Physiological insights of recent clinical diagnostic and therapeutic technologies for cardiovascular diseases

Abstract

Diagnostic and therapeutic methods for cardiovascular diseases continue to be developed in the 21st century. Clinicians should consider the physiological characteristics of the cardiovascular system to ensure successful diagnosis and treatment. In this review, we focus on the roles of cardiovascular physiology in recent diagnostic and therapeutic technologies for cardiovascular diseases. In the first section, we discuss how to evaluate and utilize left ventricular arterial coupling in the clinical settings. In the second section, we review unique characteristics of pulmonary circulation in the diagnosis and treatment of pulmonary hypertension. In the third section, we discuss physiological and anatomical factors associated with graft patency after coronary artery bypass grafting. In the last section, we discuss the usefulness of mechanical ventricular unloading after acute myocardial infarction. Clinical development of diagnostic methods and therapies for cardiovascular diseases should be based on physiological insights of the cardiovascular system.

Model‐based meta‐analysis of changes in circulatory system physiology in patients with chronic heart failure

“…The improvement in estimated E es with metoprolol was better than that with carvedilol at 12 months. On the other hand, E a at 6 and 12 months is lower for carvedilol than for metoprolol, resulting in little difference between two drugs in E es /E a which represents the efficiency of left ventricular contraction that pumps blood through the arteries 21 . For carvedilol, changes in MAP, CO, EF, Ea, and TPR were continuous through 12 months.…”

“…On the other hand, in the field of circulatory physiology, various parameters described above have been related mathematically to HR, blood pressure and ventricular volume. 11 Therefore, it may be possible to estimate them based on carefully constructed model. Current efficacious medicines, β-blockers and ACE inhibitors exert an initial effect on the circulatory system which causes direct changes in HR and blood pressure, and in addition, they may have secondary therapeutic effects to the heart.…”

“…( -) × 79.98 (11) where CVP represents the central venous pressure, which was considered negligible compared to MAP. TAC (mL/mm Hg) is an index of blood vessel compliance and was estimated by the ratio of the difference between SAP and DAP to SV.…”

Left ventricular-arterial coupling is associated with prolonged mechanical ventilation in severe post-cardiac surgery patients: an observational study

“…As we all know, left ventricular-arterial coupling (VAC) was used to assess cardiac work efficiency [ 12 ]. There are two parameters in VAC: Ea and Ees.…”

“…The ratio of SW to PVA, which can be estimated by proportion of area B to area A, is representative of cardiac work efficiency. As we have discussed above, VAC can reflect the proportion of area A to area B, so it is understandable that VAC can be a surrogate for cardiac work efficiency [ 12 , 15 ]. A heart with a high Ea/Ees usually presents an increased proportion of the PVA corresponding to potential energy rather than stroke work, denoting an unfavorable energy efficiency state [ 11 ].…”