular pressure-volume relationships can be easily and repeatedly determined as part of a routine cardiac catheterization in man.

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Section: Introductionmentioning

confidence: 99%

Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure‐volume relationships in man

Kass

Midei

Graves

et al. 1988

Cathet. Cardiovasc. Diagn.

208

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“…Evaluation of ventricular systolic performance in the PV plane has been extensively performed in the adult human and dog (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In the adult, the ESPVR has been shown to be relatively sensitive to changes in inotropic state (15,17,19,23), but evidence of nonlinearity (24)(25)(26)(27)(28) and afterload sensitivity (13,23,29,30) has been found.…”

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confidence: 99%

The End-Systolic Pressure-Volume Relationship in the Newborn Lamb: Effects of Loading and Inotropic Interventions

et al. 1991

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ABSTRACT. Indices of global systolic performance of the newborn left ventricle exceed those of the adult, despite isolated tissue studies showing immature contractile mechanisms. To evaluate contractility in situ, we investigated the end-systolic pressure-volume relationship (ESPVR) by the conductance technique in nine newborn lambs. After percutaneous placement of catheters, we generated ESPVR by inferior vena cava occlusion, aortic occlusion, and volume infusion in two control states, during three levels of dobutamine infusion, and after propranolol. We performed linear and nonlinear regression analyses of the end-systolic points and derived the slope (E.,) and volume at 14 kPa pressure. We found that reliable ESPVR could be obtained in almost all inferior vena cava and aortic occlusions (50 of 51 in each), but in only 18 of 27 volume infusions. Overall, linear regressions adequately defined the ESPVR (75 of 102 were not statistically different than nonlinear regressions; of those different, the mean linear R 2 was 0.934 ± 0.048). By multiple regression analysis, neither E es nor volume at 14 kPa significantly changed with dobutamine, but both changed after propranolol (23% less than control and 54% greater, respectively), supporting previous studies showing a limited contractile reserve in the newborn secondary to high resting p-adrenergic tone. Neither E., nor volume at 14 kPa was different between control states. However, E e , was 25% less steep when generated by inferior vena cava than by aortic occlusion. We conclude that the ESPVR can be generated reliably and reproducibly in the newborn lamb and is relatively linear and sensitive to changes in contractility, but that it is also sensitive to the technique of load intervention.

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“…The methodological prerequisites for determining all of the essential parameters of mechanical cardiac action in situ have been available for a long time -and have been improved considerably during the last few years, although some detailed problems remain to be solved (5,7,12,57,59,63,64). However, beyond a merely descriptive presentation ( Fig.…”

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confidence: 99%

Ventricular pressure-volume relations as the primary basis for evaluation of cardiac mechanics Return to Frank's diagram

Jacob

Kissling

1989

Basic Res Cardiol

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Considering ventricular function from the vantage point of the pressure-volume (P-V) diagram permits not only quantification of ventricular working capacity under normal and pathophysiological conditions but also promotes understanding of cardiac dynamics including prediction of the effects of mechanical and pharmacological interventions. Therefore it seems appropriate, at least intellectually, to classify all measured volume and pressure data into the scheme of the P-V diagram. The use of so-called contractility indices and also the restriction to the end-systolic P-V relation alone means deliberate renunciation of important information. In principle, Frank's original concept can be confirmed which, under afterloaded conditions, implies the existence of distinct end-systolic P-V curves each related to a particular end-diastolic volume. As an approximation, however, the assumption of one common end-systolic P-V relation seems tolerable. Based on Frank's diagram, a concept for assessment of ventricular and myocardial function is presented following a discussion of the determinants of the diastolic and end-systolic P-V relations, as well as the methodological difficulties and different notions with regard to the end-systolic P-V curve. The P-V area between the curves of systolic maxima and diastolic minima, up to a defined end-diastolic pressure, is recommended as a measure for quantitative evaluation of ventricular working capacity. Transformation into stress-length (sigma-l) relations is indispensable for assessment of myocardial function under the conditions of changed ventricular geometry. The normalized sigma-l area yields a measure for interindividual evaluation of myocardial working capacity. This concept of evaluation does not mean acknowledgement of the visco-elastic theory of muscle contraction nor of the Emax concept. The P-V and sigma-l relations must, however, be complemented by time related parameters in order to estimate ventricular and myocardial power capacity. After a long-lasting search through international literature for "contractility indices" of general applicability and significance it seems appropriate to return to Frank's diagram as the primary basis for evaluating cardiac mechanics.

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Instantaneous measurement of left and right ventricular stroke volume and pressure-volume relationships with an impedance catheter.

Cited by 120 publications

References 7 publications

Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure‐volume relationships in man

Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure‐volume relationships in man

The End-Systolic Pressure-Volume Relationship in the Newborn Lamb: Effects of Loading and Inotropic Interventions

Ventricular pressure-volume relations as the primary basis for evaluation of cardiac mechanics Return to Frank's diagram

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