Abstract
BackgroundPressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data.MethodsIn 17 piglets (weight range: 3.6–8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets.ResultsCorrelation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters.ConclusionsPVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.
Highlights
Congenital heart diseases do have a prevalence of 107: 10,000 live births of which 29.4% are severe defects requiring early intervention [1]
Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology
Bland-Altman analysis showed a low bias between PVL3D and PVL3D were compared to conductance catheter measurements (PVLCond)
Summary
Congenital heart diseases do have a prevalence of 107: 10,000 live births of which 29.4% are severe defects requiring early intervention [1]. The neonatal period until early infancy is the crucial time period for important and far-reaching decisions regarding operative, interventional and conservative therapy. In this age group, accurate assessment of ventricular volumes as well as systolic and diastolic performance is important for estimating disease progression and deciding on timing and choice of therapeutic interventions. Analysis of left ventricular pressure-volume loops (PVL) generates the afforded information about systolic and diastolic left ventricular function as well as ventricular-vascular coupling, and provides an important insight into cardiac physiology and the pathophysiology of congenital heart disease [3,4,5,6]. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data
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