Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations.

Gorcsan, John; Gasior, Thomas A.; Mandarino, William A.; Deneault, Lee G.; Hattler, Brack G.; Pinsky, Michael R.

doi:10.1161/01.cir.89.1.180

Cited by 121 publications

(44 citation statements)

References 44 publications

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“…14 P-A analysis has been validated for assessment of LV and RV function, including use of long-axis RV images. 16,17 P-A analysis during pre-Fontan cardiac catheterization, reducing preload with balloon occlusion of the inferior vena cava, could provide additional insights. Alternatively, Zile generated P-A curves from 3 diastolic coordinates on single beats during catheterization in adults with diastolic heart failure.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

et al. 2006

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Background-We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. Methods and Results-Sixteen children with right ventricular (RV) (n ϭ11) or left ventricular (LV) (n ϭ5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation Pϭ␣e ␤A defined the ventricular stiffness constant, ␤. Changes in ␤ and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n ϭ11, Pϭ0.023, mixed models methodology). Pre-bypass ␤ correlated well with duration of chest tube (CT) drainage (rϭ0.90, n ϭ16), net perioperative fluid balance (rϭ0.71, nϭ14), and length of stay (LOS) (rϭ0.81, n ϭ16). CT duration and LOS also correlated significantly with post-bypass ␤ (rϭ0.77 for both, nϭ11), but insignificantly with preoperative catheterization pressures. Conclusions-Intraoperative

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Section: Discussionmentioning

confidence: 99%

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

et al. 2006

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“…3,15 LV performance assessed by pressure-area relations has been shown to decrease immediately after coronary bypass surgery with cardioplegia and hypothermic arrest. 10 This decrease is thought to be due to ischemiareperfusion injury and/or hypothermia, although a precise mechanism is unknown. PLV is unique because of concomitant reductions in valvular regurgitation and the use of cardiopulmonary bypass without cardioplegia or hypothermic arrest in this series, although other centers use cardioplegia and core cooling.…”

Section: Discussionmentioning

confidence: 99%

“…9 -11 Stroke work was estimated as the integral of the pressure-area loop and PRSW as the slope of the relation of linear stroke work versus end-diastolic area. 9,10,12 Assessment of LV compliance was made by use of an exponential curve fit with end-diastolic area as a surrogate for end-diastolic volume. 13 Routine M-mode measures were made from short-axis images.…”

Section: Methodsmentioning

confidence: 99%

Heterogeneous Immediate Effects of Partial Left Ventriculectomy on Cardiac Performance

Gorcsan¹,

Feldman²,

Kormos³

et al. 1998

Circulation

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Background-Partial left ventriculectomy (PLV) is a novel surgical treatment for severe heart failure consisting of resection of a large wedge of myocardium to reduce wall stress and restore the normal mass-volume ratio. Although ejection fraction (EF) has been shown to improve after PLV, few other physiological data describing its immediate effects on left ventricular (LV) performance are available. Methods and Results-Eight patients, 58Ϯ5 years old, with severe clinical heart failure and EF of 12Ϯ3% were studied before and immediately after PLV. LV performance was assessed by the predominantly load-insensitive measures of pressure-area relations with high-fidelity pressure catheters and transesophageal automated echocardiographic measures of cross-sectional area as a surrogate for volume. LV end-diastolic volume decreased from 200Ϯ60 to 89Ϯ17 mL, EF increased from 12Ϯ3% to 41Ϯ8%, and right ventricular (RV) fractional area change increased from 24Ϯ12% to 37Ϯ16% (all PϽ.05 versus before). Changes in pressure-area relations were variable: end-systolic elastance, 6.5Ϯ3.4 to 4.3Ϯ2.5 mm Hg/cm 2 and preload recruitable stroke work, 33Ϯ16 to 34Ϯ19 mm Hg (PϭNS versus before). End-diastolic stiffness increased from 0.13Ϯ0.06 to 0.19Ϯ0.07 mm Hg/cm 2 (PϽ.05 versus before). Improvement in LV performance was inversely correlated with semiquantitative histological assessment of myocardial fibrosis and positively correlated with nuclear enlargement and hyperchromasia, indicative of myocyte hypertrophy. No long-term follow-up data were available. Conclusions-PLV resulted in reductions in LV volumes, increases in EF and RV ejection, but increases in LV stiffness.Estimates of LV performance revealed variable results associated with the degree of myocardial fibrosis. Further study of these effects in relation to patient outcome is warranted. (Circulation. 1998;97:839-842.)

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“…Pressure-volume loops were constructed using RV catheter pressure tracing and 3D RV volume curves matching representative beats and adjusting the time to achieve the most vertical isovolumic components. 16 RV stroke work was calculated from the integral of the pressure-volume loops.…”

Section: Echocardiographic Studiesmentioning

confidence: 99%

Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography

Ryo

Goda

Onishi

et al. 2015

Circ: Cardiovascular Imaging

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P ulmonary hypertension (PH) is a progressive disease associated with significant morbidity and mortality with advanced treatment options based on its stage of evolution. See Clinical Perspective See Editorial by TorbickiPatient outcomes in PH have been associated with right ventricular (RV) structural and functional changes described as RV adaptation where patients show minimal or no symptoms that progresses to a decompensated phase of RV adverse remodeling associated with catastrophic clinical deterioration and death within a year.1-3 The detection of RV adverse remodeling heralding RV failure in PH is of great importance to manage advanced treatment strategies, including continuous vasodilator infusions or lung transplantation. The contemporary clinical approach to assess for the advanced stage of PH is by invasive right heart catheterization hemodynamic data, which are important but imperfect. Morphological RV adverse remodeling in PH is clinically relevant, 2,4 but a means to quantify these changes has been challenging because of complexities of RV anatomy. Direct noninvasive quantification of the RV pathophysiology has become recently possible with technological advances in 3-dimensional (3D) echocardiography, including RV time-volume and time-strain data. 5 Accordingly, the objectives of this study were to (1) determine novel quantitative 3D echocardiographic RV structural and functional indices in patients with PH compared with normal subjects, and (2) to test the hypothesis that pathophysiological RV changes occurring with adaption and adverse remodeling in PH quantified by 3D echocardiography are associated with important patient outcomes. [6][7][8][9] The practical clinical impact is to support the potential adjunctive role of noninvasive 3D echocardiography with invasive hemodynamic data Background-Adverse right ventricular (RV) remodeling has significant prognostic and therapeutic implications to patients with pulmonary hypertension (PH). However, differentiating RV adaption from adverse remodeling associated with poor outcomes is difficult. We hypothesized that novel 3-dimensional (3D) wall motion tracking echocardiography can differentiate morphological features of RV adaption from adverse remodeling heralding an unfavorable short-term prognosis in patients with PH. Methods and Results-We studied 112 subjects: 92 patients with PH and 20 normal controls with 3D wall motion tracking for RV end-systolic volume index (ESVi), RV ejection fraction (EF), and RV global area strain. Patients with PH also had invasive hemodynamic measurements. Pressure-volume relations classified patients with PH into 3 groups, such as RV adapted, RV adapted-remodeled, and RV adverse-remodeled. The predefined combined end point was PHrelated hospitalization, death, or lung surgery (lung transplantation or pulmonary endarterectomy) during 6 months.

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Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations.

Cited by 121 publications

References 44 publications

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

Ventricular Diastolic Stiffness Predicts Perioperative Morbidity and Duration of Pleural Effusions After the Fontan Operation

Heterogeneous Immediate Effects of Partial Left Ventriculectomy on Cardiac Performance

Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography

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