Left Ventricular Function by Pressure-Volume Loop Analysis before and after Percutaneous Repair of Large Atrial Septal Defects
Aim The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ve...
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| Published in | Journal of interventional cardiology Vol. 27; no. 2; pp. 204 - 211 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Blackwell Publishing Ltd
01.04.2014
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Aim
The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load‐dependent indices. To differentiate between changes in ventricular loading and function, load‐independent indices of ventricular function must be utilized.
Methods
During transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load‐dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dtmax, and −dP/dtmax. Load‐independent indices included: elastance and tau, the preload‐independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre‐ and post‐device occlusion.
Results
In total, 29 patients (age 2–79 years) underwent ASD device occlusion (device size 12–38 mm, median 28 mm). Load‐dependent indices were obtained in all, and satisfactory pressure‐volume loops in 11. At baseline, LV end‐diastolic pressure was 5–23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dtmax rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but −dP/dtmax was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged.
Conclusions
Transcatheter occlusion of ASD is associated with acute improvement in load‐independent indices of systolic function in this cohort, without significant worsening of the preload‐independent index of diastolic function. (J Interven Cardiol 2014;27:204–211) |
|---|---|
| AbstractList | Aim
The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load‐dependent indices. To differentiate between changes in ventricular loading and function, load‐independent indices of ventricular function must be utilized.
Methods
During transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load‐dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dtmax, and −dP/dtmax. Load‐independent indices included: elastance and tau, the preload‐independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre‐ and post‐device occlusion.
Results
In total, 29 patients (age 2–79 years) underwent ASD device occlusion (device size 12–38 mm, median 28 mm). Load‐dependent indices were obtained in all, and satisfactory pressure‐volume loops in 11. At baseline, LV end‐diastolic pressure was 5–23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dtmax rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but −dP/dtmax was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged.
Conclusions
Transcatheter occlusion of ASD is associated with acute improvement in load‐independent indices of systolic function in this cohort, without significant worsening of the preload‐independent index of diastolic function. (J Interven Cardiol 2014;27:204–211) The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load-dependent indices. To differentiate between changes in ventricular loading and function, load-independent indices of ventricular function must be utilized.AIMThe intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load-dependent indices. To differentiate between changes in ventricular loading and function, load-independent indices of ventricular function must be utilized.During transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load-dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dtmax , and -dP/dtmax . Load-independent indices included: elastance and tau, the preload-independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre- and post-device occlusion.METHODSDuring transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load-dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dtmax , and -dP/dtmax . Load-independent indices included: elastance and tau, the preload-independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre- and post-device occlusion.In total, 29 patients (age 2-79 years) underwent ASD device occlusion (device size 12-38 mm, median 28 mm). Load-dependent indices were obtained in all, and satisfactory pressure-volume loops in 11. At baseline, LV end-diastolic pressure was 5-23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dtmax rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but -dP/dtmax was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged.RESULTSIn total, 29 patients (age 2-79 years) underwent ASD device occlusion (device size 12-38 mm, median 28 mm). Load-dependent indices were obtained in all, and satisfactory pressure-volume loops in 11. At baseline, LV end-diastolic pressure was 5-23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dtmax rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but -dP/dtmax was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged.Transcatheter occlusion of ASD is associated with acute improvement in load-independent indices of systolic function in this cohort, without significant worsening of the preload-independent index of diastolic function.CONCLUSIONSTranscatheter occlusion of ASD is associated with acute improvement in load-independent indices of systolic function in this cohort, without significant worsening of the preload-independent index of diastolic function. The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load-dependent indices. To differentiate between changes in ventricular loading and function, load-independent indices of ventricular function must be utilized. During transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load-dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dtmax , and -dP/dtmax . Load-independent indices included: elastance and tau, the preload-independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre- and post-device occlusion. In total, 29 patients (age 2-79 years) underwent ASD device occlusion (device size 12-38 mm, median 28 mm). Load-dependent indices were obtained in all, and satisfactory pressure-volume loops in 11. At baseline, LV end-diastolic pressure was 5-23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dtmax rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but -dP/dtmax was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged. Transcatheter occlusion of ASD is associated with acute improvement in load-independent indices of systolic function in this cohort, without significant worsening of the preload-independent index of diastolic function. |
| Author | ROCCHINI, ALBERT P. LIM, D. S. GUTGESELL, HOWARD P. |
| Author_xml | – sequence: 1 givenname: D. S. surname: LIM fullname: LIM, D. S. email: SL9PC@virginia.edu organization: Assistant Professor of Pediatrics & Medicine, University of Virginia, Virginia, Charlottesville – sequence: 2 givenname: HOWARD P. surname: GUTGESELL fullname: GUTGESELL, HOWARD P. organization: Professor of Pediatrics, University of Virginia, Virginia, Charlottesville – sequence: 3 givenname: ALBERT P. surname: ROCCHINI fullname: ROCCHINI, ALBERT P. organization: Professor of Pediatrics, University of Michigan, Michigan, Ann Arbor |
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| CitedBy_id | crossref_primary_10_1007_s10554_020_02064_4 crossref_primary_10_1016_j_cardfail_2011_07_003 crossref_primary_10_1016_j_anclin_2019_08_004 crossref_primary_10_1136_heartjnl_2013_304225 crossref_primary_10_1016_j_jvssci_2021_12_003 |
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| References_xml | – reference: Baan J, van der Velde ET, de Bruin HG, et al. Continuous measurement of left ventricular volume in animals and humans by conductance catheter. Circulation 1984; 70:812-823. – reference: Tanoue Y, Morita S, Ochiai Y, et al. Impact of atrial septal defect closure on right ventricular performance. Circ J 2006; 70:909-912. – reference: Maughan WL, Sunagawa K, Sagawa K. Ventricular systolic interdependence: Volume elastance model in isolated canine hearts. Am J Physiol 1987; 253:H1381-H1390. – reference: Cohn PF, Liedtke AJ, Serur J, et al. Maximal rate of pressure fall (peak negative dP-dt) during ventricular relaxation. Cardiovasc Res 1972; 6:263-267. – reference: Suga H, Sagawa K, Shoukas AA. Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 1973; 32:314-322. – reference: Henderson Y, Prince AL. The relative systolic discharges of the right and left ventricles and their bearing on pulmonary congestion and depletion. Heart 1914; 5:217-226. – reference: Walker RE, Moran AM, Gauvreau K, et al. Evidence of adverse ventricular interdependence in patients with atrial septal defects. Am J Cardiol 2004; 93:1374-1377, A1376. – reference: Cheung YF, Lun KS, Chau AK. Doppler tissue imaging analysis of ventricular function after surgical and transcatheter closure of atrial septal defect. Am J Cardiol 2004; 93:375-378. – reference: Beyer J. Atrial septal defect: Acute left heart failure after surgical closure. Ann Thorac Surg 1978; 25:36-43. – reference: Teitel DF, Klautz RJ, Cassidy SC, et al. The end-systolic pressure-volume relationship in young animals using the conductance technique. Eur Heart J 1992; 13(Suppl E):40-46. – reference: Flamm MD, Cohn KE, Hancock EW. Ventricular function in atrial septal defect. Am J Med 1970; 48:286-294. – reference: Little WC, Badke FR, O'Rourke RA. 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The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is... The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated... |
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| SubjectTerms | Adolescent Adult Aged Child Child, Preschool Heart Septal Defects, Atrial - physiopathology Heart Septal Defects, Atrial - surgery Humans Middle Aged Ventricular Function, Left - physiology |
| Title | Left Ventricular Function by Pressure-Volume Loop Analysis before and after Percutaneous Repair of Large Atrial Septal Defects |
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