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CLINICAL STUDY: NEW METHODS

Noninvasive single-beat determination of left ventricular end-systolic elastance in humans

^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 (E_es) 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 E_es.

METHODS: Left ventricular end-systolic elastance was calculated by a modified single-beat method employing systolic (P_s) and diastolic (P_d) arm-cuff pressures, echo-Doppler stroke volume (SV), echo-derived ejection fraction (EF) and an estimated normalized ventricular elastance at arterial end-diastole (E_Nd): E_es(sb) = [P_d – (E_Nd(est) x P_s x 0.9)[/(E_Nd(est) x SV). The E_Nd was estimated from a group-averaged value adjusted for individual contractile/loading effects; E_es(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 E_es ranged 0.4 to 8.4 mm Hg/ml and was well predicted by E_es(sb) over the full range: (r = 0.91, SEE = 0.64, p < 0.00001, n = 72). Absolute change in E_es(sb) before and after dobutamine also correlated well with invasive measures: (r = 0.88, p < 0.00001). Repeated measures of E_es(sb) over two months in a separate group of patients (n = 7) yielded a coefficient of variation of 20.3 ± 6%.

CONCLUSIONS: The E_es 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.

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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