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For: Edlund J, Arvidsson PM, Nelsson A, Smith JG, Magnusson M, Heiberg E, Steding-Ehrenborg K, Arheden H. Noninvasive Assessment of Left Ventricular Pressure-Volume Relations: Inter- and Intraobserver Variability and Assessment Across Heart Failure Subtypes. Am J Cardiol 2022;184:48-55. [PMID: 36192197 DOI: 10.1016/j.amjcard.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/04/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]

For:	Edlund J, Arvidsson PM, Nelsson A, Smith JG, Magnusson M, Heiberg E, Steding-Ehrenborg K, Arheden H. Noninvasive Assessment of Left Ventricular Pressure-Volume Relations: Inter- and Intraobserver Variability and Assessment Across Heart Failure Subtypes. Am J Cardiol 2022;184:48-55. [PMID: 36192197 DOI: 10.1016/j.amjcard.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/04/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]

Number

Cited by Other Article(s)

Deshmukh T, Selvakumar D, Thavapalachandran S, Archer O, Figtree GA, Feneley M, Grieve SM, Thomas L, Pathan F, Chong JJH. Correlation of Noninvasive Cardiac MRI Measures of Left Ventricular Myocardial Function and Invasive Pressure-Volume Parameters in a Porcine Ischemia-Reperfusion Model. Radiol Cardiothorac Imaging 2024;6:e230252. [PMID: 38842454 DOI: 10.1148/ryct.230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]

Abstract

Purpose To assess the correlation between noninvasive cardiac MRI-derived parameters with pressure-volume (PV) loop data and evaluate changes in left ventricular function after myocardial infarction (MI). Materials and Methods Sixteen adult female swine were induced with MI, with six swine used as controls and 10 receiving platelet-derived growth factor-AB (PDGF-AB). Load-independent measures of cardiac function, including slopes of end-systolic pressure-volume relationship (ESPVR) and preload recruitable stroke work (PRSW), were obtained on day 28 after MI. Cardiac MRI was performed on day 2 and day 28 after infarct. Global longitudinal strain (GLS) and global circumferential strain (GCS) were measured. Ventriculo-arterial coupling (VAC) was derived from PV loop and cardiac MRI data. Pearson correlation analysis was performed. Results GCS (r = 0.60, P = .01), left ventricular ejection fraction (LVEF) (r = 0.60, P = .01), and cardiac MRI-derived VAC (r = 0.61, P = .01) had a significant linear relationship with ESPVR. GCS (r = 0.75, P < .001) had the strongest significant linear relationship with PRSW, followed by LVEF (r = 0.67, P = .005) and cardiac MRI-derived VAC (r = 0.60, P = .01). GLS was not significantly correlated with ESPVR or PRSW. There was a linear correlation (r = 0.82, P < .001) between VAC derived from cardiac MRI and from PV loop data. GCS (-3.5% ± 2.3 vs 0.5% ± 1.4, P = .007) and cardiac MRI-derived VAC (-0.6 ± 0.6 vs 0.3 ± 0.3, P = .001) significantly improved in the animals treated with PDGF-AB 28 days after MI compared with controls. Conclusion Cardiac MRI-derived parameters of MI correlated with invasive PV measures, with GCS showing the strongest correlation. Cardiac MRI-derived measures also demonstrated utility in assessing therapeutic benefit using PDGF-AB. Keywords: Cardiac MRI, Myocardial Infarction, Pressure Volume Loop, Strain Imaging, Ventriculo-arterial Coupling Supplemental material is available for this article. © RSNA, 2024.

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Affiliation(s)

Tejas Deshmukh From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Dinesh Selvakumar From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Sujitha Thavapalachandran From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Oliver Archer From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Gemma A Figtree From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Michael Feneley From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Stuart M Grieve From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Liza Thomas From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
Faraz Pathan From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)
James J H Chong From the Centre for Heart Research, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, Sydney, NSW 2145, Australia (T.D., D.S., S.T., J.J.H.C.); Department of Cardiology, Westmead Hospital, Westmead, Australia (T.D., D.S., S.T., O.A., L.T., J.J.H.C.); Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (T.D., D.S., S.T., L.T., J.J.H.C.); Cardiovascular Discovery Group, Kolling Institute, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia (G.A.F.); Department of Cardiology, St Vincent's Hospital, Darlinghurst, Australia (M.F.); Cardiac Mechanics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, Australia (M.F.); Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia (S.M.G.); Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (S.M.G.); Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Australia (F.P.); and Department of Cardiology, Nepean Hospital, Kingswood, Australia (F.P.)

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Nordlund D, Lav T, Jablonowski R, Khoshnood A, Ekelund U, Atar D, Erlinge D, Engblom H, Arheden H. Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clin Cardiol 2024;47:e24216. [PMID: 38269628 PMCID: PMC10790509 DOI: 10.1002/clc.24216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open

Abstract

BACKGROUND

Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI).

METHODS

A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency.

RESULTS

All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25).

CONCLUSIONS

Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.

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Seemann F, Heiberg E, Bruce CG, Khan JM, Potersnak A, Ramasawmy R, Carlsson M, Arheden H, Lederman RJ, Campbell-Washburn AE. Non-invasive pressure-volume loops using the elastance model and CMR: a porcine validation at transient pre-loads. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024;2:qyae016. [PMID: 38645798 PMCID: PMC11026081 DOI: 10.1093/ehjimp/qyae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 04/23/2024]

Abstract

Aims

Pressure-volume (PV) loops have utility in the evaluation of cardiac pathophysiology but require invasive measurements. Recently, a time-varying elastance model to derive PV loops non-invasively was proposed, using left ventricular (LV) volume by cardiovascular magnetic resonance (CMR) and brachial cuff pressure as inputs. Validation was performed using CMR and pressure measurements acquired on the same day, but not simultaneously, and without varying pre-loads. This study validates the non-invasive elastance model used to estimate PV loops at varying pre-loads, compared with simultaneous measurements of invasive pressure and volume from real-time CMR, acquired concurrent to an inferior vena cava (IVC) occlusion.

Methods and results

We performed dynamic PV loop experiments under CMR guidance in 15 pigs (n = 7 naïve, n = 8 with ischaemic cardiomyopathy). Pre-load was altered by IVC occlusion, while simultaneously acquiring invasive LV pressures and volumes from real-time CMR. Pairing pressure and volume signals yielded invasive PV loops, and model-based PV loops were derived using real-time LV volumes. Haemodynamic parameters derived from invasive and model-based PV loops were compared. Across 15 pigs, 297 PV loops were recorded. Intra-class correlation coefficient (ICC) agreement was excellent between model-based and invasive parameters: stroke work (bias = 0.007 ± 0.03 J, ICC = 0.98), potential energy (bias = 0.02 ± 0.03 J, ICC = 0.99), ventricular energy efficiency (bias = -0.7 ± 2.7%, ICC = 0.98), contractility (bias = 0.04 ± 0.1 mmHg/mL, ICC = 0.97), and ventriculoarterial coupling (bias = 0.07 ± 0.15, ICC = 0.99). All haemodynamic parameters differed between naïve and cardiomyopathy animals (P < 0.05). The invasive vs. model-based PV loop dice similarity coefficient was 0.88 ± 0.04.

Conclusion

An elastance model-based estimation of PV loops and associated haemodynamic parameters provided accurate measurements at transient loading conditions compared with invasive PV loops.

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Affiliation(s)

Felicia Seemann Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Einar Heiberg Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
Christopher G Bruce Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Jaffar M Khan Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Amanda Potersnak Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Rajiv Ramasawmy Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Marcus Carlsson Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Håkan Arheden Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Entrégatan 7, 221 85 Lund, Sweden
Robert J Lederman Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA
Adrienne E Campbell-Washburn Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D219, Bethesda, MD 20892, USA

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Arvidsson PM, Green PG, Watson WD, Shanmuganathan M, Heiberg E, De Maria GL, Arheden H, Herring N, Rider OJ. Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023;1:qyad035. [PMID: 37969333 PMCID: PMC10631830 DOI: 10.1093/ehjimp/qyad035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023]

Abstract

Aims

Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. A non-invasive method for the computation of PV loops from magnetic resonance imaging and brachial cuff blood pressure has recently been proposed. Here we evaluated the fidelity of the non-invasive PV algorithm against invasive LV pressures in humans.

Methods and results

Four heart failure patients with EF < 35% and LV dyssynchrony underwent cardiovascular magnetic resonance (CMR) imaging and subsequent LV catheterization with sequential administration of two different intravenous metabolic substrate infusions (insulin/dextrose and lipid emulsion), producing eight datasets at different haemodynamic states. Pressure-volume loops were computed from CMR volumes combined with (i) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, or (ii) invasive pressures averaged from 19 to 30 sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Non-invasively derived PV loop parameters demonstrated high correlation and low bias when compared to invasive data for stroke work (R2 = 0.96, P < 0.0001, bias 4.6%), potential energy (R2 = 0.83, P = 0.001, bias 1.5%), end-systolic pressure-volume relationship (R2 = 0.89, P = 0.0004, bias 5.8%), ventricular efficiency (R2 = 0.98, P < 0.0001, bias 0.8%), arterial elastance (R2 = 0.88, P = 0.0006, bias -8.0%), mean external power (R2 = 0.92, P = 0.0002, bias 4.4%), and energy per ejected volume (R2 = 0.89, P = 0.0001, bias 3.7%). Variations in estimated end-diastolic pressure did not significantly affect results (P > 0.05 for all). Intraobserver analysis after one year demonstrated 0.9-3.4% bias for LV volumetry and 0.2-5.4% for PV loop-derived parameters.

Conclusion

Pressure-volume loops can be precisely and accurately computed from CMR imaging and brachial cuff blood pressure in humans.

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