CLINICAL STUDY: NEW METHODS
Noninvasive single-beat determination of left ventricular end-systolic elastance in humans
Chen-Huan Chen, MDa,b,
Barry Fetics, BEc,
Erez Nevo, MD, DScc,
Carlos E. Rochitte, MDc,
Kuan-Rau Chiou, MDa,b,
PhillipYu-An Ding, MD, PhDa,b,
Miho Kawaguchi, MDc and
David A. Kass, MDc,*
a Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. Taiwan
b National Yang-Ming University, Taipei, Taiwan, R.O.C. Taiwan
c Division of Cardiology, Department of Internal Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Manuscript received March 9, 2001;
revised manuscript received July 25, 2001,
accepted August 20, 2001.
* Reprint requests and correspondence: Dr. David A. Kass, Halsted 500, Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287 USA. dkass{at}bme.jhu.edu
OBJECTIVES: The goal of this study was to develop and validate a method to estimate left ventricular end-systolic elastance (Ees) in humans from noninvasive single-beat parameters.
BACKGROUND: Left ventricular end-systolic elastance is a major determinant of cardiac systolic function and ventricular-arterial interaction. However, its use in heart failure assessment and management is limited by lack of a simple means to measure it noninvasively. This study presents a new noninvasive method and validates it against invasively measured Ees.
METHODS: Left ventricular end-systolic elastance was calculated by a modified single-beat method employing systolic (Ps) and diastolic (Pd) arm-cuff pressures, echo-Doppler stroke volume (SV), echo-derived ejection fraction (EF) and an estimated normalized ventricular elastance at arterial end-diastole (ENd): Ees(sb) = [Pd (ENd(est) x Ps x 0.9)[/(ENd(est) x SV). The ENd was estimated from a group-averaged value adjusted for individual contractile/loading effects; Ees(sb) estimates were compared with invasively measured values in 43 patients with varying cardiovascular disorders, with additional data recorded after inotropic stimulation (n = 18, dobutamine 5 to 10 µg/kg per min). Investigators performing noninvasive analysis were blinded to the invasive results.
RESULTS: Combined baseline and dobutamine-stimulated Ees ranged 0.4 to 8.4 mm Hg/ml and was well predicted by Ees(sb) over the full range: (r = 0.91, SEE = 0.64, p < 0.00001, n = 72). Absolute change in Ees(sb) before and after dobutamine also correlated well with invasive measures: (r = 0.88, p < 0.00001). Repeated measures of Ees(sb) over two months in a separate group of patients (n = 7) yielded a coefficient of variation of 20.3 ± 6%.
CONCLUSIONS: The Ees can be reliably estimated from simple noninvasive measurements. This approach should broaden the clinical applicability of this useful parameter for assessing systolic function, therapeutic response and ventricular-arterial interaction.
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Abbreviations and Acronyms
| | Ed | | left ventricular end-diastolic elastance | | Ees | | left ventricular end-systolic elastance | | Ees(sb) | | left ventricular elastance at end-systole derived by single-beat technique | | EF | | ejection fraction | | ENd(avg) | | group-averaged normalized left ventricular elastance at the onset of ejection | | ENd(est) | | noninvasive estimated normalized left ventricular elastance at the onset of ejection | | ESPVR | | end-systolic pressure volume relation | | LV | | left ventricle or left ventricular | | Pd | | diastolic arterial pressure at the onset of ejection | | Pes | | left ventricular end-systolic pressure | | Ps | | systolic arterial pressure at the onset of ejection | | SV | | stroke volume | | Vd | | left ventricular volume at the onset of ejection | | Ved | | left ventricular end-diastolic volume | | Ves | | left ventricular end-systolic volume | | V0 | | volume axis intercept of the end-systolic pressure volume relation |
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