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Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data

Nordlund, David LU ; Lav, Theodor LU ; Jablonowski, Robert LU ; Khoshnood, Ardavan LU orcid ; Ekelund, Ulf LU orcid ; Atar, Dan ; Erlinge, David LU orcid ; Engblom, Henrik LU and Arheden, Håkan LU (2024) In Clinical Cardiology 47(1). p.1-9
Abstract
Background: Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods: A total of 100 patients with acute MI and 75 controls were included in the study. All patients... (More)
Background: Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods: A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2?6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax) reflecting contractility, Ea, ventriculoarterial coupling (Ea/Emax), SW, potential energy, external power, energy per ejected volume, and efficiency. Results: All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax: 1.34?±?0.48 versus 1.50?±?0.41?mmHg/mL, p?=?.024), ventriculoarterial coupling (Ea/Emax: 1.27?±?0.61 versus 0.73?±?0.17, p?<?.001) and SW (0.96?±?0.32 versus 1.38?±?0.32?J, p?<?.001). These variables correlated to both MaR and IS (Emax: r2?=?0.25 and r2?=?0.29; Ea/Emax: r2?=?0.36 and r2?=?0.41; SW: r2?=?0.21 and r2?=?0.25). Conclusions: Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
contractility, coupling, efficiency, elastance, myocardium at risk, stroke work
in
Clinical Cardiology
volume
47
issue
1
article number
e24216
pages
1 - 9
publisher
Wiley-Blackwell
external identifiers
  • scopus:85182462873
  • pmid:38269628
ISSN
0160-9289
DOI
10.1002/clc.24216
language
English
LU publication?
yes
id
dfc94b1d-cf45-48df-8e57-f20d6441c041
date added to LUP
2024-01-17 03:24:28
date last changed
2024-04-18 03:00:08
@article{dfc94b1d-cf45-48df-8e57-f20d6441c041,
  abstract     = {{Background: Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods: A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2?6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax) reflecting contractility, Ea, ventriculoarterial coupling (Ea/Emax), SW, potential energy, external power, energy per ejected volume, and efficiency. Results: All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax: 1.34?±?0.48 versus 1.50?±?0.41?mmHg/mL, p?=?.024), ventriculoarterial coupling (Ea/Emax: 1.27?±?0.61 versus 0.73?±?0.17, p?&lt;?.001) and SW (0.96?±?0.32 versus 1.38?±?0.32?J, p?&lt;?.001). These variables correlated to both MaR and IS (Emax: r2?=?0.25 and r2?=?0.29; Ea/Emax: r2?=?0.36 and r2?=?0.41; SW: r2?=?0.21 and r2?=?0.25). Conclusions: Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.}},
  author       = {{Nordlund, David and Lav, Theodor and Jablonowski, Robert and Khoshnood, Ardavan and Ekelund, Ulf and Atar, Dan and Erlinge, David and Engblom, Henrik and Arheden, Håkan}},
  issn         = {{0160-9289}},
  keywords     = {{contractility; coupling; efficiency; elastance; myocardium at risk; stroke work}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{1--9}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Cardiology}},
  title        = {{Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data}},
  url          = {{http://dx.doi.org/10.1002/clc.24216}},
  doi          = {{10.1002/clc.24216}},
  volume       = {{47}},
  year         = {{2024}},
}