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Updated: Feb 19, 2026
Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model
Published on: May 18, 2021
Damped and Ventricularized Coronary Pressure Waveforms
1Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657 USA. lloydklein@comcast.net.
Insights
Ventricularization and damping, commonly used terms in cardiac catheterization, indicate flow limitation. These distinct hemodynamic patterns arise from distorted wave conduction due to catheter- vessel interactions, not synonymous meanings.
Area of Science:
- Cardiovascular Physiology
- Interventional Cardiology
- Hemodynamics
Background:
- Ventricularization and damping are frequently observed in cardiac catheterization but their precise hemodynamic origins remain poorly understood.
- These phenomena are often incorrectly considered synonymous, despite distinct characteristics.
- Both patterns are attributed to the distortion of normal wave conduction harmonics.
Purpose of the Study:
- To elucidate the distinct hemodynamic mechanisms underlying ventricularization and damping.
- To differentiate the specific catheter-vessel interactions that precipitate each waveform pattern.
- To clarify the clinical significance of recognizing these distinct pressure waveform anomalies.
Main Methods:
- Analysis of pressure waveforms recorded during cardiac catheterization.
- Correlation of waveform characteristics with specific catheter positions and vessel anatomy.
- Distinguishing features of pressure damping (e.g., catheter diameter vs. ostial diameter, catheter against vessel wall) and ventricularization (e.g., catheter in ostial stenosis).
Main Results:
- Pressure damping is characterized by reduced mean coronary pressure, narrow pulse pressure, and delayed waveform upstroke/downstroke.
- Ventricularization presents with a diastolic pressure decline, wide pulse pressure, absent dicrotic notch, and presystolic deflection.
- Ventricularized waveforms exhibit characteristics intermediate between coronary arterial and coronary wedge pressures.
Conclusions:
- Ventricularization and damping represent distinct hemodynamic events with unique physiological origins.
- Accurate differentiation is crucial for interpreting potential flow limitations during cardiac catheterization.
- Understanding these patterns aids in optimizing catheter placement and procedure safety.
Abstract:
Although the terms ventricularization and damping are commonly used in the cath lab and are widely recognized as indicating possible flow limitation due to catheter position, their hemodynamic origins and mechanism have not been well studied. Often, they are thought to be synonymous terms. Both patterns are due to distortion of the normal harmonic frequencies of wave conduction. Pressure damping is seen when the outer diameter of the catheter is larger than the ostial diameter or when the tip of the catheter is pressed against the vessel wall. It is characterized by an abrupt decline of mean coronary pressure with narrow pulse pressure and delayed upstroke and downstroke. Conversely, ventricularization is seen when the catheter tip is advanced into an ostial stenosis, partially obstructing flow, and is characterized by a steep decline of pressure in diastole with large pulse pressure, absence of the dicrotic notch, and appearance of presystolic positive deflection. A ventricularized pressure waveform can be considered a hybrid between coronary arterial pressure and coronary wedge pressure.
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