Disparity between ejection and end-systolic indexes of left ventricular contractility in mitral regurgitation.

Berko, Barbara A.; Gaasch, William H.; Tanigawa, N; Smith, Donna; Craige, Ernest

doi:10.1161/01.cir.75.6.1310

Cited by 62 publications

(24 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This value compares well with those found in the isolated heart, 6.6 mm Hg/ml 7 and 3.6 mm Hg/ml, 24 as well as in the intact dog (obtained with vena cava occlusion), 5.8±3.6 mm Hg/ml, 17 4.7±2.3 mm Hg/ml, 22 7.7 ±2.9 mm Hg/ml, 23 5.1 and 6.7 mm Hg/ml (with and without autonomic blockade, respectively), 27 and 4.6 ± 2.5 mm Hg/ml. 20 In contrast, Ees found by aortic occlusion, an intervention not studied by others, was 1.37 ±0.45 kPa/ml or 10.3 ± 3.4 mm Hg/ml, exceeding all of the above values. Hypothetically, the conductance method measuring LV volume, in itself, may have caused some differences in slopes of the ESPVR with the two load interventions because of its slight sensitivity to the contents of the right heart.…”

Section: Discussionmentioning

confidence: 57%

Sensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs.

Baan

Velde

1988

Circulation Research

124

View full text Add to dashboard Cite

The influence of different types of loading intervention on the resulting end-systolic pressure-volume relation (ESPVR) of the left ventricle in situ was investigated in anesthetized open-chest dogs. Left ventricular volume was measured by conductance catheter and pressure was measured by tip-micromanometer. Two loading interventions were applied: a pressure intervention (INp) by gradually occluding the descending aorta and a volume intervention (INv) by rapidly infusing 180 ml blood into the vena cava. The pressure-volume loops during an intervention always showed a linear ESPVR, the slope of which, Ees, was calculated. Possible method-related artifacts were assessed and could be excluded. Results from 16 dogs show that Ees(INp) was always larger (1.37 ±0.45 kPa/ml) than Ees(INv) (0.73 ± 0.32 kPa/ml) (p<0.001). This difference was enhanced by /3-blockade through metoprolol. The same phenomenon was found for the slope (SdPV) of the relation between d P / d t^ and end-diastolic volume: SdPV(INp) = 45.17±22.63 kPa/ml/sec and SdPV(INv) = 20.55±11.13 kPa/ml/ sec. In seven dogs, a right heart bypass was performed to study the influence of stroke volume on the ESPVR by applying a pressure intervention under three conditions: with constant end-diastolic volume (decreasing stroke volume), Ees = 2.27 ±0.79 kPa/ml; with constant stroke volume, Ees = 1.59 ±0.51 kPa/ml; and with increasing stroke volume (and increasing end-diastolic volume), Ees = 1.36 ± 0.49 kPa/ml. Analysis of variance revealed a statistically significant relation between Ees and stroke volume (/X0.01). From the right heart bypass experiments, we conclude that shorteningrelated deactivation plays a role in the observed behavior of the ESPVR. However, the results from the series with intact circulation indicate that aortic occlusion has an additional effect on the slope of the ESPVR, leading to increased myocardial inotropism, perhaps mediated through a peripheral stimulus in response to decreased perfusion. (Circulation Research 1988;62:1247-1258 D iastolic cardiac muscle length, reflected by I end-diastolic ventricular volume (EDV), has a strong influence on the mechanical function of the ventricle, whether expressed as stroke volume (SV), systolic pressure, or external work. This formulation, known as Starling's law of the heart, 1 is considered rather inadequate nowadays because other variables such as aortic pressure and heart rate have an even more profound influence on cardiac mechanical performance. A reduction in total vascular resistance, for example, brought on by vasodilator therapy, reduces aortic pressure and increases SV primarily by a reduction in end-systolic volume. Rather than using ventricular function curves or graphs representing the dependence of variables such as SV or work and ejection fraction on preload (EDV) or afterload [aortic pressure, systolic left ventricular (LV) pressure], it is useful to describe ventricular performance in the pressurevolume (PV) plane. The first to propose such methods to describe the work performed by ...

show abstract

Section: Discussionmentioning

confidence: 57%

Sensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs.

Baan

Velde

1988

Circulation Research

124

View full text Add to dashboard Cite

show abstract

“…Previous work has also shown substantial disparity between EF and end-systolic indexes of LV contractility in the presence of MR. 34 Interestingly, neither load-independent parameters of LV contractility nor EF demonstrated a clinically relevant correlation to cardiac output, indicating that the improvement in hemodynamic status is achieved through the reduction of regurgitant flow rather than any substantial changes in LV contractility.…”

Section: Effects Of Percutaneous Mvr On LV Contractilitymentioning

confidence: 92%

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Gaemperli¹,

Biaggi²,

Gugelmann³

et al. 2013

Circulation

108

View full text Add to dashboard Cite

Background— Percutaneous mitral valve repair with the MitraClip device has emerged as an alternative to surgery for treating severe mitral regurgitation. However, its effects on left ventricular loading conditions and contractility have not been investigated yet. Methods and Results— Pressure-volume loops were recorded throughout the MitraClip procedure using conductance catheter in 33 patients (mean age, 78±10 years) with functional (45%), degenerative (48%), or mixed (6%) mitral regurgitation. Percutaneous mitral valve repair increased end-systolic wall stress (WS ES ; from [median] 184 mm Hg [interquartile range (IQR), 140–200 mm Hg] to 209 mm Hg [IQR, 176–232 mm Hg]; P =0.001) and decreased end-diastolic WS (WS ED ; from 48 mm Hg [IQR, 28–58 mm Hg] to 34 mm Hg [IQR, 21–46 mm Hg]; P =0.005), whereas the end-systolic pressure-volume relationship was not significantly affected. Conversely, cardiac index increased (from 2.6 L·min −1 ·m −2 [IQR, 2.2–3.0 L·min −1 ·m −2 ] to 3.2 L·min −1 ·m −2 [IQR, 2.6–3.8 L·min −1 ·m −2 ]; P <0.001) and mean pulmonary capillary wedge pressure decreased (from 15 mm Hg [IQR, 12–20 mm Hg] to 12 mm Hg [IQR, 10–13 mm Hg]; P <0.001). Although changes in WS ES were not correlated with changes in cardiac index, changes in WS ED correlated significantly with changes in mean pulmonary capillary wedge pressure ( r =0.63, P <0.001). Total mechanical energy assessed by the pressure-volume area remained unchanged, resulting in a more favorable index of forward output (cardiac index) to mechanical energy (pressure-volume area) after mitral valve repair. On follow-up (153±94 days), New York Heart Association functional class was reduced from 2.9±0.6 to 1.9±0.5 ( P <0.001) at 3 months, and echocardiographic follow-up documented a stepwise reduction in end-diastolic volume (from 147 mL [IQR, 95–191 mL] to 127 mL [IQR, 82–202 mL]; P =0.036). Conclusions— Percutaneous mitral valve repair improves hemodynamic profiles and induces reverse left ventricular remodeling by reducing left ventricular preload while preserving contractility. In nonsurgical candidates with compromised left ventricular function, MitraClip therapy could be considered an alternative to surgical mitral valve repair.

show abstract

“…The end-systolic stress-volume ratio might be more useful than the end-systolic volume alone, but in chronically remodeled hearts, this ratio, like systolic elastance, requires consideration of body size and LV geometry. 16,22 These and other indices of function certainly can be useful in many circumstances, but the EF appears to be the most clinically relevant index of LV systolic function in MR, and it provides a scientifically valid and clinically reliable index on which to base management decisions.…”

Section: Ejection Fractionmentioning

confidence: 99%

Left Ventricular Response to Mitral Regurgitation

2008

View full text Add to dashboard Cite

Disparity between ejection and end-systolic indexes of left ventricular contractility in mitral regurgitation.

Abstract: To examine left ventricular function in mitral regurgitation (MR), we compared the ejection phase indexes of left ventricular contractility with maximal systolic elastance (Emax)

Cited by 62 publications

References 57 publications

Sensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs.

Sensitivity of left ventricular end-systolic pressure-volume relation to type of loading intervention in dogs.

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Left Ventricular Response to Mitral Regurgitation

Contact Info

Product

Resources

About