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Noninvasive assessment of ejection intraventricular pressure gradients

Raquel Yotti, MD^*, Javier Bermejo, MD, PhD^*,*, J. Carlos Antoranz, PhD, José Luis Rojo-Álvarez, MEng, PhD, Carmen Allue, RDNS^*, Jacobo Silva, MD, M. Mar Desco, MD^||, Mar Moreno, MD^* and Miguel A. García-Fernández, MD^*

^* Department of Cardiology, Madrid, Spain
Department of Cardiovascular Surgery, Madrid, Spain
^|| Unit of Experimental Medicine and Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Spain

View larger version (63K): [in a new window]   Figure 1 Validation example from a swine experiment. (A) Greyscale M-mode recording. The electrocardiogram (bottom) and synchronicity (top) signals are shown. Micromanometer echoes are visualized in the mid-cavity and left ventricular outflow tract (LVOT), and were confirmed by two-dimensional sequences acquired simultaneously. (B) Raw color M-mode Doppler image. (C) Parametrical intraventricular pressure gradient (IVPG) (p/s) image overlay on the greyscale figure of A. The sign and magnitude of the gradient is given by the color bar, representing the ejection intraventricular pressure difference (P) between each pixel and another one located 1 cm closer to the transducer. The equivalent location of the three micromanometers in this IVPG field has been traced (dashed lines). (D, E, and F) The P curves between the sensor locations represented in C, obtained by micromanometers (thin lines) and by Doppler-echocardiography (thick lines). Ejection onset and end are shown (dashed lines in B and ticks in C to F). Curve parameters analyzed in the present study are displayed in D.

View larger version (22K): [in a new window]   Figure 2 Correlation (A) and Bland-Altman (B) plots of the agreement between noninvasive and micromanometer measurements of peak ejection intraventricular pressure difference. LVOT = left ventricular outflow tract.

View larger version (20K): [in a new window]   Figure 3 Predominant contribution of inertial over convective forces to total interventricular pressure gradient. P = ejection interventricular pressure difference.

View larger version (124K): [in a new window]   Figure 4 Effects of inotropic interventions on interventricular pressure gradients (IVPGs) in a healthy volunteer. Ejection IVPG images obtained at baseline (A), during dobutamine (B), esmolol (C), and atropine (D) infusion. White ticks represent ejection onset and end. In the color scale used for visualization, IVPGs above and below the scale limits (±4 mm Hg/cm) are displayed in white and green, respectively. A fixed color scale for all panels has been used to allow a visual comparison among phases as well as with images in Figure 5.

View larger version (71K): [in a new window]   Figure 5 Ejection interventricular pressure gradient (IVPG) in a patient with dilated cardiomyopathy. Images were obtained at baseline (A) and during dobutamine infusion (B). Notice the differences in magnitude, spatial, and temporal extent of ejection IVPGs as compared to Figure 4.