CLINICAL APPLICATION OF END-SYSTOLIC P-V RELATIONS

本研究提案的长期目标是确定临床 右心室和左心室收缩末期血流动力学的有用性和局限性 压力-体积（P-V）关系。 因此，假设 构成本研究建议的基本原理是：1）Emax和Vo 可以使用有创高保真微压计在患者中计算 右心室和左心室压力测量以及右心室和左心室压力测量 双平面对比电影血管造影心室容积和平衡 放射性核素血管造影; 2）Emax与 右心室收缩末期P-V关系的非电影血管造影估计 和左心室; 3）变力性干预产生等效 Emax的方向和数量变化相似， 两个心室的非电影血管造影收缩末期P-V关系;以及4） 收缩末期P-V关系的Emax和非电影血管造影估计值 可用于右心室或左心室容量超负荷的患者， 预测手术矫正的结果。 以下具体 研究旨在回答这些假设：1）关系 非电影血管造影收缩末期压（应力）-容积之间 从峰或重搏获得的（维数）关系和体积截距 切迹肺动脉或主动脉压和绝对右心室和左心室 通过平衡放射性核素血管造影和左室舒张末期容积 通过M型超声心动图测量心室尺寸和室壁厚度， 通过与相应右侧的Emax和Vo进行比较进行评估， 从侵入性高保真微压计获得的左心室 双平面造影脑室造影的压力记录和容积 放射性核素血管造影; 2）方向性和定量变化 Emax和Vo以及非造影收缩末期P-V关系， 将比较静息时和变力性肌力期间的容积截距 状态使用多巴酚丁胺或β-阻滞剂;和3）右和左的值 心室Emax、Vo和非造影收缩末期压 （应力）-体积（维数）关系和体积（维数）截距 预测手术结果将在纵向研究中进行评估， 接受右心室或左心室手术矫正的患者 容量超负荷病变。 因此，这项研究将提供新的 关于潜在临床有用性和局限性的数据 收缩末期P-V关系，特别是在右或左 心室容量超负荷。

The long term goal of this research proposal is to define the clinical usefulness and limitations of right and left ventricular end-systolic pressure-volume (P-V) relations. Accordingly, the hypotheses which constitute the rationale for this research proposal are: 1) Emax and Vo can be calculated in patients using invasive high-fidelity micromanometer right and left ventricular pressure measurements and right and left ventricular volumes from biplane contrast cineangiography and equilibrium radionuclide angiography; 2) a relationship exists between Emax and non-cineangiographic estimates of end-systolic P-V relations of the right and left ventricles; 3) inotropic interventions produce equivalent directional and quantitatively similar changes in Emax and non-cineangiographic end-systolic P-V relations of both ventricles; and 4) Emax and non-cineangiographic estimates of end-systolic P-V relations are useful in patients with right or left ventricular volume overload for predicting the results of operative correction. The following specific studies are designed to answer these hypotheses: 1) the relationship between non-cineangiographic end-systolic pressure (stress)-volume (dimension) relations and volume intercepts obtained from peak or dicrotic notch pulmonary or aortic pressures and absolute right and left ventricular end-systolic volumes by equilibrium radionuclide angiography and left ventricular dimensions and wall thickness by M-mode echocardiography will be assessed by comparison to Emax and Vo for the corresponding right and left ventricles obtained from invasive high-fidelity micromanometer pressure recordings and volumes from biplane contrast cineventriculography and radionuclide angiography; 2) the directional and quantitative changes in Emax and Vo and the non-cineangiographic end-systolic P-V relations and volume intercepts will be compared at rest and during altered inotropic state using dobutamine or beta-blockade; and 3) the value of right and left ventricular Emax and Vo and the non-cineangiographic end-systolic pressure (stress)-volume (dimension) relations and volume (dimension) intercepts for predicting surgical outcome will be assessed during longitudinal studies in patients undergoing operative correction of their right or left ventricular volume overload lesions. Thus, this research proposal will provide new data regarding the potential clinical usefulness and limitations of end-systolic P-V relations, especially in patients with right or left ventricular volume overload.