The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Elazer R Edelman - One of the best experts on this subject based on the ideXlab platform.
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mechanical circulatory support device heart hysteretic interaction can predict left ventricular end Diastolic Pressure
Science Translational Medicine, 2018Co-Authors: Brian Y Chang, Steven P Keller, Sonya Sanat Bhavsar, Noam Josephy, Elazer R EdelmanAbstract:The full potential of mechanical circulatory systems in the treatment of cardiogenic shock is impeded by the lack of accurate measures of cardiac function to guide clinicians in determining when to initiate and how to optimally titrate support. The left ventricular end Diastolic Pressure (LVEDP) is an established metric of cardiac function that refers to the Pressure in the left ventricle at the end of ventricular filling and immediately before ventricular contraction. In clinical practice, LVEDP is typically only inferred from, and poorly correlates with, the pulmonary capillary wedge Pressure (PCWP). We leveraged the position of an indwelling percutaneous ventricular assist device and advanced data analysis methods to obtain LVEDP from the hysteretic operating metrics of the device. We validated our hysteresis-derived LVEDP measurement using mock flow loops, an animal model of cardiac dysfunction, and data from a patient in cardiogenic shock to show greater measurement precision and correlation with actual Pressures than traditional inferences via PCWP. Delineation of the nonlinear relationship between device and heart adds insight into the interaction between ventricular support devices and the native heart, paving the way for continuous assessment of underlying cardiac state, metrics of cardiac function, potential closed-loop automated control, and rational design of future innovations in mechanical circulatory support systems.
Daniel Burkhoff - One of the best experts on this subject based on the ideXlab platform.
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Diastolic Pressure volume quotient dpvq as a novel echocardiographic index for estimation of lv stiffness in hfpef
Clinical Research in Cardiology, 2015Co-Authors: Mario Kasner, Daniel Burkhoff, David Sinning, Carsten TschopeAbstract:End-Diastolic Pressure–volume relationship and LV stiffness, key parameter for diagnosing Diastolic dysfunction within Heart failure with preserved ejection fraction (HFpEF) patients, can be directly obtained only by invasive Pressure–volume (PV) measurements. Therefore, we aimed to establish Diastolic Pressure–volume quotient (DPVQ), as a new non-invasive parameter for estimation of LV stiffness in HFpEF obtained by 3D echocardiography (3DE) and tissue Doppler imaging. Twenty-three HFpEF patients with suspected Diastolic dysfunction, scheduled for invasive Pressure–volume loop analyses obtained by conductance catheterization were included. PV loop measurements were compared with simultaneous 3DE full-volume recordings of the LV and tissue Doppler measurements for LV Diastolic function. LV filling index E/E′ was used for estimation of Diastolic Pressure. Single-beat method was performed to calculate LV stiffness constant (β SB). Fourteen of twenty-three patients showed increased and 9/23 revealed normal LV stiffness β. End-Diastolic, end-systolic and stroke volume obtained by 3DE correlated with those from PV loop analysis (r = 0.63, r = 0.57 and r = 0.71, respectively). Estimated Diastolic Pressure and DPVQ correlated with invasive measurements (r = 0.81 and r = 0.91, both p < 0.001). Accordingly, calculated stiffness constant β SB revealed a significant correlation with invasive determined stiffness coefficient β (r = 0.73, p < 0.001). DPVQ and β SB correlated with NT-proBNP plasma level (r = 0.67 and r = 0.58, both, p < 0.001). 3D echocardiography allows accurate non-invasive measurements of Diastolic Pressure–volume quotient which correlates with invasive determined LV stiffness in HFpEF.
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single beat estimation of the left ventricular end Diastolic Pressure volume relationship in patients with heart failure
Heart, 2010Co-Authors: Ellen Ten A Brinke, Daniel Burkhoff, Carsten Tschope, Robert J M Klautz, Martin J Schalij, Jeroen J Bax, Ernst E Van Der Wall, R Dion, Paul SteendijkAbstract:Aims To test a method to predict the end-Diastolic Pressureevolume relationship (EDPVR) from a single beat in patients with heart failure. Methods and results Patients (New York Heart Association class IIIeIV) scheduled for mitral annuloplasty (n¼9) or ventricular restoration (n¼10) and patients with normal left ventricular function undergoing coronary artery bypass grafting (n¼12) were instrumented with Pressure-conductance catheters to measure Pressureevolume loops before and after surgery. Data obtained during vena cava occlusion provided directly measured EDPVRs. Baseline end- Diastolic Pressure (Pm) and volume (Vm) were used for single-beat prediction of EDPVRs. Root-mean-squared error (RMSE) between measured and predicted EDPVRs, was 2.7960.21 mm Hg. Measured versus predicted end-Diastolic volumes at Pressure levels 5, 10, 15 and 20 mm Hg showed tight correlations (R 2 ¼0.69e0.97). BlandeAltman analyses indicated overestimation at 5 mm Hg (bias: pre-surgery 44 ml (95% CI 29 to 58 ml); post-surgery 35 ml (23 to 47 ml)) and underestimation at 20 mm Hg (bias: pre-surgery � 57 ml (� 80 to � 34 ml); post-surgery � 13 ml (� 20 to � 7.0 ml)). End-Diastolic volumes were significantly different between groups and between conditions, but these differences were not dependent on the method (ie, measured versus predicted). RMSEs were not different between groups or conditions, nor dependent on Vm or Pm, indicating that EDPVR prediction was equally accurate over a wide volume range. Conclusions Single-beat EDPVRs obtained from hearts spanning a wide range of sizes and conditions accurately predicted directly measured EDPVRs with low RMSE. Single-beat EDPVR indices correlated well with directly measured values, but systematic biases were present at low and high Pressures. The single-beat method facilitates less invasive EDPVR estimation, particularly when coupled with emerging non-invasive techniques to measure Pressures and volumes.
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A computational method of prediction of the end- Diastolic Pressure-volume relationship by single beat
Nature protocols, 2007Co-Authors: Stefan Klotz, Marc L Dickstein, Daniel BurkhoffAbstract:The end-Diastolic Pressure–volume relation (EDPVR) is an important descriptor of passive cardiac pump properties. However, clinical utility has been limited by the need for measurement of Pressures and volumes over relatively large ranges. In this protocol, we describe an algorithm to estimate the entire EDPVR in humans from a single measured Pressure–volume (P–V) point. This algorithm was developed from observations made from accurately measured EDPVRs of human hearts, which indicated that when normalized by appropriate left ventricular volume scaling (to arrive at volume-normalized EDPVRs, EDPVRn) EDPVRns were nearly identical in all patients. In this protocol, we demonstrate how to use EDPVRns to predict a second P–V point on the EDPVR, in which case the entire EDPVR can then be predicted. With recent advances for accurate noninvasive measurement of end-Diastolic Pressure and volumes, this protocol permits the assessment of passive properties in a broader range of research and clinical settings.
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single beat estimation of end Diastolic Pressure volume relationship a novel method with potential for noninvasive application
American Journal of Physiology-heart and Circulatory Physiology, 2006Co-Authors: Stefan Klotz, David A Kass, Ilan Hay, Marc L Dickstein, Jie Wang, Mathew S Maurer, Daniel BurkhoffAbstract:Whereas end-systolic and end-Diastolic Pressure-volume relations (ESPVR, EDPVR) characterize left ventricular (LV) pump properties, clinical utility of these relations has been hampered by the need...
Adnan Kastrati - One of the best experts on this subject based on the ideXlab platform.
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relationship of left ventricular end Diastolic Pressure with extent of myocardial ischemia myocardial salvage and long term outcome in patients with st segment elevation myocardial infarction
Catheterization and Cardiovascular Interventions, 2019Co-Authors: Gjin Ndrepepa, Salvatore Cassese, Desard Hashorva, Sebastian Kufner, Erion Xhepa, Endri Hasimi, Massimiliano Fusaro, Karlludwig Laugwitz, Heribert Schunkert, Adnan KastratiAbstract:OBJECTIVES We aimed to assess the association of left ventricular end-Diastolic Pressure (LVEDP) with myocardial salvage and long-term mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). BACKGROUND The association of LVEDP with myocardial salvage or long-term mortality in patients with STEMI has not been investigated. METHODS This study included 1,312 patients with STEMI undergoing primary PCI between 2002 and 2007. LVEDP was measured at the time of intervention. Patients were divided into three groups: a group with LVEDP in the 1st tertile (LVEDP, 4-19 mmHg; n = 496), a group with LVEDP in the 2nd tertile (LVEDP >19-24 mmHg; n = 410) and a group with LVEDP in the 3rd tertile (LVEDP >24-45 mmHg; n = 406). The primary outcome was 8-year cardiac mortality. RESULTS The primary outcome (cardiac deaths) occurred in 114 patients. Deaths occurred in 26 (7.9%), 36 (11.5%), and 52 (16.4%) patients with LVEDP in the 1st to 3rd tertiles, respectively (adjusted hazard ratio = 1.18, 95% confidence interval 1.02-1.36, P = 0.022, for 5 mmHg increment in the LVEDP values). LVEDP correlated with the extent of myocardial ischemia (R = 0.351; P < 0.001). In patients with LVEDP in the 1st to 3rd tertiles, the salvage index (proportion of initial area at risk salvaged) was 0.53 [0.27-0.84], 0.53 [0.28-0.80], and 0.43 [0.18-0.75], respectively (P = 0.012). After adjustment, LVEDP correlated inversely with myocardial salvage (P < 0.001). CONCLUSIONS In patients with STEMI, elevated LVEDP correlated with the extent of myocardial ischemia, reduced myocardial salvage and increased risk of 8-year cardiac mortality.
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relation of ratio of left ventricular ejection fraction to left ventricular end Diastolic Pressure to long term prognosis after st segment elevation acute myocardial infarction
American Journal of Cardiology, 2019Co-Authors: Gjin Ndrepepa, Salvatore Cassese, Sebastian Kufner, Erion Xhepa, Massimiliano Fusaro, Karlludwig Laugwitz, Heribert Schunkert, Mirabella Emmer, Katharina Mayer, Adnan KastratiAbstract:Risk stratification of patients with ST-segment elevation acute myocardial infarction (STEMI) is suboptimal. We assessed the prognostic value of the left ventricular ejection fraction to left ventricular end-Diastolic Pressure (LVEF/LVEDP) ratio in patients with STEMI who underwent primary percutaneous coronary intervention (PPCI). The study included 1,283 patients with STEMI. LVEF and LVEDP were measured at the time of PPCI. The primary outcome was 8-year cardiac mortality. Patients were divided into 3 groups: a group with a LVEF/LVEDP ratio within the first tertile (LVEF/LVEDP ratio 3; n = 424 patients). There were 109 cardiac deaths during the follow-up: 55 (17.1%), 36 (10.9%), and 18 (6.5%) deaths occurring in patients of the first, second, and third LVEF/LVEDP ratio tertiles, respectively (adjusted hazard ratio = 0.80, 95% confidence interval 0.66 to 0.97, p = 0.022 for 1 unit increment in the LVEF/LVEDP ratio). LVEF/LVEDP ratio (p = 0.035) but not LVEF (p = 0.290) or LVEDP (p = 0.145) alone improved the risk prediction of the models for cardiac mortality (p values show the difference in C-statistics between the models without and with LVEF/LVEDP ratio, LVEF or LVEDP). In conclusion, in patients with STEMI who underwent PPCI, a lower LVEF/LVEDP ratio was independently associated with increased risk of cardiac mortality up to 8 years after PPCI. The LVEF/LVEDP ratio, but not LVEF or LVEDP alone improved predictivity of multivariable models with respect to long-term cardiac mortality.
David Sinning - One of the best experts on this subject based on the ideXlab platform.
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association of left ventricular end Diastolic Pressure with mortality in patients undergoing percutaneous coronary intervention for acute coronary syndromes
Catheterization and Cardiovascular Interventions, 2020Co-Authors: David M Leistner, Steven Dietrich, Aslihan Erbay, Julia Steiner, Youssef S Abdelwahed, Patrick T Siegrist, Matthias Schindler, Carsten Skurk, Arash Haghikia, David SinningAbstract:OBJECTIVES This study sought to investigate the relation between left ventricular end-Diastolic Pressure (LVEDP) and outcomes in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). BACKGROUND Risk stratification in ACS patients is important. Data on the role of LVEDP in the prognostication of ACS patients are scarce. METHODS A total of 1,410 patients undergoing PCI for ACS and with available data on LVEDP were divided according to LVEDP tertiles (lowest tertile: ≤13 mmHg, intermediate tertile: 14-20 mmHg, and highest tertile: >20 mmHg). The primary endpoint was all-cause mortality at a median follow-up of 246 [28-848] days. RESULTS Median LVEDP was 16 (11-22) mmHg. All-cause mortality was 2.8%, 4.5%, and 15.0% in the lowest, the intermediate, and the highest LVEDP tertile groups (p < .001), respectively. Belonging to the highest LVEDP tertile was associated with an increased risk of all-cause mortality (adjusted hazard ratio [HR] = 2.66, 95% confidence interval [CI] [1.30, 5.47], p = .008). By receiver operating characteristic curve analysis, the optimal cut-off value for predicting all-cause mortality was 20 mmHg (sensitivity 68.3%, specificity 72.5%). There was no differential effect of LVEDP on mortality in patients with and without LV dysfunction (interaction p = .23) or ST-elevation myocardial infarction as index ACS event (interaction p = .86). CONCLUSIONS In patients undergoing PCI for ACS, LVEDP was independently related with mortality. Hence, LVEDP should be incorporated into early risk stratification and clinical decision making of ACS patients.
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Diastolic Pressure volume quotient dpvq as a novel echocardiographic index for estimation of lv stiffness in hfpef
Clinical Research in Cardiology, 2015Co-Authors: Mario Kasner, Daniel Burkhoff, David Sinning, Carsten TschopeAbstract:End-Diastolic Pressure–volume relationship and LV stiffness, key parameter for diagnosing Diastolic dysfunction within Heart failure with preserved ejection fraction (HFpEF) patients, can be directly obtained only by invasive Pressure–volume (PV) measurements. Therefore, we aimed to establish Diastolic Pressure–volume quotient (DPVQ), as a new non-invasive parameter for estimation of LV stiffness in HFpEF obtained by 3D echocardiography (3DE) and tissue Doppler imaging. Twenty-three HFpEF patients with suspected Diastolic dysfunction, scheduled for invasive Pressure–volume loop analyses obtained by conductance catheterization were included. PV loop measurements were compared with simultaneous 3DE full-volume recordings of the LV and tissue Doppler measurements for LV Diastolic function. LV filling index E/E′ was used for estimation of Diastolic Pressure. Single-beat method was performed to calculate LV stiffness constant (β SB). Fourteen of twenty-three patients showed increased and 9/23 revealed normal LV stiffness β. End-Diastolic, end-systolic and stroke volume obtained by 3DE correlated with those from PV loop analysis (r = 0.63, r = 0.57 and r = 0.71, respectively). Estimated Diastolic Pressure and DPVQ correlated with invasive measurements (r = 0.81 and r = 0.91, both p < 0.001). Accordingly, calculated stiffness constant β SB revealed a significant correlation with invasive determined stiffness coefficient β (r = 0.73, p < 0.001). DPVQ and β SB correlated with NT-proBNP plasma level (r = 0.67 and r = 0.58, both, p < 0.001). 3D echocardiography allows accurate non-invasive measurements of Diastolic Pressure–volume quotient which correlates with invasive determined LV stiffness in HFpEF.
Gregg W Stone - One of the best experts on this subject based on the ideXlab platform.
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prognostic utility of left ventricular end Diastolic Pressure in patients with st segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
American Journal of Cardiology, 2011Co-Authors: David Planer, Roxana Mehran, Bernhard Witzenbichler, Giulio Guagliumi, Jan Z Peruga, Bruce R Brodie, Dariusz Dudek, Martin Mockel, Selene Leon Reyes, Gregg W StoneAbstract:Measurement of left ventricular end-Diastolic Pressure (LVEDP) is readily obtainable in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). However, the prognostic utility of LVEDP during primary PCI has never been studied. LVEDP was measured in 2,797 patients during primary PCI in the Harmonizing Outcomes with RevascularIZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Outcomes were assessed at 30 days and 2 years stratified by medians of LVEDP. Multivariable analysis was performed to determine whether LVEDP was an independent determinate of adverse outcomes. The median (interquartile range) for LVEDP was 18 mm Hg (12 to 24). For patients with LVEDP >18 mm Hg versus those with ≤18 mm Hg, hazard ratios (95% confidence intervals) for death and death or reinfarction at 30 days were 2.00 (1.20 to 3.33, p = 0.007) and 1.84 (1.24 to 2.73, p = 0.002), respectively, and at 2 years were 1.57 (1.12 to 2.21, p = 0.009) and 1.45 (1.14 to 1.85, p = 0.002), respectively. Patients in the highest quartile of LVEDP (≥24 mm Hg) were at the greatest risk of mortality. Only a weak correlation was present between LVEDP and left ventricular ejection fraction (LVEF; R(2) = 0.03, p <0.01). By multivariable analysis increased LVEDP was an independent predictor of death or reinfarction at 2 years (hazard ratio 1.20, 95% confidence interval 1.02 to 1.42, p = 0.03) even after adjustment for baseline LVEF. In conclusion, baseline increased LVEDP is an independent predictor of adverse outcomes in patients with STEMI undergoing primary PCI even after adjustment for baseline LVEF. Patients with LVEDP ≥24 mm Hg are at the greatest risk for early and late mortality.