Non invasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension

Abstract : End-systolic left ventricular (LV) elastance (Ees) has been previously calculated and validated invasively using LV pressure-volume (P-V) loops. Noninvasive methods have been proposed, but clinical application remains complex. The aims of the present study were to 1) estimate Ees according to modeling of the LV P-V curve during ejection (“ejection P-V curve” method) and validate our method with existing published LV P-V loop data and 2) test the clinical applicability of noninvasively detecting a difference in Ees between normotensive and hypertensive subjects. On the basis of the ejection P-V curve and a linear relationship between elastance and time during ejection, we used a nonlinear least-squares method to fit the pressure waveform. We then computed the slope and intercept of time-varying elastance as well as the volume intercept (V0). As a validation, 22 P-V loops obtained from previous invasive studies were digitized and analyzed using the ejection P-V curve method. To test clinical applicability, ejection P-V curves were obtained from 33 hypertensive subjects and 32 normotensive subjects with carotid tonometry and real-time three-dimensional echocardiography during the same procedure. A good univariate relationship (r2 = 0.92, P < 0.005) and good limits of agreement were found between the invasive calculation of Ees and our new proposed ejection P-V curve method. In hypertensive patients, an increase in arterial elastance (Ea) was compensated by a parallel increase in Ees without change in Ea/Ees. In addition, the clinical reproducibility of our method was similar to that of another noninvasive method. In conclusion, Ees and V0 can be estimated noninvasively from modeling of the P-V curve during ejection. This approach was found to be reproducible and sensitive enough to detect an expected increase in LV contractility in hypertensive patients. Because of its noninvasive nature, this methodology may have clinical implications in various disease states.
Type de document :
Article dans une revue
AJP - Heart and Circulatory Physiology, American Physiological Society, 2017, 313 (2), pp.H237-H243. 〈10.1152/ajpheart.00086.2017〉
Liste complète des métadonnées

Littérature citée [7 références]  Voir  Masquer  Télécharger

https://hal.archives-ouvertes.fr/hal-01668992
Contributeur : François Gibier <>
Soumis le : mercredi 3 janvier 2018 - 16:41:40
Dernière modification le : jeudi 11 octobre 2018 - 17:34:02
Document(s) archivé(s) le : mercredi 4 avril 2018 - 12:37:10

Fichier

Art_Jourdan_al_Non-invasive_ev...
Fichiers produits par l'(les) auteur(s)

Identifiants

Collections

Citation

Benjamin Bonnet, Franck Jourdan, Guilhem Du Cailar, Pierre Fesler. Non invasive evaluation of left ventricular elastance according to pressure-volume curves modeling in arterial hypertension. AJP - Heart and Circulatory Physiology, American Physiological Society, 2017, 313 (2), pp.H237-H243. 〈10.1152/ajpheart.00086.2017〉. 〈hal-01668992〉

Partager

Métriques

Consultations de la notice

176

Téléchargements de fichiers

38