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Seemann F, Bruce CG, Khan JM, Ramasawmy R, Potersnak AG, Herzka DA, Kakareka JW, Jaimes AE, Schenke WH, O'Brien KJ, Lederman RJ, Campbell-Washburn AE. Dynamic pressure-volume loop analysis by simultaneous real-time cardiovascular magnetic resonance and left heart catheterization. J Cardiovasc Magn Reson 2023; 25:1. [PMID: 36642713 PMCID: PMC9841727 DOI: 10.1186/s12968-023-00913-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Left ventricular (LV) contractility and compliance are derived from pressure-volume (PV) loops during dynamic preload reduction, but reliable simultaneous measurements of pressure and volume are challenging with current technologies. We have developed a method to quantify contractility and compliance from PV loops during a dynamic preload reduction using simultaneous measurements of volume from real-time cardiovascular magnetic resonance (CMR) and invasive LV pressures with CMR-specific signal conditioning. METHODS Dynamic PV loops were derived in 16 swine (n = 7 naïve, n = 6 with aortic banding to increase afterload, n = 3 with ischemic cardiomyopathy) while occluding the inferior vena cava (IVC). Occlusion was performed simultaneously with the acquisition of dynamic LV volume from long-axis real-time CMR at 0.55 T, and recordings of invasive LV and aortic pressures, electrocardiogram, and CMR gradient waveforms. PV loops were derived by synchronizing pressure and volume measurements. Linear regression of end-systolic- and end-diastolic- pressure-volume relationships enabled calculation of contractility. PV loops measurements in the CMR environment were compared to conductance PV loop catheter measurements in 5 animals. Long-axis 2D LV volumes were validated with short-axis-stack images. RESULTS Simultaneous PV acquisition during IVC-occlusion was feasible. The cardiomyopathy model measured lower contractility (0.2 ± 0.1 mmHg/ml vs 0.6 ± 0.2 mmHg/ml) and increased compliance (12.0 ± 2.1 ml/mmHg vs 4.9 ± 1.1 ml/mmHg) compared to naïve animals. The pressure gradient across the aortic band was not clinically significant (10 ± 6 mmHg). Correspondingly, no differences were found between the naïve and banded pigs. Long-axis and short-axis LV volumes agreed well (difference 8.2 ± 14.5 ml at end-diastole, -2.8 ± 6.5 ml at end-systole). Agreement in contractility and compliance derived from conductance PV loop catheters and in the CMR environment was modest (intraclass correlation coefficient 0.56 and 0.44, respectively). CONCLUSIONS Dynamic PV loops during a real-time CMR-guided preload reduction can be used to derive quantitative metrics of contractility and compliance, and provided more reliable volumetric measurements than conductance PV loop catheters.
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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 B1D47, Bethesda, MD, 20892, USA.
| | - 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 B1D47, 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 B1D47, 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 B1D47, Bethesda, MD, 20892, USA
| | - Amanda G Potersnak
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - John W Kakareka
- Instrumentation Development and Engineering Application Solutions, Division of Intramural Research, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andrea E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - William H Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - Kendall J O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood, Institute, National Institutes of Health, 10 Center Drive, Building 10 Rm B1D47, Bethesda, MD, 20892, USA
| | - 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 B1D47, 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 B1D47, Bethesda, MD, 20892, USA
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Giao DM, Wang Y, Rojas R, Takaba K, Badathala A, Spaulding KA, Soon G, Zhang Y, Wang VY, Haraldsson H, Liu J, Saloner D, Guccione JM, Ge L, Wallace AW, Ratcliffe MB. Left ventricular geometry during unloading and the end-systolic pressure volume relationship: Measurement with a modified real-time MRI-based method in normal sheep. PLoS One 2020; 15:e0234896. [PMID: 32569290 PMCID: PMC7307770 DOI: 10.1371/journal.pone.0234896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 06/04/2020] [Indexed: 01/08/2023] Open
Abstract
The left ventricular (LV) end-systolic (ES) pressure volume relationship (ESPVR) is the cornerstone of systolic LV function analysis. We describe a 2D real-time (RT) MRI-based method (RTPVR) with separate software tools for 1) semi-automatic level set-based shape prior method (LSSPM) of the LV, 2) generation of synchronized pressure area loops and 3) calculation of the ESPVR. We used the RTPVR method to measure ventricular geometry, ES pressure area relationship (ESPAR) and ESPVR during vena cava occlusion (VCO) in normal sheep. 14 adult sheep were anesthetized and underwent measurement of LV systolic function. Ten of the 14 sheep underwent RTMRI and eight of the 14 underwent measurement with conductance catheter; 4 had both RTMRI and conductance measurements. 2D cross sectional RTMRI were performed at apex, mid-ventricle and base levels during separate VCOs. The Dice similarity coefficient was used to compare LSSPM and manual image segmentation and thus determine LSSPM accuracy. LV cross-sectional area, major and minor axis length, axis ratio, major axis orientation angle and ESPAR were measured at each LV level. ESPVR was calculated with a trapezoidal rule. The Dice similarity coefficient between LSSPM and manual segmentation by two readers was 87.31±2.51% and 88.13±3.43%. All cross sections became more elliptical during VCO. The major axis orientation shifted during VCO but remained in the septo-lateral direction. LV chamber obliteration at the apical level occurred during VCO in 7 of 10 sheep that underwent RTMRI. ESPAR was non-linear at all levels. Finally, ESPVR was non-linear because of apical collapse. ESPVR measured by conductance catheter (EES,Index = 2.23±0.66 mmHg/ml/m2) and RT (EES,Index = 2.31±0.31 mmHg/ml/m2) was not significantly different. LSSPM segmentation of 2D RT MRI images is accurate and allows calculation of LV geometry, ESPAR and ESPVR during VCO. In the future, RTPVR will facilitate determination of regional systolic material parameters underlying ESPVR.
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Affiliation(s)
- Duc M. Giao
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yan Wang
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Renan Rojas
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kiyoaki Takaba
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Anusha Badathala
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Kimberly A. Spaulding
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Gilbert Soon
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Vicky Y. Wang
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Henrik Haraldsson
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Jing Liu
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - David Saloner
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Radiology, University of California, San Francisco, CA, United States of America
| | - Julius M. Guccione
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Liang Ge
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
| | - Arthur W. Wallace
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Anesthesia, University of California, San Francisco, CA, United States of America
| | - Mark B. Ratcliffe
- Veterans Affairs Medical Center, San Francisco, California, United States of America
- Department of Bioengineering, University of California, San Francisco, CA, United States of America
- Department of Surgery, University of California, San Francisco, CA, United States of America
- * E-mail:
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