Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application

Klotz, Stefan; Hay, Ilan; Dickstein, Marc L.; Geng, Ying; Wang, Jie; Maurer, Mathew S.; Kass, David A.; Burkhoff, Daniel

doi:10.1152/ajpheart.01240.2005

Cited by 237 publications

(288 citation statements)

References 28 publications

(25 reference statements)

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“…To overcome some of the inherent complexities of generating pressure-volume loops to determine Ees and Ea, respectively, some investigators have validated and now use the single-beat method, both invasively and noninvasively using CMR. 60,61 The future incorporation of these and other more sophisticated measurements of ventriculovascular coupling into translational research, clinical trials, and ultimately clinical practice appears promising.…”

Section: Ventriculoarterial Coupling and The Cardiopulmonary Unitmentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

102

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1820T here has been an increased recognition of pulmonary hypertension (PH) in clinical practice over the past 30 years. It is likely that this rise in PH diagnoses is attributable to multiple factors, including increased awareness by clinicians, the routine use of diagnostic tools such as Doppler echocardiography, and the availability and marketing of the many PH-specific drugs.1 Although the increased awareness of the disease should be viewed as a favorable development, the unintended consequences include overdiagnosis, misclassification, and at times indiscriminate use of expensive, PH-specific drugs. In this review, we address the epidemiology, prognosis, and updated clinical classification of PH. We then focus on the diagnostic approach to the patient with suspected PH with an emphasis placed on highlighting key pearls for the clinician to consider. Finally, we review an evolving conceptual framework of viewing the pulmonary vasculature and the right ventricle as a single, coupled cardiopulmonary unit.

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Section: Ventriculoarterial Coupling and The Cardiopulmonary Unitmentioning

confidence: 99%

Clinical Diagnosis of Pulmonary Hypertension

Rich

2014

Circulation

102

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“…3 In left heart failure, this was circumvented by the development of single-beat analyses of diastolic PV relationship. 5,6 However, it is unclear whether this analysis could also be used for the RV in PAH.…”

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confidence: 99%

“…Single-Beat PV Analysis PV relations were constructed by fitting a nonlinear exponential curve through the diastolic PV points using the following formula: P=α(e Vβ −1), 5,6 where P is pressure, α is a curve-fitting constant, β is a diastolic stiffness constant, and V is volume.…”

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confidence: 99%

Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension

et al. 2013

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I diopathic pulmonary arterial hypertension (PAH) is a rare but fatal disease with a survival rate of 58% at 3 years. Present therapy is unable to normalize pulmonary arterial pressures, and PAH patients ultimately develop right heart failure. Editorial see p 1999 Clinical Perspective on p 2025Previous studies have demonstrated that PAH patients have reduced systolic function as measured by right ventricular Background-The role of right ventricular (RV) diastolic stiffness in pulmonary arterial hypertension (PAH) is not well established. Therefore, we investigated the presence and possible underlying mechanisms of RV diastolic stiffness in PAH patients. Methods and Results-Single-beat RV pressure-volume analyses were performed in 21 PAH patients and 7 control subjects to study RV diastolic stiffness. Data are presented as mean±SEM. RV diastolic stiffness (β) was significantly increased in PAH patients (PAH, 0.050±0.005 versus control, 0.029±0.003; P<0.05) and was closely associated with disease severity. Subsequently, we searched for possible underlying mechanisms using RV tissue of PAH patients undergoing heart/lung transplantation and nonfailing donors. Histological analyses revealed increased cardiomyocyte cross-sectional areas (PAH, 453±31 μm 2 versus control, 218±21 μm 2 ; P<0.001), indicating RV hypertrophy. In addition, the amount of RV fibrosis was enhanced in PAH tissue (PAH, 9.6±0.7% versus control, 7.2±0.6%; P<0.01). To investigate the contribution of stiffening of the sarcomere (the contractile apparatus of RV cardiomyocytes) to RV diastolic stiffness, we isolated and membrane-permeabilized single RV cardiomyocytes. Passive tension at different sarcomere lengths was significantly higher in PAH patients compared with control subjects (>200%; P interaction <0.001), indicating stiffening of RV sarcomeres. An important regulator of sarcomeric stiffening is the sarcomeric protein titin. Therefore, we investigated titin isoform composition and phosphorylation. No alterations were observed in titin isoform composition (N2BA/N2B ratio: PAH, 0.78±0.07 versus control, 0.91±0.08), but titin phosphorylation in RV tissue of PAH patients was significantly reduced (PAH, 0.16±0.01 arbitrary units versus control, 0.20±0.01 arbitrary units; P<0.05). In addition, these measures are highly sensitive to the confounding effects of increased preload and afterload and are therefore not reliable in the setting of PAH. 4 On the other hand, the gold standard of measuring load-independent diastolic stiffness by pressure-volume (PV) analysis is not without risk in PAH patients because it requires temporal preload reduction. Conclusions-RV3 In left heart failure, this was circumvented by the development of single-beat analyses of diastolic PV relationship. 5,6 However, it is unclear whether this analysis could also be used for the RV in PAH.There are several possible contributing factors explaining RV diastolic stiffness in PAH. Hypertrophy and fibrosis are known to increase ventricular stiffness.7 However, RV diastolic stiffn...

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“…Mitral Doppler E wave to e′ ratio was used as a surrogate of mean LV diastolic pressure 19, 20. LV diastolic pressure‐volume relationship was calculated as described elsewhere 21. All recordings were taken by the same operator (E.A.…”

Section: Methodsmentioning

confidence: 99%

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

Aslanger

Assous

Bihry

et al. 2015

JAHA

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BackgroundSuccess of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO 2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular‐arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX‐derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.Methods and ResultsThirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise‐based CR. Noninvasive LV pressure‐volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO 2 was not in a significant correlation with the change in VAC (r=−0.18; P=0.31), mechanical efficiency (r=−0.16, P=0.39), or the change in ejection fraction (r=−0.07; P=0.68).Conclusions CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX‐derived data in predicting clinical outcomes.

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Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application

Cited by 237 publications

References 28 publications

Clinical Diagnosis of Pulmonary Hypertension

Clinical Diagnosis of Pulmonary Hypertension

Right Ventricular Diastolic Impairment in Patients With Pulmonary Arterial Hypertension

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure

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