Assessing left ventricular systolic dysfunction after myocardial infarction: are ejection fraction and dP/dt_max complementary or redundant?

Abstract

Among the various cardiac contractility parameters, left ventricular (LV) ejection fraction (EF) and maximum dP/dt (dP/dt(max)) are the simplest and most used. However, these parameters are often reported together, and it is not clear if they are complementary or redundant. We sought to compare the discriminative value of EF and dP/dt(max) in assessing systolic dysfunction after myocardial infarction (MI) in swine. A total of 220 measurements were obtained. All measurements included LV volumes and EF analysis by left ventriculography, invasive ventricular pressure tracings, and echocardiography. Baseline measurements were performed in 132 pigs, and 88 measurements were obtained at different time points after MI creation. Receiver operator characteristic (ROC) curves to distinguish the presence or absence of an MI revealed a good predictive value for EF [area under the curve (AUC): 0.998] but not by dP/dt(max) (AUC: 0.69, P < 0.001 vs. EF). Dividing dP/dt(max) by LV end-diastolic pressure and heart rate (HR) significantly increased the AUC to 0.87 (P < 0.001 vs. dP/dt(max) and P < 0.001 vs. EF). In naïve pigs, the coefficient of variation of dP/dt(max) was twice than that of EF (22.5% vs. 9.5%, respectively). Furthermore, in n = 19 pigs, dP/dt(max) increased after MI. However, echocardiographic strain analysis of 23 pigs with EF ranging only from 36% to 40% after MI revealed significant correlations between dP/dt(max) and strain parameters in the noninfarcted area (circumferential strain: r = 0.42, P = 0.05; radial strain: r = 0.71, P < 0.001). In conclusion, EF is a more accurate measure of systolic dysfunction than dP/dt(max) in a swine model of MI. Despite the variability of dP/dt(max) both in naïve pigs and after MI, it may sensitively reflect the small changes of myocardial contractility.

Carbon Monoxide-Saturated Hemoglobin-Based Oxygen Carriers Attenuate High-Altitude-Induced Cardiac Injury by Amelioration of the Inflammation Response and Mitochondrial Oxidative Damage

“…On the 8th day after hypobaric hypoxia, the mice were anesthetized with pentobarbital (40mg/kg, i.p.) and cardiac function was measured by invasive hemodynamics using pressure-volume loops (BL-420A, Tai Meng Biological Data Acquisition and Analysis System), which is a more sensitive assessment of cardiac function than conventional echocardiography [22]. Parameters that were measured included left-ventricular developed pressure (LVDP), left-ventricular end-diastolic pressure (LVEDP) and rates of maximum LVDP increase (+ dp/dt) and decrease (- dp/dt).…”

Correlation between Serum Calcineurin Activity and Left Ventricular Hypertrophy in Hypertensive Patients and Its Clinical Significance

“…CaN research was mainly focused on animal experiments for years, and yet few data are available about its clinical verification. One of the main advantages of our study is the fact that we evaluated our patients using echocardiography, which has been demonstrated as a more accurate measurement of cardiac function than invasive hemodynamics [21]. This study provides a convenient and inexpensive method to assess serum CaN activity without radiation exposure.…”

Characterizing preclinical models of ischemic heart failure: differences between LAD and LCx infarctions

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“…The methods for pressure measurement were previously described in detail (15). Briefly, percutaneous punctures were performed to establish the vascular access to the femoral artery and femoral vein.…”