Abstract
BackgroundCardiac and systemic hemodynamics have been historically in the domain of invasive cardiology, but recent advances in real-time 3-Dimensional echocardiography (RT3D echo) provide a reliable measurement of ventricular volumes, allowing to measure a set of hemodynamic parameters previously difficult or impossible to obtain with standard 2D echo.AimTo assess the feasibility of a comprehensive hemodynamic study with RT-3D echo.MethodsWe enrolled 136 patients referred for routine echocardiography: 44 normal (N), 57 hypertensive (HYP), and 35 systolic heart failure patients (HF). All patients underwent standard 2D echo examination followed by RT3D echo examination, including measurement of left ventricular (LV) end-diastolic and end-systolic volumes and derived assessment of LV elastance (an index of LV contractility), arterial elastance (characterizing the distal impedance of the arterial system downstream of the aortic valve); ventricular-arterial coupling (a central determinant of net cardiovascular performance); systemic vascular resistances. Blood pressure was derived from cuff sphygmomanometer and heart rate from ECG.ResultsA complete 2D echo was performed in all 136 patients. 3D echo examination was obtained in 130 patients (feasibility = 95 %). Standard 2D echo examination was completed in 14.8 ± 2.2 min. Acquisition of 3D images required an average time of 5 ± 0.9 min (range 3.5-7.5 min) and image analysis was completed in 10.1 ± 2.8 min (range 6–12 min) per patient. Compared to N and HYP, HF patients showed reduced LV elastance (1.7 ± 1.5 mmHg mL-1 m-2, p <0.001 vs N = 3.8 ± 1.3 and HYP = 3.8 ± 1.3) and ventricular-arterial coupling (0.6 ± 0.5, p < 0.01 vs N = 1.4 ± 0.4 and HYP = 1.2 ± 0.4). Systemic vascular resistances were highest in HYP (2736 ± 720, p < .01 vs N = 1980 ± 432 and vs HF = 1855 ± 636 dyne*s/cm5). The LV elastance was related to EF (r = 0.73, p < 0.01) and arterial pressure was moderately related to vascular elastance (r = 0.54, p < 0.01). The ventricular-arterial coupling was unrelated to systemic vascular resistances (r = −0.04, p NS).ConclusionRT-3D echo allows a non invasive, comprehensive assessment of cardiac and systemic hemodynamics, offering insight access to key variables – such as increased systemic vascular resistances in hypertensives and reduced ventricular-arterial coupling in heart failure patients.
Highlights
left ventricular (LV) function, ventricular volumes, and ejection fraction are routinely assessed by standard 2D echo for early detection of cardiac disease, to monitor disease progression and to assess response to treatment
Because stroke volume varies directly with body size, arterial elastance was corrected for body surface area (BSA) (EaE) to better reflect differences in arterial properties with age and between the genders adjusted for differences in body size [11]
Of note ventricular-arterial coupling is ventricular elastance/arterial elastance, which can further be described as: end-systolic pressure (ESP)/end-systolic volumes (ESV) divided by ESP/ SV: the pressure terms in the numerator and the denominator cancel out, and ventricular-arterial coupling equals to stroke volume/end-systolic volume
Summary
LV function, ventricular volumes, and ejection fraction are routinely assessed by standard 2D echo for early detection of cardiac disease, to monitor disease progression and to assess response to treatment. RT-3D echo, by accurate assessment of stroke volume (SV), allows to derive a set of hemodynamic measures usually difficult or impossible to obtain with 2D echo, such as LV elastance, arterial elastance, ventricular-arterial coupling and systemic vascular resistances [3,4,5]. The underlying idea of the present study was to take advantage of the superiority of 3D over 2D echocardiography in assessing LV volumes to derive more accurate non invasive estimates of cardiac-vascular function [6,7]. Cardiac and systemic hemodynamics have been historically in the domain of invasive cardiology, but recent advances in real-time 3-Dimensional echocardiography (RT3D echo) provide a reliable measurement of ventricular volumes, allowing to measure a set of hemodynamic parameters previously difficult or impossible to obtain with standard 2D echo
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