CLINICAL STUDIES
Comparison of ventricular pressure relaxation assessments in human heart failure
Quantitative influence on load and drug sensitivity analysis
Hideaki Senzaki, MDa,
Barry Fetics, MAa,
Chen-Huan Chen, MDa and
David A. Kass, MDa
a Division of Cardiology, Department of Internal Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Manuscript received May 21, 1998;
revised manuscript received May 27, 1999,
accepted June 28, 1999.
Reprint requests and correspondence: Dr. David A. Kass, Halsted 500, Department of Cardiology, The Johns Hopkins Hopital, 600 North Wolfe Street, Baltimore, Maryland 21287
dkass{at}eureka.wbme.jhu.edu
OBJECTIVES
We contrasted various methods for assessing ventricular pressure decay time constants to test whether sensitivity to slight data instability or disparities between model-assumed and real decay are systematically altered by cardiac failure. We hypothesized that such discrepancies could result in apparent increased relaxation sensitivity to load and drug stimulation.
BACKGROUND
Deviation of relaxation behavior from model-assumed waveforms may be worsened by failure, enhancing instability and apparent load and drug sensitivity of commonly used indexes.
METHODS
Pressure-volume relations were measured in patients with normal (n = 14), hypertrophic (hypertrophic cardiomyopathy [HCM], n = 15) and dilated-myopathic (dilated cardiomyopathy [DCM], n = 37) hearts before and during preload reduction or inotropic stimulation. Relaxation parameters (monoexponential [ME] model assuming zero-Tln or non-zero-TD, TF asymptote:, hybrid logistic-TL, linear-TLR, and pressure halftime-T1/2) were contrasted regarding sensitivity to slight data range manipulation and loading or drug changes.
RESULTS
In DCM, TD and TF prolonged 15% to 25% (p < 0.0001) by deletion of only 1–2 data points, whereas this had minimal effect on controls or HCM. This stemmed from systematic deviation of relaxation from an ME decay in DCM. T1/2 and Tln were highly sensitive to pure pressure offsets, whereas TL was most stable to both manipulations in all hearts. As a result, TD and TF appeared to be much more sensitive to systolic load in DCM than T1/2 or TL and disproportionately sensitive to increased cyclic adenosine monophosphate (cAMP).
CONCLUSIONS
Relaxation consistently deviates from an ME decay in DCM resulting in instability and amplified relaxation systolic load or drug dependence of ME-based indexes in failing versus control (or HCM) hearts. The hybrid-logistic method improves quantitative analyses by providing more consistent data fits with all three heart types.
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Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | cAMP | = cyclic adenosine monophosphate | | DCM | = dilated cardiomyopathy | | EDP | = end-diastolic pressure | | Ees | = end-systolic elastance | | HCM | = hypertrophic cardiomyopathy | | HL | = hybrid-logistic | | LV | = left ventricle or ventricular | | ME | = monoexponential | | Pes | = end-systolic pressure |
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