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Related Experiment Videos

Estimating left ventricular contractility using inspiratory-hold maneuvers.

Hyung Kook Kim1, Mohammed T Alhammouri, Yasser M Mokhtar

  • 1Cardiopulmonary Research Laboratory, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA.

Intensive Care Medicine
|November 15, 2006
PubMed
Summary
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Estimating left ventricular (LV) end-systolic elastance using 5 mmHg continuous positive airway pressure (CPAP) is comparable to inferior vena cava (IVC) occlusion. Higher CPAP levels yield different, though related, contractility estimates.

Area of Science:

  • Cardiovascular Physiology
  • Hemodynamic Monitoring
  • Animal Research

Background:

  • Accurate assessment of left ventricular (LV) contractility is crucial for managing cardiovascular diseases.
  • Inferior vena cava (IVC) occlusion and continuous positive airway pressure (CPAP) are methods used to reduce preload for contractility assessment.
  • Comparing these methods is essential to validate their clinical applicability.

Purpose of the Study:

  • To compare the accuracy of LV end-systolic elastance estimations derived from IVC occlusion versus apneic CPAP.
  • To evaluate the impact of varying CPAP levels (5, 10, 15 mmHg) on contractility measurements.
  • To assess contractility under pharmacologic interventions (esmolol, dobutamine) using both methods.

Main Methods:

  • A prospective interventional study was conducted in 16 anesthetized mongrel dogs.

Related Experiment Videos

  • LV pressure-volume catheters were used to measure hemodynamics.
  • IVC occlusion and sequential CPAP levels (5, 10, 15 mmHg) were applied during apnea.
  • Measurements were repeated during esmolol and dobutamine infusions.

    • Main Results:

    • LV end-systolic elastance estimates were similar between 5 mmHg CPAP and IVC occlusion.
    • Higher CPAP levels (10, 15 mmHg) produced different, yet covarying, elastance values compared to IVC occlusion.
    • Pharmacologic interventions demonstrated expected changes in contractility, consistent across maneuvers.
    • Increasing CPAP shifted LV filling and elastance, suggesting an influence of intrathoracic pressure.

    Conclusions:

    • 5 mmHg CPAP effectively estimates LV end-systolic elastance and preload-recruitable stroke work in intact dogs.
    • CPAP levels exceeding 10 mmHg provide contractility estimates that differ from IVC occlusion but show a consistent relationship.
    • These findings support the use of controlled preload reduction techniques for assessing LV contractility.