Abstract 17816: Accuracy of Noninvasive Indices of Left Ventricular Systolic Chamber Function. A Human Simultaneous Pressure-Volume and Echocardiographic Study.
Background: Indices derived from the pressure-volume relationship are the reference methods to evaluate LV global systolic chamber function. Noninvasive approximations of these indices are used in population-based studies, but a specific validation study in humans is lacking.
Methods: Nineteen patients (3 chest pain, 7 dilated cardiomyopathy, and 9 evaluation for liver-transplantation) underwent simultaneous LV catheterization and Doppler-echocardiography. A high-fidelity LV pressure-conductance catheter was calibrated using the hypertonic technique. Pressure-volume loops were obtained during transient caval occlusion. Reference indices, maximal elastance (Emax), and preload-recruitable stroke-work (PRSW) were measured from the end-systolic pressure-volume and the stroke work-volume relationships, respectively. The following noninvasive surrogates were estimated: 1) single-beat end-systolic elastance (Ees), PRSW, and Emax; 2) global peak systolic circunferencial strain, and strain rate (speckle-tracking), 3) ejection fraction, and 4) peak ejection intraventricular pressure difference (EIVPD, color-Doppler M-mode digital processing).
Results: No complications were observed during the invasive procedure, and pressure-volume curves were not suitable for measurement in two patients. A wide range of LV volume (127±50 ml), ejection fraction (EF: 0.51±0.20) and systemic vascular resistance (1261±645 dynes·s/cm5) was observed. Agreement between noninvasive indices and reference methods is shown in the Table.
Conclusions: Noninvasive approximations are limited to characterize global LV systolic chamber function in patients. The Doppler-derived peak EIVDP best correlates with reference indices, and should be preferred for assessing the state of global LV systolic chamber function.
- © 2010 by American Heart Association, Inc.