Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application
Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application
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DOI：
10.1152/ajpheart.01240.2005
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发表时间：
2006-07-01
影响因子：
4.8
通讯作者：
Burkhoff, Daniel
中科院分区：
文献类型：
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作者：
Klotz, Stefan;Hay, Ilan;Burkhoff, Daniel
尽管收缩末期和舒张末期压力-容积关系（ESPVR、EDPVR）表征左心室（LV）泵特性，但是这些关系的临床实用性受到在压力和容积范围内进行侵入性测量的需要的阻碍。我们提出了一个单拍的方法来估计整个EDPVR从一个测量的体积压力（V-m和P-m）点。从80个不同病因（正常、充血性心力衰竭、左心室辅助装置支持）的人心脏测量离体EDPVR。与病因无关，当通过适当缩放LV体积将EDPVR标准化（EDPVRn）时，EDPVR（n）几乎相同，并且最佳描述为EDP = A（n）.EDVBn，其中A（n）= 28.2 mmHg，B-n = 2.79。通过使用关系式V-0 = V-m预测V-0（在近似于0 mmHg的压力下的体积）。（0.6 - 0.006.P-m）和V-30 × V-30 = V-0 +（V-m，V-n- V-0）/（P-m/A（n））（（1/Bn））。然后通过将曲线强制通过Vm、Pm以及预测的V0和V30来预测单个心脏的整个EDPVR。该技术前瞻性地应用于未用于确定最佳An和Bn值的离体人EDPVR，以及36项体内人、12项急性和14项慢性犬以及80项体内和离体大鼠研究。在所有设置中，在0 - 40 mmHg范围内测量的EDPVR和预测的EDPVR之间的压力的均方根误差（RMSE）< 3 mmHg，表明该方法具有良好的预测价值。体积标准化EDPVR具有共同的形状，尽管病因和物种不同。这使得整个曲线可以通过一种新的方法进行预测，具有非侵入性应用的潜力。结果是最准确的，当应用于群体的心脏，而不是个人的心脏。
Whereas endsystolic and end-diastolic pressure-volume relations ( ESPVR, EDPVR) characterize left ventricular ( LV) pump properties, clinical utility of these relations has been hampered by the need for invasive measurements over a range of pressure and volumes. We propose a single-beat approach to estimate the whole EDPVR from one measured volume-pressure ( V-m and P-m) point. Ex vivo EDPVRs were measured from 80 human hearts of different etiologies ( normal, congestive heart failure, left ventricular assist device support). Independent of etiology, when EDPVRs were normalized ( EDPVRn) by appropriate scaling of LV volumes, EDPVR(n)s were nearly identical and were optimally described by the relation EDP = A(n).EDVBn, with A(n) = 28.2 mmHg and B-n = 2.79. V-0 ( the volume at the pressure of similar to 0 mmHg) was predicted by using the relation V-0 = V-m.( 0.6 - 0.006.P-m) and V-30 by V-30 = V-0 + ( V-m,V- n - V-0)/( P-m/A(n))((1/Bn)). The entire EDPVR of an individual heart was then predicted by forcing the curve through Vm, Pm, and the predicted V0 and V30. This technique was applied prospectively to the ex vivo human EDPVRs not used in determining optimal An and Bn values and to 36 in vivo human, 12 acute and 14 chronic canine, and 80 in vivo and ex vivo rat studies. The root-mean-square error ( RMSE) in pressure between measured and predicted EDPVRs over the range of 0 - 40 mmHg was < 3 mmHg of measured EDPVR in all settings, indicating a good predictive value of this approach. Volume-normalized EDPVRs have a common shape, despite different etiology and species. This allows the entire curve to be predicted by a new method with a potential for noninvasive application. The results are most accurate when applied to groups of hearts rather than to individual hearts.