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Published on: December 13, 2019
Single-beat estimation of the left ventricular end-diastolic pressure-volume relationship in patients with heart
Ellen A Ten Brinke1, Daniel Burkhoff, Robert J Klautz
1Department of Cardiology, Leiden University Medical Centre, PO Box 9600, 2300RC, Leiden, The Netherlands.
Insights
A novel single-beat method accurately predicts the end-diastolic pressure-volume relationship (EDPVR) in heart failure patients. This approach offers a less invasive way to estimate EDPVR, especially when combined with new non-invasive techniques.
Area of Science:
- Cardiovascular Physiology
- Medical Engineering
- Diagnostic Methods
Background:
- The end-diastolic pressure-volume relationship (EDPVR) is crucial for assessing left ventricular diastolic function.
- Accurate EDPVR measurement typically requires invasive procedures like pressure-conductance catheterization.
Purpose of the Study:
- To evaluate a novel single-beat method for predicting EDPVR in patients with heart failure.
- To assess the accuracy and reliability of this method across various cardiac conditions and surgical states.
Main Methods:
- Utilized pressure-conductance catheters in 21 heart failure patients (mitral annuloplasty or ventricular restoration) and 12 healthy controls undergoing coronary artery bypass grafting.
- Measured pressure-volume loops and directly determined EDPVRs via vena cava occlusion.
- Developed a single-beat prediction model using baseline end-diastolic pressure (P(m)) and volume (V(m)).
Main Results:
- The single-beat method demonstrated a low root-mean-squared error (RMSE) of 2.79+/-0.21 mm Hg compared to directly measured EDPVRs.
- High correlations (R(2)=0.69-0.97) were observed between measured and predicted end-diastolic volumes at various pressure levels.
- While systematic biases were noted at low (overestimation) and high (underestimation) pressures, the prediction accuracy was consistent across different patient groups and conditions.
Conclusions:
- The single-beat method provides an accurate prediction of EDPVR in diverse cardiac conditions, with low RMSE.
- This technique offers a less invasive alternative for EDPVR estimation, particularly valuable when integrated with emerging non-invasive pressure and volume measurement technologies.
Aims:
To test a method to predict the end-diastolic pressure-volume relationship (EDPVR) from a single beat in patients with heart failure.
Methods And Results:
Patients (New York Heart Association class III-IV) scheduled for mitral annuloplasty (n=9) or ventricular restoration (n=10) and patients with normal left ventricular function undergoing coronary artery bypass grafting (n=12) were instrumented with pressure-conductance catheters to measure pressure-volume loops before and after surgery. Data obtained during vena cava occlusion provided directly measured EDPVRs. Baseline end-diastolic pressure (P(m)) and volume (V(m)) were used for single-beat prediction of EDPVRs. Root-mean-squared error (RMSE) between measured and predicted EDPVRs, was 2.79+/-0.21 mm Hg. Measured versus predicted end-diastolic volumes at pressure levels 5, 10, 15 and 20 mm Hg showed tight correlations (R(2)=0.69-0.97). Bland-Altman analyses indicated overestimation at 5 mm Hg (bias: pre-surgery 44 ml (95% CI 29 to 58 ml); post-surgery 35 ml (23 to 47 ml)) and underestimation at 20 mm Hg (bias: pre-surgery -57 ml (-80 to -34 ml); post-surgery -13 ml (-20 to -7.0 ml)). End-diastolic volumes were significantly different between groups and between conditions, but these differences were not dependent on the method (ie, measured versus predicted). RMSEs were not different between groups or conditions, nor dependent on V(m) or P(m), indicating that EDPVR prediction was equally accurate over a wide volume range.
Conclusions:
Single-beat EDPVRs obtained from hearts spanning a wide range of sizes and conditions accurately predicted directly measured EDPVRs with low RMSE. Single-beat EDPVR indices correlated well with directly measured values, but systematic biases were present at low and high pressures. The single-beat method facilitates less invasive EDPVR estimation, particularly when coupled with emerging non-invasive techniques to measure pressures and volumes.
