Noninvasive assessment of ejection intraventricular pressure gradients

Yotti, Raquel; Bermejo, Javier; Antoranz, J. C.; Rojo-Álvarez, José Luis; Allué, Carmen; Silva, Jacobo; Desco, Manuel; Moreno, Mar; Garcı́a-Fernández, Miguel Ángel

doi:10.1016/j.jacc.2003.09.066

Cited by 56 publications

(57 citation statements)

References 26 publications

(42 reference statements)

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“…11 We have recently developed and validated a new method to obtain noninvasive measurements of EIVPDs by postprocessing color Doppler M-mode (CDMM) echocardiograms. 12,13 The present study was designed to study the utility of EIVPD as a noninvasive index of systolic chamber function in vivo with a high-fidelity pressure and conductance instrumentation animal setup. The specific objectives were (1) to correlate Doppler-derived EIVPDs with invasive reference indices of systolic function in a range of inotropic states induced by pharmacological interventions and acute ischemic cardiomyopathy (study 1), (2) to assess the modification of EIVPDs caused by acute load changes (study 2), and (3) to assess the potential error caused by scan line misalignment on the estimation of EIVPDs (study 3).…”

Section: See P 1684mentioning

confidence: 99%

“…CDMM images were obtained from 5-chamber views as described. 13 The method used for digital image processing to obtain EIVPDs has been reported 12 and validated elsewhere. 13 Other authors have also demonstrated the accuracy of a similar approach to measure intraventricular pressure differences in diastole and its applicability in the clinical setting.…”

Section: Echocardiographic Image Acquisition and Analysismentioning

confidence: 99%

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Doppler-Derived Ejection Intraventricular Pressure Gradients Provide a Reliable Assessment of Left Ventricular Systolic Chamber Function

et al. 2005

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Background-Ejection intraventricular pressure gradients are caused by the systolic force developed by the left ventricle (LV). By postprocessing color Doppler M-mode (CDMM) images, we can measure noninvasively the ejection intraventricular pressure difference (EIVPD) between the LV apex and the outflow tract. This study was designed to assess the value of Doppler-derived EIVPDs as noninvasive indices of systolic chamber function. Methods and Results-CDMM images and pressure-volume (conductance) signals were simultaneously acquired in 9 minipigs undergoing pharmacological interventions and acute ischemia. Inertial, convective, and total EIVPD curves were calculated from CDMM recordings. Peak EIVPD closely correlated with indices of systolic function based on the pressure-volume relationship: peak elastance (within-animal Rϭ0.98; between-animals Rϭ0.99), preload recruitable stroke work , and peak of the first derivative of pressure corrected for end-diastolic volume (within-animal Rϭ0.88; between-animals Rϭ0.91). The correlation of peak inertial EIVPD with these indices was also high (all RϾ0.75). Load dependence of EIVPDs was studied in another 5 animals in which consecutive beats obtained during load manipulation were analyzed. During caval occlusion (40% EDV reduction), dP/dt max , ejection fraction, and stroke volume significantly changed, whereas peak EIVPD remained constant. Aortic occlusion (40% peak LV pressure increase) significantly modified dP/dt max , ejection fraction, and stroke volume; a nearly significant trend toward decreasing peak EIVPD was observed (Pϭ0.06), whereas inertial EIVPD was unchanged (Pϭ0.6). EIVPD beat-to-beat and interobserver variabilities were 2Ϯ12% and 5Ϯ11%, respectively. Conclusions-Doppler-derived

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Section: See P 1684mentioning

confidence: 99%

Section: Echocardiographic Image Acquisition and Analysismentioning

confidence: 99%

Doppler-Derived Ejection Intraventricular Pressure Gradients Provide a Reliable Assessment of Left Ventricular Systolic Chamber Function

et al. 2005

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“…Recently, the possibility of measuring intracardiac pressure gradients by digital processing of color Doppler M-mode images has been developed by our [11][12][13][14] and other groups. 15,16 We hypothesized that this method also could be suitable for measuring the RVFPD in clinical practice.…”

Section: Clinical Perspective P 1023mentioning

confidence: 99%

“…[11][12][13] Briefly, if the M-mode cursor closely approximates a flow streamline, the spatiotemporal velocity distribution of a discrete blood sample is provided by the value of its corresponding pixel color: v(s,t), where v represents velocity, s represents the linear dimension of the streamline, and t is time. Thus, the color M-mode Doppler recording provides the data necessary to solve Euler's momentum equation:…”

Section: Echocardiographic Image Acquisition and Analysismentioning

confidence: 99%

Noninvasive Assessment of the Right Ventricular Filling Pressure Gradient

et al. 2007

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Background-The physiological basis of right ventricular (RV) diastolic function remains incompletely studied in humans.The driving force responsible for RV filling, the pressure gradient along the RV inlet from the right atrium to the RV apex, has never been measured in the clinical setting. Methods and Results-We validated a method for measuring the RV filling pressure difference (RVFPD) from color Doppler M-mode recordings in 12 pigs undergoing interventions on RV preload, afterload, and lusitropic states (error, Ϫ0.1Ϯ0.4 mm Hg compared with micromanometers; intraclass correlation coefficient, 0.88). Peak early RVFPD correlated directly with mean right atrial pressure and inversely with the time constant of RV relaxation. In 21 patients with dilated cardiomyopathy, the peak RVFPD was 1.0 mm Hg (95% CI, 0.8 to 1.2), significantly lower than in age-matched control subjects (1.4 mm Hg; 95% CI, 1.2 to 1.6). In another population of 19 young healthy volunteers, the peak RVFPD was 2.3 mm Hg (95% CI, 2.0 to 2.6), which was reduced by nitroglycerine and esmolol and was augmented by volume overload and atropine infusions. RVFPD was generated almost exclusively by inertial forces. Conclusions-For the first time, the RV driving filling force can be accurately measured noninvasively in the clinical setting, and the method is sensitive to detect the effects of preload, chronotropic, and lusitropic states. In patients with dilated cardiomyopathy, the RV filling force is markedly reduced, indicating severely impaired RV relaxation. These findings suggest that this is a useful tool for improving the clinical assessment of RV diastolic function. (Circulation.

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“…To measure them requires simultaneous high-fidelity pressure measurements with multiple micromanometer catheters placed invasively within the heart, a highly demanding task technically and entirely inappropriate for clinical use. Fortunately, Yotti et al have applied fluid dynamics principles to measure noninvasively ejection intraventricular pressure differences (EIVPD) from color M-mode Doppler data, 1,6 extending concepts originally developed for diastolic IVPG by Thomas, Greenberg, and others from the Cleveland Clinic. 7,8 To understand how we can measure pressure gradients from velocity data, we start with the "almost" complete Bernoulli equation with both inertial and convective terms (we still omit the viscous term because it is negligible in almost every intracardiac situation):…”

Section: See P 1771mentioning

confidence: 99%