Performance comparison of ventricular and arterial dP/dt max for assessing left ventricular systolic function during different experimental loading and contractile conditions

• Published in: Critical care (London, England) Vol. 22; no. 1; p. 325
• Main Authors: Monge Garcia, Manuel Ignacio, Jian, Zhongping, Settels, Jos J, Hunley, Charles, Cecconi, Maurizio, Hatib, Feras, Pinsky, Michael R
• Format: Journal Article
• Language: English
• Published: England 29.11.2018
• Subjects: dP/dtmax; Contractility; Arterial pressure; Left ventricular function
• ISSN: 1466-609X

Maximal left ventricular (LV) pressure rise (LV dP/dt ), a classical marker of LV systolic function, requires LV catheterization, thus surrogate arterial pressure waveform measures have been proposed. We compared LV and arterial (femoral and radial) dP/dt to the slope of the LV end-systolic pressure-volume relationship (Ees), a load-independent measure of LV contractility, to determine the interactions between dP/dt and Ees as loading and LV contractility varied. We measured LV pressure-volume data using a conductance catheter and femoral and radial arterial pressures using a fluid-filled catheter in 10 anesthetized pigs. Ees was calculated as the slope of the end-systolic pressure-volume relationship during a transient inferior vena cava occlusion. Afterload was assessed by the effective arterial elastance. The experimental protocol consisted of sequentially changing afterload (phenylephrine/nitroprusside), preload (bleeding/fluid bolus), and contractility (esmolol/dobutamine). A linear-mixed analysis was used to assess the contribution of cardiac (Ees, end-diastolic volume, effective arterial elastance, heart rate, preload-dependency) and arterial factors (total vascular resistance and arterial compliance) to LV and arterial dP/dt . Both LV and arterial dP/dt allowed the tracking of Ees changes, especially during afterload and contractility changes, although arterial dP/dt was lower compared to LV dP/dt (bias 732 ± 539 mmHg⋅s for femoral dP/dt , and 625 ± 501 mmHg⋅s for radial dP/dt ). Changes in cardiac contractility (Ees) were the main determinant of LV and arterial dP/dt changes. Although arterial dP/dt is a complex function of central and peripheral arterial factors, radial and particularly femoral dP/dt allowed reasonably good tracking of LV contractility changes as loading and inotropic conditions varied.