Cited 5 times since 2006 (0.3 per year) source: EuropePMC Journal of cardiothoracic and vascular anesthesia, Volume 20, Issue 3, 5 1 2006, Pages 340-346 Time-varying elastance concept applied to the relation of carotid arterial flow velocity and ventricular area. Broscheit JA, Weidemann F, Strotmann J, Steendijk P, Karle H, Roewer N, Greim CA
Objective
In this study, the relationship V(f)AR, which was obtained from carotid blood-flow velocity (V(f)) and the cross-sectional area (A) of the left ventricle, was used to assess changes in left ventricular (LV) systolic performance as indicated by the LV pressure-volume relationship (PVR) and end-systolic LV elastance (E(es)).
Background
The relationship of maximum systolic V(f) as a surrogate for LV pressure and end-systolic LV area as a surrogate for end-systolic LV volume may allow for the estimation of LV elastance and ejection properties.
Methods
In 25 pigs, internal carotid V(f) was recorded by using continuous-wave Doppler mode. Echocardiographic measurements of A were continuously performed with an automated border detection system and combined with data for V(f) to display V(f)AR as a series of loop diagrams. These were shifted during acute preload reduction, and an index E'(es) was calculated by applying the time varying elastance concept to end-systolic V(f)AR. Simultaneously, E(es) was acquired by conductance catheter and micromanometer techniques. Comparisons of E'(es) and E(es) were made at various contractility levels obtained by the administration of dobutamine, 5 microg/kg/min, and esmolol, 40 to 60 mg, and at various cardiac load levels, obtained by a fluid bolus infusion or administration of a vasoconstrictor.
Results
Highly linear elastance curves (r >or= 0.85, p < 0.0001) were derived from both end-systolic V(f)AR and PVR. Correlation of E'(es) and E(es) revealed an almost linear function: E'(es) = 0.052 + 0.11 E(es) (r = 0.98, p < 0.0001). Administration of dobutamine increased E(es) from 5.8 +/- 3.04 mmHg/mL to 10.1 +/- 4.19 mmHg/mL (p < 0.05), and E('es) from 0.68 +/- 0.288 cm(2)/min/mL to 1.24 +/- 0.458 cm(2)/min/mL (p < 0.05). After administration of esmolol, E(es) and E'(es) both dropped significantly by 3.7 +/- 2.4 mmHg/mL and 0.44 +/- 0.15 cm(2)/min/mL, respectively. No load dependency of E'(es) was seen. Bland-Altman analysis revealed that the change in E'(es), which is required to predict a significant change in E(es), should exceed +16.9% or -13.1% of the preceding value.
Conclusion
Application of the time-varying elastance concept on the relation of V(f) and LV area allows for the determination of an index E'(es) that may be used to estimate E(es).
