Manuel J Richter1, Athiththan Yogeswaran1, Faeq Husain-Syed1, István Vadász1, Zvonimir Rako1, Emad Mohajerani1, Hossein A Ghofrani1,2,3, Robert Naeije4, Werner Seeger1,5, Ulrike Herberg6, Andreas Rieth7, Ryan J Tedford8, Friedrich Grimminger5,9, Henning Gall1, Khodr Tello1. 1. Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Klinikstrasse 32, Giessen 35392, Germany. 2. Department of Pneumology, Kerckhoff Heart, Rheuma and Thoracic Center, Benekestr. 2-8, Bad Nauheim 61231, Germany. 3. Department of Medicine, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London SW7 2AZ, UK. 4. Erasme University Hospital, Route de Lennik 808, Brussels 1070, Belgium. 5. Department of Internal Medicine, German Center for Lung Research (DZL), Cardio-Pulmonary Institute (CPI), Justus-Liebig-University Giessen, Aulweg 130, Giessen 35392, Germany. 6. Department of Pediatric Cardiology, University of Bonn, Building 30, Venusberg-Campus 1, Bonn 53127, Germany. 7. Department of Thoracic Surgery, Kerckhoff Heart, Rheuma and Thoracic Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany. 8. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. 9. Institute for Lung Health (ILH), Justus-Liebig-University Giessen, Giessen, Germany.
Abstract
AIMS: We sought to assess the feasibility of constructing right ventricular (RV) pressure-volume (PV) loops solely by echocardiography. METHODS AND RESULTS: We performed RV conductance and pressure wire (PW) catheterization with simultaneous echocardiography in 35 patients with pulmonary hypertension. To generate echocardiographic PV loops, a reference RV pressure curve was constructed using pooled PW data from the first 20 patients (initial cohort). Individual pressure curves were then generated by adjusting the reference curve according to RV isovolumic and ejection phase duration and estimated RV systolic pressure. The pressure curves were synchronized with echocardiographic volume curves. We validated the reference curve in the remaining 15 patients (validation cohort). Methods were compared with correlation and Bland-Altman analysis. In the initial cohort, echocardiographic and conductance-derived PV loop parameters were significantly correlated {rho = 0.8053 [end-systolic elastance (Ees)], 0.8261 [Ees/arterial elastance (Ea)], and 0.697 (stroke work); all P < 0.001}, with low bias [-0.016 mmHg/mL (Ees), 0.1225 (Ees/Ea), and -39.0 mmHg mL (stroke work)] and acceptable limits of agreement. Echocardiographic and PW-derived Ees were also tightly correlated, with low bias (-0.009 mmHg/mL) and small limits of agreement. Echocardiographic and conductance-derived Ees, Ees/Ea, and stroke work were also tightly correlated in the validation cohort (rho = 0.9014, 0.9812, and 0.9491, respectively; all P < 0.001), with low bias (0.0173 mmHg/mL, 0.0153, and 255.1 mmHg mL, respectively) and acceptable limits. CONCLUSION: The novel echocardiographic method is an acceptable alternative to invasively measured PV loops to assess contractility, RV-arterial coupling, and RV myocardial work. Further validation is warranted. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We sought to assess the feasibility of constructing right ventricular (RV) pressure-volume (PV) loops solely by echocardiography. METHODS AND RESULTS: We performed RV conductance and pressure wire (PW) catheterization with simultaneous echocardiography in 35 patients with pulmonary hypertension. To generate echocardiographic PV loops, a reference RV pressure curve was constructed using pooled PW data from the first 20 patients (initial cohort). Individual pressure curves were then generated by adjusting the reference curve according to RV isovolumic and ejection phase duration and estimated RV systolic pressure. The pressure curves were synchronized with echocardiographic volume curves. We validated the reference curve in the remaining 15 patients (validation cohort). Methods were compared with correlation and Bland-Altman analysis. In the initial cohort, echocardiographic and conductance-derived PV loop parameters were significantly correlated {rho = 0.8053 [end-systolic elastance (Ees)], 0.8261 [Ees/arterial elastance (Ea)], and 0.697 (stroke work); all P < 0.001}, with low bias [-0.016 mmHg/mL (Ees), 0.1225 (Ees/Ea), and -39.0 mmHg mL (stroke work)] and acceptable limits of agreement. Echocardiographic and PW-derived Ees were also tightly correlated, with low bias (-0.009 mmHg/mL) and small limits of agreement. Echocardiographic and conductance-derived Ees, Ees/Ea, and stroke work were also tightly correlated in the validation cohort (rho = 0.9014, 0.9812, and 0.9491, respectively; all P < 0.001), with low bias (0.0173 mmHg/mL, 0.0153, and 255.1 mmHg mL, respectively) and acceptable limits. CONCLUSION: The novel echocardiographic method is an acceptable alternative to invasively measured PV loops to assess contractility, RV-arterial coupling, and RV myocardial work. Further validation is warranted. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Michael I Brener; Amirali Masoumi; Vivian G Ng; Khodr Tello; Marcelo B Bastos; William K Cornwell; Steven Hsu; Ryan J Tedford; Philipp Lurz; Karl-Philipp Rommel; Karl-Patrik Kresoja; Sherif F Nagueh; Manreet K Kanwar; Navin K Kapur; Gurumurthy Hiremath; Mohammad Sarraf; Antoon J M Van Den Enden; Nicolas M Van Mieghem; Paul M Heerdt; Rebecca T Hahn; Susheel K Kodali; Gabriel T Sayer; Nir Uriel; Daniel Burkhoff Journal: Circ Heart Fail Date: 2021-12-29 Impact factor: 8.790