Document Detail


Noninvasive Quantification of Left Ventricular Elastance and Ventricular-Arterial Coupling using Three-Dimensional Echocardiography and Arterial Tonometry.
MedLine Citation:
PMID:  21908790     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Most techniques previously used to assess left ventricular (LV) elastance (E(es)) and ventricular-arterial coupling (C(LV-A)) relied on invasive measurements and data acquisition over a wide range of loading conditions. Our goals were to: (1) assess the feasibility of noninvasive assessment of E(es) and C(LV-A) using real-time three-dimensional echocardiography (RT3DE) and arterial tonometry, (2) test the ability of this approach to detect changes in LV contractility, and (3) study its reproducibility. We studied pharmacologically-induced changes in inotropic state (5 and 10 μg/kg/min dobutamine) in normal volunteers (N=8), and compared 10 normal volunteers with 10 patients with dilated cardiomyopathy (DCM; ejection fraction<35%). RT3DE LV images, calibrated carotid artery tonometry and Doppler tracings were obtained to noninvasively estimate E(es) and C(LV-A), using two alternative calculations. Dobutamine caused a significant step-wise increase in blood pressure, heart rate, ejection fraction and E(es) and a decreased C(LV-A). In patients with DCM, E(es) was significantly reduced and C(LV-A) elevated, compared to controls. Both inter- and intra-observer variability were good for all measured parameters, as reflected by intra-class correlation coefficients (ICC >0.8) and coefficients of variation (CV<20%). While both E(es) estimates showed significant differences between DCM patients and controls, one estimate resulted in no overlap and better reproducibility (inter-observer ICC 0.83 vs 0.47, CV 20% vs 29%). This is the first study to test the feasibility of using RT3DE-derived LV volumes in conjunction with arterial tonometry to noninvasively quantify LV elastance and LV-arterial coupling. This approach was found to be sensitive enough to detect expected differences in LV contractility and reproducible. Due to its noninvasive nature, this methodology may have clinical implications in various disease states.
Authors:
Etienne Gayat; Victor Mor-Avi; Lynn Weinert; Chattanong Yodwut; Roberto M Lang
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-9
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  -     ISSN:  1522-1539     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1University of Chicago.
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