Overestimation of Left Ventricular Volume by the Indicator Dilution Technique

Carleton, Richard A.; Bowyer, Allen F.; Graettinger, John S.

doi:10.1161/01.res.18.3.248

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…At the other extreme, the uniform observation of a slower washout of indicator from the apex, consistent with the findings of Scarpa-Smith (14) and of Carleton, Bowyer, and Graettinger (15) in the left ventricle, indicates that the turnover rate of blood at the ventricular apex is slow.…”

Section: Resultssupporting

confidence: 87%

“…However, because of differences in the myocardial distensibility of living and dead animals, this observation is of doubtful significance. Indeed, comparisons of this method with angiocardiographic assessments of ventricular volume indicate that volumes obtained with the indicator washout technique are uniformly and significantly larger (15,36,37).…”

Section: Right Ventricular and Pulmonary Artery Mixing -I C Further mentioning

confidence: 99%

“…The application of this method to the study of ventricular responses to various stimuli can only provide information concerning the direction of changes in volume if the pattern of blood transfer across the ventricle remains unchanged. Recent findings suggest that this condition may be met in the absence of marked changes in heart rate or in the ejected fraction (15). Reported alterations in EDVW in response to physiological manipulations (39)(40)(41) should be evaluated with these considerations in mind.…”

Section: Right Ventricular and Pulmonary Artery Mixing -I C Further mentioning

confidence: 99%

“…Although the existence of homogeneous ventricular mixing is a prerequisite condition for the valid application of this technique, only a few descriptions of ventricular mixing have been reported. While the available information indicates that mixing does not appear to be homogeneous (12)(13)(14)(15), the significance of this observation with respect to estimations of ventricular volume has not been characterized adequately. Volume may still be estimated with validity in the absence of perfect mixing if the inhomogeneities are randomly distributed (16); if systematic regional differences in mixing do occur in the ventricle, however, estimates of volume will be systematically in error.…”

Section: Introductionmentioning

confidence: 99%

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Mixing in the right ventricle and pulmonary artery in man: evaluation of ventricular volume measurements from indicator washout curves

Maseri¹,

Enson²

1968

J. Clin. Invest.

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A B S T R A C T To assess the mixing characteristics of the right ventricle and pulmonary artery, radioiodinated 131I serum albumin and indocyanine green dye were injected simultaneously in 16 subjects. One indicator was injected into the atrium and the other into the ventricle, or both were injected at different sites in the ventricle. Washout curves were obtained by rapid catheter sampling alternately just above or just below the pulmonic valve. The washout of radioisotope was also recorded with a precordial scintillation detection probe.Indicator washout from the ventricular inflow tract was rapid, while washout from the region of the ventricular apex was quite slow. Protosystolic dips in indicator concentration, noted in curves drawn below the pulmonic valve, suggest that the ventricle emptied sequentially. Flow values computed from curves sampled below the valve, when compared with reference values, suggest that a significant volume of atrial blood passed through the ventricle without mixing, or mixing to only a small extent, with the residual volume of the chamber. Peak concentration of indicator was higher below the pulmonic valve than above. This finding, plus the close agreement between flow values computed from curves sampled above the valve and the reference values, indicates that further mixing occurred above the valve.Dr. Maseri's present address is

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Section: Resultssupporting

confidence: 87%

Section: Right Ventricular and Pulmonary Artery Mixing -I C Further mentioning

confidence: 99%

Section: Right Ventricular and Pulmonary Artery Mixing -I C Further mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mixing in the right ventricle and pulmonary artery in man: evaluation of ventricular volume measurements from indicator washout curves

Maseri¹,

Enson²

1968

J. Clin. Invest.

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“…Subsequently, arterial pressure progressively declined, associated with bradycardia and the development of cardiac standstill. (22). In regard to the state of the myocardium in these animals, it is difficult to make precise inferences when abnormal tissue may be in series with normal muscle, but a summation of effects may be seen as operative.…”

Section: Resultsmentioning

confidence: 99%

Influence of scar on left ventricular performance at the onset of myocardial ischemia: shock versus heart failure

Regan¹,

Passannante²,

Khan³

et al. 1971

J. Clin. Invest.

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A B S T R A C T Obstruction of a major branch of the left coronary artery in a previously normal ventricle is not usually associated with shock, experimentally or clinically. To examine the early hemodynamic alterations which may determine the course of ischemia when myocardial scar exists from previous infarction, 16 animals were successfully studied 9 wk after obstruction of the left circumflex artery. Acute ischemia during thrombus formation in the anterior descending artery of intact anesthetized dogs with scar was compared with animals undergoing the same procedure in the absence of scar (group 1). In the chronic animals, two types of hemodynamic responses were observed. Group 2 was characterized by heart failure usually persisting through 3 hr, and group 3 by a different ventricular volume response and rapidly developing shock. The weight of ischemic and scar areas were comparable and coronary blood flow ('Kr method) to the ischemic site was reduced to a similar extent. Animals in groups 1 and 2 remained normotensive and had similar elevations of left ventricular end. diastolic volume (indicator dilution method) during the initial 60 min of ischemia. Group 2 had a significantly larger rise of end-diastolic pressure, presumably related to altered elastic properties associated with scar of subendocardial distribution.Group 3 had a stroke volume decline that was not significantly greater than group 2 and both groups had an initial rise of peripheral vascular resistance. Despite a nearly fourfold increase of left ventricular end-diastolic pressure, there was a significant decline of left ventricular end-diastolic volume in group 3. This preceded the onset of hypotension in group 3, with arterial pressure

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The thermodilution technique in on‐line computation of the left ventricular volumes on anaesthetized dogs

Kettunen

1985

Cathet. Cardiovasc. Diagn.

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The thermal dilution technique and its suitability for automatic computation of left ventricular volumes were evaluated on 28 anaesthetized dogs. The end-diastolic volume (EDV) was computed from ventricular washout curves in two ways, first utilizing the ratio between the indicator amount and its peak concentration (first ejection method); and secondly the ratio between stroke volume and ejection fraction with the latter obtained by subtracting the residual fraction from 1.0. The residual fraction was determined as the mean of ratios between successive steps of four ventricular ejections on the downslope of the curve (downslope method). The linear correlation coefficient between the EDV determinations (n = 366) was 0.926, and slope y = 1.14 X + 0.5 ml with 4.6 ml as standard error of estimate. The first ejection method gave on average 15% higher EDV values than the downslope method. When heart rate was increased by pacing from 88 to 240/min, both methods showed a reduction of the EDV, but the downslope method to a greater degree. When afterload was increased but heart rate decreased by phenylephrine, the first ejection method but not the downslope method indicated an increase in EDV. Otherwise, when pronounced tachy- or bradycardia were avoided, ventricular volumes yielded by the two methods were comparable. Indicator injection did not substantially affect ventricular pressure dynamics. The first ejection method seems to be a simple means for repeated measurements of EDV even in the case of diseased hearts.

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Overestimation of Left Ventricular Volume by the Indicator Dilution Technique

Cited by 25 publications

References 17 publications

Mixing in the right ventricle and pulmonary artery in man: evaluation of ventricular volume measurements from indicator washout curves

Mixing in the right ventricle and pulmonary artery in man: evaluation of ventricular volume measurements from indicator washout curves

Influence of scar on left ventricular performance at the onset of myocardial ischemia: shock versus heart failure

The thermodilution technique in on‐line computation of the left ventricular volumes on anaesthetized dogs

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