High-fidelity Pressure Research Articles

Novel clinical method: left ventricular diastolic pressure curve by echocardiography

Abstract Background A non-invasive clinical method for construction of the systolic part of the left ventricular (LV) pressure curve was recently introduced. There is, however, no clinical method available to construct the LV diastolic pressure curve. Purpose The aim of this study was construction of patient-specific LV diastolic pressure curves from echocardiographic data and have initial validation against simultaneously acquired pressure curves by high-fidelity LV pressure catheters (micromanometers). Methods The study included 108 patients referred for diagnostic left heart catheterization due to suspected coronary artery disease. 81 patients were used as a training cohort. The construction of a diastolic pressure curve is based on a reference unitless pressure trace and seven key pressure-time diastolic events estimated in each patient. The reference diastolic pressure trace was generated from a group of 8 patients with LV pressures recorded by micromanometer. Each individual pressure trace from the reference cohort was first annotated with the occurrence of the key diastolic events: mitral valve (MV) opening, minimum LV pressure, peak of early-diastolic mitral flow velocity (E) and start and peak of atrial contraction-induced velocity (A), and MV closure. Then the temporal intervals between these events were normalized before calculating an averaged pressure curve (Figure 1, panels A-C). A patient-specific LV diastolic pressure curve was constructed by adjusting the standard curve according to estimated LV pressure at the key diastolic events (shown in Figure 1D). The estimation of the pressure-time instants is based on the LV volume temporal transient, used to estimate filling flow rate (Q=dV/dt) and flow acceleration and deceleration (dQ/dt=d2V/dt2), as well as a set of biomarkers including left atrial reservoir strain, peak systolic LV pressure, and body mass index. LV volume temporal traces were generated by combining global 2D volumes with global longitudinal strain. The ability to generate patient-specific diastolic LV pressure curves was validated in a second cohort of 7 patients studied with micromanometer-tipped catheters. Echocardiography and LV pressure were recorded from the same series of beats and recordings were done during breath-hold at end-expiration. The agreement was accessed qualitatively and considering the mean diastolic LV pressure. Results There was good agreement between measured and estimated LV diastolic pressure curves, qualitatively and quantitatively, via mean diastolic PLV: Bias 0.2 mmHg, limits of agreement <3.2 mmHg (Figure 1D-F). Conclusions The results suggest that the LV diastolic pressure curve can be estimated by echocardiography. The method needs validation in larger populations.Non-invasive diastolic LV pressure curve

A Simple Method for Obtaining High-Fidelity Pressure Tracings.

A Simple Method for Obtaining High-Fidelity Pressure Tracings.

Data-driven learning algorithm to predict full-field aerodynamics of large structures subject to crosswinds

Quick and high-fidelity updates about aerodynamic loads of large-scale structures, from trains, planes, and automobiles to many civil infrastructures, serving under the influence of a broad range of crosswinds are of practical significance for their design and in-use safety assessment. Herein, we demonstrate that data-driven machine learning (ML) modeling, in combination with conventional computational methods, can fulfill the goal of fast yet faithful aerodynamic prediction for moving objects subject to crosswinds. Taking a full-scale high-speed train, we illustrate that our data-driven model, trained with a small amount of data from simulations, can readily predict with high fidelity pressure and viscous stress distributions on the train surface in a wide span of operating speed and crosswind velocity. By exploring the dependence of aerodynamic coefficients on yaw angles from ML-based predictions, a rapid update of aerodynamic forces is realized, which can be effectively generalized to trains operating at higher speed levels and subject to harsher crosswinds. The method introduced here paves the way for high-fidelity yet efficient predictions to capture the aerodynamics of engineering structures and facilitates their safety assessment with enormous economic and social significance.

A parametric study on pulse duplicator design and valve hemodynamics.

In vitro assessment is mandatory for artificial heart valve development. This study aims to investigate the effects of pulse duplicator features on valve responsiveness, conduct a sensitivity analysis across valve prosthesis types, and contribute on the development of versatile pulse duplicator systems able to perform reliable prosthetic aortic valve assessment under physiologic hemodynamic conditions. A reference pulse duplicator was established based on literature. Further optimization process led to new designs that underwent a parametric study, also involving different aortic valve prostheses. These designs were evaluated on criteria such as mean pressure differential and pulse pressure (assessed from high-fidelity pressure measurements), valve opening and closing behavior, flow, and regurgitation. Finally, the resulting optimized setup was tested under five different hemodynamic settings simulating a range of physiologic and pathologic conditions. The results show that both, pulse duplicator design and valve type significantly influence aortic and ventricular pressure, flow, and valve kinematic response. The optimal design comprised key features such as a compliance chamber and restrictor for diastolic pressure maintenance and narrow pulse pressure. Additionally, an atrial reservoir was included to prevent atrial-aortic interference, and a bioprosthetic valve was used in mitral positionto avoid delayed valve closing effects. This study showed that individual pulse duplicator features can have a significant effect on valve's responsiveness. The optimized versatile pulse duplicator replicated physiologic and pathologic aortic valve hemodynamic conditions, serving as a reliable characterization tool for assessing and optimizing aortic valve performance.

Respiratory gating improves correlation between pulse wave transit time and pulmonary artery pressure in experimental pulmonary hypertension

Objective. Since pulse wave transit time (PWTT) shortens as pulmonary artery pressure (PAP) increases it was suggested as a potential non-invasive surrogate for PAP. The state of tidal lung filling is also known to affect PWTT independently of PAP. The aim of this retrospective analysis was to test whether respiratory gating improved the correlation coefficient between PWTT and PAP. Approach. In each one of five anesthetized and mechanically ventilated pigs two high-fidelity pressure catheters were placed, one directly behind the pulmonary valve, and the second one in a distal branch of the pulmonary artery. PAP was raised using the thromboxane A2 analogue U46619 and animals were ventilated in a pressure controlled mode (I:E ratio 1:2, respiratory rate 12/min, tidal volume of 6 ml kg−1). All signals were recorded using the multi-channel platform PowerLab®. The arrival of the pulse wave at each catheter tip was determined using a MATLAB-based modified hyperbolic tangent algorithm and PWTT calculated as the time interval between these arrivals. Main results. Correlation coefficient for PWTT and mean PAP was r = 0.932 for thromboxane. This correlation coefficient increased considerably when heart beats either at end-inspiration (r = 0.978) or at end-expiration (r = 0.985) were selected (=respiratory gating). Significance. The estimation of mean PAP from PWTT improved significantly when taking the respiratory cycle into account. Respiratory gating is suggested to improve for the estimation of PAP by PWTT.

Abstract 13299: Are There Differences in Left Ventricular and Aortic Pressures Measured With Fluid-Filled and Solid-State Pressure Catheters

Purpose: To compare left-ventricular and aortic pressures obtained using fluid-filled and high-fidelity solid-state pressure catheters in subjects undergoing left heart catheterization. Methods: Twenty subjects scheduled for a left heart catheterization were enrolled and 18 subjects completed this IRB-approved study. During catheterization, left-ventricular (LV) and aortic (AO) pressures were obtained using a fluid-filled pressure catheter (standard-of-care) and a high-fidelity solid-state pressure catheter synchronously. The pressure tracings were analyzed by two independent readers to measure LV systolic (LVSP), LV minimum diastolic (LVMDP), LV end diastolic (LVEDP), AO systolic (AOSP), and AO diastolic (AODP) pressures. Derivatives of the pressure waveforms were computed to estimate the isovolumic contraction and relaxation rates (peak ± dp/dt). The measurements were made over multiple cardiac cycles and averaged results were used for comparisons using repeated measures analysis of variance, post-hoc tests with Bonferroni corrections and Bland-Altman plots. Results: A significant main effect of the pressure catheter was noted for LVSP, LVMDP and AOSP (p < 0.025). The LVSP and AOSP measured with fluid-filled pressure catheters were higher by 6.6 ± 6.9 mmHg and 4.6 ± 5.2 mmHg in comparison to the high-fidelity solid-state pressure catheter assessments. In contrast, the LVMDP measurements were 3.5 ± 5.7 mmHg lower than the solid-state pressure catheter measurements. When evaluating the differences between readers, the maximum difference was noted for LVEDP measurements (3.1 ± 2.4 mmHg; p ≤ 0.001). The differences in isovolumic contraction rate (66.4 ± 116.0 mmHg/s) and relaxation rate (60.5 ± 113.5 mmHg/s) were not significantly different between the two catheter systems after Bonferroni corrections for multiple comparisons (p > 0.06). Bland-Altman analysis revealed a bias ranging from 0.8 to 6.6 mmHg for all the pressure measurements. Conclusions: There are differences in LVSP, LVMDP, and AOSP measured using fluid-filled and high-fidelity solid-state pressure catheters. Clinicians should be aware that the fluid-filled catheters commonly overestimate the true systolic pressures in the left ventricle and aorta.

Development of the Gravel Pressure and Voice Synchronous Observation System and Application in Bedload Transport Measurement

Bedload sediment transport is critical in the natural river environmental and ecological system. It is quite challenging to measure the bedload sediment transport rate in rivers with any degree of accuracy. In this study, the authors developed the Gravel Pressure and Voice Synchronous observation system (GPVS) to estimate the bedload sediment transport rate in rivers. The core of the GPVS includes an underwater high-fidelity audio recorder and pressure sensor. The audio recorder is intended to monitor the low bedload sediment transport rate, whereas the pressure sensor is utilized to detect relatively substantial bedload sediment transport. The GPVS is tested by running flume experiments with natural gravel to evaluate the system’s reliability and feasibility. Results reveal that the GPVS has a very high sensitivity for detecting bedload transport. When the bedload sediment transport rate is relatively low, the audio recorder can measure it quantitatively, showing that the system is not impacted by ambient noise.

Coronary artery disease is associated with impaired atrial function regardless of left ventricular filling pressure

BackgroundLeft atrial (LA) strain is impaired in left ventricular (LV) diastolic dysfunction, associated with increased LV end diastolic pressure (LVEDP). In patients with preserved LV ejection fraction (LVEF), coronary artery disease (CAD) is known to impair LV diastolic function. The relationship of LVEDP with CAD and impact on LA strain is not well studied. Methods and resultsPatients with LVEF >50% (n = 37, age 61 ± 7 years) underwent coronary angiography, high-fidelity LV pressure measurements and cardiac magnetic resonance imaging. LA volumes, LA emptying fraction (LAEF), LA reservoir strain (LARS) and LA long-axis shortening (LALAS) were measured. By coronary angiography, patients were assigned into 3 groups: severe-CAD (n = 19, with obstruction of major coronary arteries >70% and/or history of coronary revascularization), mild-to-moderate-CAD (n = 10, obstruction of major coronary arteries 30–60%), and no-CAD (n = 8, obstruction of major coronary arteries and branches <30%). Overall, LVEF was 65 ± 8% and LVEDP was 14.4 ± 5.6 mmHg. Clinical characteristics, LVEDP and LV function measurements were similar in 3 groups. Severe-CAD group had lower LAEF, LALAS and LARS than those in no-CAD group (P < 0.05 all). In regression analysis, LARS and LALAS were associated with CAD severity and treatment with Nitrates, whereas LAEF and LAEFactive were associated with CAD severity, treatment with Nitrates and LA minimum volume (P < 0.05 all). LAEFpassive was associated with LVED volume (P < 0.05). ConclusionsLA functional impairment may be affected by coexistent CAD severity, medications, in particular, Nitrates, and loading conditions, which should be considered when assessing LA function and LA-LV interaction. Our findings inspire exploration in a larger cohort.

High Fidelity Pressure Wires Provide Accurate Validation of Non-Invasive Central Blood Pressure and Pulse Wave Velocity Measurements.

Central blood pressure (cBP) is known to be a better predictor of the damage caused by hypertension in comparison with peripheral blood pressure. During cardiac catheterization, we measured cBP in the ascending aorta with a fluid-filled guiding catheter (FF) in 75 patients and with a high-fidelity micromanometer tipped wire (FFR) in 20 patients. The wire was withdrawn into the brachial artery and aorto-brachial pulse wave velocity (abPWV) was calculated from the length of the pullback and the time delay between the ascending aorta and the brachial artery pulse waves by gating to the R-wave of the ECG for both measurements. In 23 patients, a cuff was inflated around the calf and an aorta-tibial pulse wave velocity (atPWV) was calculated from the distance between the cuff around the leg and the axillary notch and the time delay between the ascending aorta and the tibial pulse waves. Brachial BP was measured non-invasively and cBP was estimated using a new suprasystolic oscillometric technology. The mean differences between invasively measured cBP by FFR and non-invasive estimation were -0.4 ± 5.7 mmHg and by FF 5.4 ± 9.4 mmHg in 52 patients. Diastolic and mean cBP were both overestimated by oscillometry, with mean differences of -8.9 ± 5.5 mmHg and -6.4 ± 5.1 mmHg compared with the FFR and -10.6 ± 6.3 mmHg and -5.9 ± 6.2 mmHg with the FF. Non-invasive systolic cBP compared accurately with the high-fidelity FFR measurements, demonstrating a low bias (≤5 mmHg) and high precision (SD ≤ 8 mmHg). These criteria were not met when using the FF measurements. Invasively derived average Ao-brachial abPWV was 7.0 ± 1.4 m/s and that of Ao-tibial atPWV was 9.1 ± 1.8 m/s. Non-invasively estimated PWV based on the reflected wave transit time did not correlate with abPWV or with atPWV. In conclusion, we demonstrate the advantages of a novel method of validation for non-invasive cBP monitoring devices using acknowledged gold standard FFR wire transducers and the possibility to easily measure PWV during coronary angiography with the impact of cardiovascular risk factors.

Automatic Detection of Aortic Valve Events Using Deep Neural Networks on Cardiac Signals From Epicardially Placed Accelerometer.

Miniaturized accelerometers incorporated in pacing leads attached to the myocardium, are used to monitor cardiac function. For this purpose functional indices must be extracted from the acceleration signal. A method that automatically detects the time of aortic valve opening (AVO) and aortic valve closure (AVC) will be helpful for such extraction. We tested if deep learning can be used to detect these valve events from epicardially attached accelerometers, using high fidelity pressure measurements to establish ground truth for these valve events. A deep neural network consisting of a CNN, an RNN, and a multi-head attention module was trained and tested on 130 recordings from 19 canines and 159 recordings from 27 porcines covering different interventions. Due to limited data, nested cross-validation was used to assess the accuracy of the method. The correct detection rates were 98.9% and 97.1% for AVO and AVC in canines and 98.2% and 96.7% in porcines when defining a correct detection as a prediction closer than 40 ms to the ground truth. The incorrect detection rates were 0.7% and 2.3% for AVO and AVC in canines and 1.1% and 2.3% in porcines. The mean absolute error between correct detections and their ground truth was 8.4 ms and 7.2 ms for AVO and AVC in canines, and 8.9 ms and 10.1 ms in porcines. Deep neural networks can be used on signals from epicardially attached accelerometers for robust and accurate detection of the opening and closing of the aortic valve.

Performance of the Hypotension Prediction Index With Noninvasive Arterial Pressure Waveforms in Awake Cesarean Delivery Patients Under Spinal Anesthesia

(Anesth Analg. 2022;134:633–643) Many consider spinal anesthesia (SA) the foremost method for cesarean delivery, but previous studies show this can lead to hypotension. A previous research team determined the effectiveness of the noninvasive hypotension prediction index (HPI) algorithm, an algorithm using high-fidelity arterial pressure waveform recordings and 22 additional features to measure the likelihood of a hypotensive event on a scale from 1 to 100, in predicting hypotension. This study assessed the ability of the HPI algorithm and the ClearSight system in comparison with noninvasive blood pressure monitoring (NIBP) during SA procedures.

Use of a Pressure Wire for Automatically Correcting Artifacts in Phasic Pressure Tracings From a Fluid-Filled Catheter

Background/purposeMatching phasic pressure tracings between a fluid-filled catheter and high-fidelity pressure wire has received limited attention, although each part contributes half of the information to clinical decisions. We aimed to study the impact of a novel and automated method for improving the phasic calibration of a fluid-filled catheter by accounting for its oscillatory behavior. Methods/materialsRetrospective analysis of drift check tracings was performed using our algorithm that corrects for mean difference (offset), temporal delays (timing), differential sensitivity of the manifold transducer and pressure wire sensor (gain), and the oscillatory behavior of the fluid-filled catheter described by its resonant frequency and damping factor (how quickly oscillations disappear after a change in pressure). ResultsAmong 2886 cases, correcting for oscillations showed a large improvement in 28 % and a medium improvement in 41 % (decrease in root mean square error >0.5 mmHg to <1 or 1-2 mmHg, respectively). 96 % of oscillators were underdamped with median damping factor 0.27 and frequency 10.6 Hz. Fractional flow reserve or baseline Pd/Pa demonstrated no clinically important bias when ignoring oscillations. However, uncorrected subcycle non-hyperemic pressure ratios (NHPR) displayed both bias and scatter. ConclusionsBy automatically accounting for the oscillatory behavior of a fluid-filled catheter system, phasic matching against a high-fidelity pressure wire can be improved compared to standard equalization methods. The majority of tracings contain artifacts, mainly due to underdamped oscillations, and neglecting them leads to biased estimates of equalization parameters. No clinically important bias exists for whole-cycle metrics, in contrast to significant effects on subcycle NHPR.

High-Fidelity Flexible Pressure Sensor Based on Nanofibers and Carbon Nanotubes for Artificial Electronic Skin and Human Motion Monitoring

High-Fidelity Flexible Pressure Sensor Based on Nanofibers and Carbon Nanotubes for Artificial Electronic Skin and Human Motion Monitoring

New Method to Estimate Central Systolic Blood Pressure From Peripheral Pressure: A Proof of Concept and Validation Study.

Objective: The non-invasive estimation of central systolic blood pressure (cSBP) is increasingly performed using new devices based on various pulse acquisition techniques and mathematical analyses. These devices are most often calibrated assuming that mean (MBP) and diastolic (DBP) BP are essentially unchanged when pressure wave travels from aorta to peripheral artery, an assumption which is evidence-based. We tested a new empirical formula for the direct central blood pressure estimation of cSBP using MBP and DBP only (DCBP = MBP2/DBP).Methods and Results: First, we performed a post-hoc analysis of our prospective invasive high-fidelity aortic pressure database (n = 139, age 49 ± 12 years, 78% men). The cSBP was 146.0 ± 31.1 mmHg. The error between aortic DCBP and cSBP was −0.9 ± 7.4 mmHg, and there was no bias across the cSBP range (82.5–204.0 mmHg). Second, we analyzed 64 patients from two studies of the literature in whom invasive high-fidelity pressures were simultaneously obtained in the aorta and brachial artery. The weighed mean error between brachial DCBP and cSBP was 1.1 mmHg. Finally, 30 intensive care unit patients equipped with fluid-filled catheter in the radial artery were prospectively studied. The cSBP (115.7 ± 18.2 mmHg) was estimated by carotid tonometry. The error between radial DCBP and cSBP was −0.4 ± 5.8 mmHg, and there was no bias across the range.Conclusion: Our study shows that cSBP could be reliably estimated from MBP and DBP only, provided BP measurement errors are minimized. DCBP may have implications for assessing cardiovascular risk associated with cSBP on large BP databases, a point that deserves further studies.

RANS simulations for transition and turbulent flow regimes in wire-wrapped rod bundles

Internal flows through rod assemblies are commonly found in heat exchangers, steam generators, and nuclear reactors. One of the fuel assembly designs considered for liquid metal-cooled reactors utilizes wires helically wrapped around each fuel rod as spacers. The wires keep the fuel pins separated, enhancing the turbulent mixing, and heat transfer, but also affecting the pressure drop. It is of interest the understanding of the fluid flow phenomena in the sodium-cooled fast reactor as it is one of the Generation IV advanced reactor designs and it has been a motivating topic of research for the last decade. A wire-wrapped fuel assembly replica with 61-pins has been in operation at the Thermal-Hydraulic Research Laboratory of Texas A&M University. This facility produced high-fidelity velocity and pressure drop data for validation of computational fluid dynamics codes. This study investigates the effects of geometrical features and operating conditions on the flow behavior of the 61-pin wire wrapped bundle using Reynolds-Averaged Navier-Stokes (RANS) models to predict the axial and transverse pressure drops for a range of Reynolds numbers from 1,270 to 100,000. The friction factor predictions were in satisfactory agreement with the experimental data and the Upgraded Chen and Todreas correlation. The internal subchannel velocity results were compared with experimental data and Large Eddy Simulations (LES) and found in reasonable agreement. This study demonstrates that RANS is a suitable approach in predicting velocity and pressure fields in wire-wrapped rod bundles, with a relatively low computational effort.

Right Heart Phenotype in Heart Failure With Preserved Ejection Fraction.

The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry.

Antenatal betamethasone redistributes central blood flows and preferentially augments right ventricular output and pump function in preterm fetal lambs.

The glucocorticosteroid betamethasone, which is routinely administered prior to anticipated preterm birth to enhance maturation of the lungs and the cardiovascular system, has diverse fetal regional blood flow effects ranging from increased pulmonary flow to decreased cerebral flow. The aim of this study was to test the hypothesis that these diverse effects reflect alterations in major central flow patterns that are associated with complementary shifts in left ventricular (LV) and right ventricular (RV) pumping performance. Studies were performed in anesthetized preterm fetal lambs (gestation = 127 ± 1 days, term = 147 days) with (n = 14) or without (n = 12) preceding betamethasone treatment via maternal intramuscular injection. High-fidelity central arterial blood pressure and flow signals were obtained to calculate LV and RV outputs and total hydraulic power. Betamethasone therapy was accompanied by 1) increased RV, but not LV, output; 2) a greater RV than LV increase in total power; 3) a redistribution of LV output away from the fetal upper body region and toward the lower body and placenta; 4) a greater proportion of RV output passing to the lungs, and a lesser proportion to the lower body and placenta; and 5) a change in the relative contribution of venous streams to ventricular filling, with the LV having increased pulmonary venous and decreased foramen ovale components, and the RV having lesser superior vena caval and greater inferior vena caval portions. Taken together, these findings suggest that antenatal betamethasone produces a widespread redistribution of central arterial and venous flows in the fetus, accompanied by a preferential rise in RV pumping performance.

Experimental Response of Capillary Tube Attenuated Pressure Measurements Under High-Amplitude, Nonlinear Forcing

The response behavior of capillary tube attenuated pressure sensor arrangements is studied using a rotating detonation engine as a nonlinear pressure wave source. The resulting measured pressures are examined as a function of the magnitude of the nonlinear pressure fluctuations, the mean pressure, and the forcing frequency applied to the pressure input port of the sensor. In addition, length and inner diameter of the sensor tubes are studied as a way to tie the current work into the established body of literature. Analytic models are used to provide understanding and predict the expected behaviors of the various tested sensor configurations, in an effort to supply reliable and accurate measurements of high-fidelity static pressures with specific application to ongoing rotating detonation engine research.

Echocardiographic diagnosis of left ventricular diastolic dysfunction: Impact of coronary artery disease.

In 2016, the American Society of Echocardiography (ASE) released guidelines for identifying left ventricular (LV) diastolic dysfunction (DD), but its ability to detect early hemodynamic abnormalities is not well established, especially in the setting of subclinical coronary artery disease (CAD). We hypothesize that the accuracy of ASE categorization of early LVDD is affected by knowledge of whether CAD history is present. We studied 34 patients (age 62±7years) with NYHA class I to II symptoms and with transthoracic echocardiography without findings suggesting myocardial disease (all with preserved LV ejection fraction), who underwent cardiac catheterization with high-fidelity LV pressure measurement. Echocardiographic images were evaluated for LVDD using ASE algorithm without and with knowledge of CAD history and angiography findings. CAD was considered as having DD for the algorithm. CAD was identified in 22 patients at catheterization (65%). Using ASE guidelines without including history of CAD or angiographic results, 29 patients were DD-, 3 were DD+ (all grade II), and 2 were indeterminate. Inclusion of CAD history recategorized 59% (n=20) patients to DD+ (all grade I) from DD- (P<.0001). Nineteen of the recategorized patients (95%) had increased isovolumetric relaxation time (IVRT). The addition of echocardiographic IVRT improved discrimination between DD- and DD+, when the presence of CAD is unknown. 2016-ASE algorithm reasonably accurately identifies early LVDD at rest as reflected by LV catheterization when CAD is disclosed, but without knowledge of the presence of CAD, it underdiagnoses DD+grade I. The addition of IVRT may improve early LVDD diagnostics.

Novel Neuromodulation Approach to Improve Left Ventricular Contractility in Heart Failure: A First-in-Human Proof-of-Concept Study.

Morbidity and mortality outcomes for patients admitted for acute decompensated heart failure are poor and have not significantly changed in decades. Current therapies are focused on symptom relief by addressing signs and symptoms of congestion. The objective of this study was to test a novel neuromodulation therapy of stimulation of epicardial cardiac nerves passing along the posterior surface of the right pulmonary artery. Fifteen subjects admitted for defibrillator implantation and ejection fraction ≤35% on standard heart failure medications were enrolled. Through femoral arterial access, high fidelity pressure catheters were placed in the left ventricle and aortic root. After electro anatomic rendering of the pulmonary artery and branches, either a circular or basket electrophysiology catheter was placed in the right pulmonary artery to allow electrical intravascular stimulation at 20 Hz, 4 ms pulse width, and ≤20 mA. Changes in maximum positive dP/dt (dP/dtMax) indicated changes in ventricular contractility. Of 15 enrolled subjects, 5 were not studied due to equipment failure or abnormal pulmonary arterial anatomy. In the remaining subjects, dP/dtMax increased significantly by 22.6%. There was also a significant increase in maximum negative dP/dt (dP/dtMin), mean arterial pressure, systolic pressure, diastolic pressure, and left ventricular systolic pressure. There was no significant change in heart rate or left ventricular diastolic pressure. In this first-in-human study, we demonstrated that in humans with stable heart failure, left ventricular contractility could be accentuated without an increase in heart rate or left ventricular filling pressures. This benign increase in contractility may benefit patients admitted for acute decompensated heart failure.