Pressure-Volume Loops in Clinical Research

Burkhoff, Daniel

doi:10.1016/j.jacc.2013.05.049

Cited by 46 publications

(32 citation statements)

References 19 publications

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“…This result is also in accordance with our previous study in which dP/dt min and tau were lengthened when metoprolol was given to anesthetized guinea pigs [17]. The end-diastolic pressure-volume relationship (EDPVR) has been used as an index of lusitrope, since it measures the relationship between pressure and volume at the end-diastole [5]. Similar to the results of tau and dP/dt min , EDPVR was elevated at an escalating dose of 2.5 mg/kg compared to baseline, suggesting diastolic dysfunction due to acute effect of β-blockade.…”

Section: Discussionsupporting

confidence: 90%

Acute effects of intravenous dronedarone on electrocardiograms, hemodynamics and cardiac functions in anesthetized dogs

Saengklub

Limprasutr

Sawangkoon

et al. 2016

The Journal of Veterinary Medical Science

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ABSTRACT. Dronedarone is a class III antiarrhythmic that has been used for management of atrial fibrillation in humans, but limited information was found in dogs. The objective of this study was to determine the acute effects of escalating concentrations of dronedarone on electrocardiograms (ECG), hemodynamics and cardiac mechanics in healthy dogs. A total of 7 beagle dogs were anesthetized with isoflurane and instrumented to obtain lead II ECG, pressures at ascending aorta, right atrium, pulmonary artery and left ventricle, and left ventricular pressure-volume relationship. Five dogs were given vehicle and followed by escalating doses of dronedarone (0.5, 1.0 and 2.5 mg/kg, 15 min for each dose), and two dogs were used as a vehicle-treated control. All parameters were measured at 15 min after the end of each dose. The results showed that all parameters in vehicle-treated dogs were unaltered. Dronedarone at 2.5 mg/kg significantly lengthened PQ interval (P<0.01), reduced cardiac output (P<0.01) and increased systemic vascular resistance (P<0.01). Dronedarone produced negative inotropy assessed by significantly lowered end-systolic pressure-volume relationship, preload recruitable stroke work, contractility index and dP/dt max . It also impaired diastolic function by significantly increased end-diastolic pressure-volume relationship, tau and dP/dt min . These results suggested that acute effects of dronedarone produced negative dromotropy, inotropy and lusitropy in anesthetized dogs. Care should be taken when given dronedarone to dogs, especially when the patients have impaired cardiac function.

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Section: Discussionsupporting

confidence: 90%

Acute effects of intravenous dronedarone on electrocardiograms, hemodynamics and cardiac functions in anesthetized dogs

Saengklub

Limprasutr

Sawangkoon

et al. 2016

The Journal of Veterinary Medical Science

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“…Our long-axis shortening of approximately 7.0mm agrees nicely with previous simulations of a bi-ventricular human heart model, which predicted a shortening of 7.6mm [48] and with clinical observations [39]. Our pressure-volume loop with left ventricular volumes between 83mL and 103mL and pressures between 5mmHg and 118mmHg lies nicely within the clinically expected range [4, 8]. Our current run time for the electro-mechanical simulation of an entire cardiac cycle is 94 minutes on a standard 16 CPU machine.…”

Section: Discussionsupporting

confidence: 89%

The Living Heart Project: A robust and integrative simulator for human heart function

Baillargeon

Rebelo

Fox

et al. 2014

European Journal of Mechanics - A/Solids

303

266

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The heart is not only our most vital, but also our most complex organ: Precisely controlled by the interplay of electrical and mechanical fields, it consists of four chambers and four valves, which act in concert to regulate its filling, ejection, and overall pump function. While numerous computational models exist to study either the electrical or the mechanical response of its individual chambers, the integrative electro-mechanical response of the whole heart remains poorly understood. Here we present a proof-of-concept simulator for a four-chamber human heart model created from computer topography and magnetic resonance images. We illustrate the governing equations of excitation-contraction coupling and discretize them using a single, unified finite element environment. To illustrate the basic features of our model, we visualize the electrical potential and the mechanical deformation across the human heart throughout its cardiac cycle. To compare our simulation against common metrics of cardiac function, we extract the pressure-volume relationship and show that it agrees well with clinical observations. Our prototype model allows us to explore and understand the key features, physics, and technologies to create an integrative, predictive model of the living human heart. Ultimately, our simulator will open opportunities to probe landscapes of clinical parameters, and guide device design and treatment planning in cardiac diseases such as stenosis, regurgitation, or prolapse of the aortic, pulmonary, tricuspid, or mitral valve.

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“…According to the univariate results (accepted level p < 0.1) of the Cox regression analysis ΔE/DT ( p = 0.013), taken as a cumulative descriptor of ventricular filling, ΔEDV 20 ( p = 0.021), expression of the amount of CRT-induced ventricular reverse remodeling [19], and changes in end-systolic volume (ΔESV, p = 0.002), used as an index of ventricular performance, were included, as continuous covariates expressed as a percent change, in the multivariate analysis. Gender and etiology of ventricular dysfunction (ischemic/nonischemic) were also included as categorical covariates together with age and duration of QRS, gender acting as a stratum [20].…”

Section: Resultsmentioning

confidence: 99%

Systolic heart failure and cardiac resynchronization therapy: a focus on diastole

Facchini

Varalda

Sartori

et al. 2014

Int J Cardiovasc Imaging

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Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aim of the study was to assess if and how CRT affects DF in systolic heart failure patients. We also investigated potential relations between CRT-induced left ventricular changes and the composite clinical endpoint of progressive heart failure and cardiac death over 3 years follow-up. 119 CRT patients underwent clinical evaluation and echocardiography before CRT and 4 months later. DF was quantified by transmitral velocities [E/A waves, deceleration time (DT), E/DT], early diastolic mitral annulus velocity (E′), E/E′ ratio and 2-D speckle tracking strain rate during isovolumetric relaxation (IVR, SRivr). End-diastolic pressure–volume relationship (EDPVR) was also assessed noninvasively using a single-beat method. Overall stiffness was quantified by ventricular stiffness (Klv) normalized to end-diastolic volume (EDV). New York Heart Association class improved at 4 months (from 2.7 ± 0.7 to 1.9 ± 0.6, p < 0.001) as did ventricular filling (E/DT from 0.48 ± 0.29 to 0.39 ± 0.31 cm/s2, p = 0.01). In contrast, relaxation (E′, SRivr) and filling pressures (E/E′, E/SRivr) did not change. Slope of EDPVR did not change with CRT. Such finding, together with an unmodified Klv/EDV and a 7 ± 18 % reduction in EDV (p = 0.001), suggested reverse remodelling towards a smaller equilibrium volume. Finally, end-systolic LV volume decreased from 147 ± 59 to 125 ± 52 ml and ejection fraction increased from 0.26 ± 0.07 to 0.32 ± 0.09 (both p < 0.001). Using a Cox regression model we found that only changes (Δ) in diastolic, but not systolic indexes, correlated with the composite clinical endpoint, with increments in ΔEDV20 and ΔE/DT, single or combined, greatly increasing risk of heart failure and/or cardiac death (p = 0.003). Ventricular reverse remodelling, together with improvement in ventricular filling, rather than improvements of systolic function, predict clinical prognosis long-term post-CRT.

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Pressure-Volume Loops in Clinical Research

Cited by 46 publications

References 19 publications

Acute effects of intravenous dronedarone on electrocardiograms, hemodynamics and cardiac functions in anesthetized dogs

Acute effects of intravenous dronedarone on electrocardiograms, hemodynamics and cardiac functions in anesthetized dogs

The Living Heart Project: A robust and integrative simulator for human heart function

Systolic heart failure and cardiac resynchronization therapy: a focus on diastole

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