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Noninvasive Quantification of Pressure-Volume Loops From Brachial Pressure and Cardiovascular Magnetic Resonance

Seemann, Felicia LU ; Arvidsson, Per LU ; Nordlund, David LU ; Kopic, Sascha LU ; Carlsson, Marcus LU ; Arheden, Håkan LU and Heiberg, Einar LU (2019) In Circulation. Cardiovascular imaging 12(1). p.008493-008493
Abstract

BACKGROUND: Pressure-volume (PV) loops provide a wealth of information on cardiac function but are not readily available in clinical routine or in clinical trials. This study aimed to develop and validate a noninvasive method to compute individualized left ventricular PV loops. METHODS: The proposed method is based on time-varying elastance, with experimentally optimized model parameters from a training set (n=5 pigs), yielding individualized PV loops. Model inputs are left ventricular volume curves from cardiovascular magnetic resonance imaging and brachial pressure. The method was experimentally validated in a separate set (n=9 pig experiments) using invasive pressure measurements and cardiovascular magnetic resonance images and... (More)

BACKGROUND: Pressure-volume (PV) loops provide a wealth of information on cardiac function but are not readily available in clinical routine or in clinical trials. This study aimed to develop and validate a noninvasive method to compute individualized left ventricular PV loops. METHODS: The proposed method is based on time-varying elastance, with experimentally optimized model parameters from a training set (n=5 pigs), yielding individualized PV loops. Model inputs are left ventricular volume curves from cardiovascular magnetic resonance imaging and brachial pressure. The method was experimentally validated in a separate set (n=9 pig experiments) using invasive pressure measurements and cardiovascular magnetic resonance images and subsequently applied to human healthy controls (n=13) and patients with heart failure (n=28). RESULTS: There was a moderate-to-excellent agreement between in vivo-measured and model-calculated stroke work (intraclass correlation coefficient, 0.93; bias, -0.02±0.03 J), mechanical potential energy (intraclass correlation coefficient, 0.57; bias, -0.04±0.03 J), and ventricular efficiency (intraclass correlation coefficient, 0.84; bias, 3.5±2.1%). The model yielded lower ventricular efficiency ( P<0.0001) and contractility ( P<0.0001) in patients with heart failure compared with controls, as well as a higher potential energy ( P<0.0001) and energy per ejected volume ( P<0.0001). Furthermore, the model produced realistic values of stroke work and physiologically representative PV loops. CONCLUSIONS: We have developed the first experimentally validated, noninvasive method to compute left ventricular PV loops and associated quantitative measures. The proposed method shows significant agreement with in vivo-derived measurements and could support clinical decision-making and provide surrogate end points in clinical heart failure trials.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
bias, biomarkers, heart failure, humans, magnetic resonance imaging
in
Circulation. Cardiovascular imaging
volume
12
issue
1
pages
008493 - 008493
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85059828658
ISSN
1942-0080
DOI
10.1161/CIRCIMAGING.118.008493
language
English
LU publication?
yes
id
1d1c203d-7967-408d-aa6a-e98b561aa9df
date added to LUP
2019-01-23 08:15:30
date last changed
2019-02-20 11:43:58
@article{1d1c203d-7967-408d-aa6a-e98b561aa9df,
  abstract     = {<p>BACKGROUND: Pressure-volume (PV) loops provide a wealth of information on cardiac function but are not readily available in clinical routine or in clinical trials. This study aimed to develop and validate a noninvasive method to compute individualized left ventricular PV loops. METHODS: The proposed method is based on time-varying elastance, with experimentally optimized model parameters from a training set (n=5 pigs), yielding individualized PV loops. Model inputs are left ventricular volume curves from cardiovascular magnetic resonance imaging and brachial pressure. The method was experimentally validated in a separate set (n=9 pig experiments) using invasive pressure measurements and cardiovascular magnetic resonance images and subsequently applied to human healthy controls (n=13) and patients with heart failure (n=28). RESULTS: There was a moderate-to-excellent agreement between in vivo-measured and model-calculated stroke work (intraclass correlation coefficient, 0.93; bias, -0.02±0.03 J), mechanical potential energy (intraclass correlation coefficient, 0.57; bias, -0.04±0.03 J), and ventricular efficiency (intraclass correlation coefficient, 0.84; bias, 3.5±2.1%). The model yielded lower ventricular efficiency ( P&lt;0.0001) and contractility ( P&lt;0.0001) in patients with heart failure compared with controls, as well as a higher potential energy ( P&lt;0.0001) and energy per ejected volume ( P&lt;0.0001). Furthermore, the model produced realistic values of stroke work and physiologically representative PV loops. CONCLUSIONS: We have developed the first experimentally validated, noninvasive method to compute left ventricular PV loops and associated quantitative measures. The proposed method shows significant agreement with in vivo-derived measurements and could support clinical decision-making and provide surrogate end points in clinical heart failure trials.</p>},
  author       = {Seemann, Felicia and Arvidsson, Per and Nordlund, David and Kopic, Sascha and Carlsson, Marcus and Arheden, Håkan and Heiberg, Einar},
  issn         = {1942-0080},
  keyword      = {bias,biomarkers,heart failure,humans,magnetic resonance imaging},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {008493--008493},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Circulation. Cardiovascular imaging},
  title        = {Noninvasive Quantification of Pressure-Volume Loops From Brachial Pressure and Cardiovascular Magnetic Resonance},
  url          = {http://dx.doi.org/10.1161/CIRCIMAGING.118.008493},
  volume       = {12},
  year         = {2019},
}