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Michael P Feneley - One of the best experts on this subject based on the ideXlab platform.

  • right ventricular preload recruitable stroke work End systolic pressure Volume and dp dtmax End Diastolic Volume relations compared as indexes of right ventricular contractile performance in conscious dogs
    Circulation Research, 1992
    Co-Authors: M K Karunanithi, J Michniewicz, S E Copeland, Michael P Feneley
    Abstract:

    Three indexes developed originally to assess left ventricular contractile performance were applied instead to the right ventricle (RV) in 11 conscious dogs: the relation between stroke work and End-Diastolic Volume (EDV), termed the preload recruitable stroke work (PRSW) relation; the End-systolic pressure-Volume (ESPV) relation; and the maximum dP/dt (dP/dtmax)-EDV relation. The reproducibility, inotropic sensitivity, chronotropic sensitivity, and afterload sensitivity of these RV relations were compared. RV Volume was determined with an ellipsoidal shell subtraction model from orthogonal dimensions measured by sonomicrometry. RV transmural pressure was measured with micromanometers. After autonomic blockade, preload was varied by repeated, transient vena caval occlusions before and during partial occlusion of the main pulmonary artery, after release of the pulmonary arterial occlusion, after calcium infusion, and over a range of heart rates induced by atrial pacing. The slope and Volume-axis intercept of the PRSW relation were more reproducible (SD/mean, 7.8 +/- 3.3% and 6.2 +/- 4.1%, respectively) than the slope and Volume-axis intercept of the ESPV relation (10.1 +/- 6.7% and 23.0 +/- 31.3%, both p less than 0.05) or the slope and Volume-axis intercept of the dP/dtmax-EDV relation (43.4 +/- 70.4% and 153.8 +/- 184.6%, both p less than 0.05). The slope of the PRSW relation increased 32 +/- 17% (p less than 0.05) after calcium infusion, but the Volume-axis intercept did not change significantly. In contrast, the slopes of the ESPV and dP/dtmax-EDV relations did not change significantly after calcium infusion, but the Volume-axis intercepts decreased significantly (both p less than 0.05). Despite a 71 +/- 26% increase in mean RV ejection pressure during partial occlusion of the main pulmonary artery, the slopes and Volume-axis intercepts of both the PRSW and dP/dtmax-EDV relations did not change significantly, but the slope of the ESPV relation increased 45 +/- 22% (p less than 0.05) without significant change in the Volume-axis intercept. None of the relations demonstrated significant chronotropic sensitivity. The PRSW relation is the preferred index of RV contractile performance because 1) it is the most reproducible, 2) its slope alone sensitively detects changes in contractile state, and 3) unlike the ESPV relation, it is relatively insensitive to afterload.

  • comparison of preload recruitable stroke work End systolic pressure Volume and dpdtmax End Diastolic Volume relations as indexes of left ventricular contractile performance in patients undergoing routine cardiac catheterization
    Journal of the American College of Cardiology, 1992
    Co-Authors: Michael P Feneley, Thomas N Skelton, Katherine B Kisslo, J W Davis, Thomas M Bashore, Scott J Rankin
    Abstract:

    Abstract The End-systolic pressure-Volume relation, the relation between stroke work and End-Diastolic Volume, termed the preload recruitable stroke work relation, and the relation between the peak of the first derivative of left ventricular pressure (dPdtmax) and End-Diastolic Volume have been employed as linear indexes of left ventricular contractile performance in laboratory animals. The purpose of this study was to examine the relative utility of these indexes during routine cardiac catheterization in seven human subjects (mean age 48 ± 18 [SD]years) with a normal left ventriculogram and coronary angiogram. Left ventricular pressure was recorded continuously with a micromanometer catheter, and left ventricular Volume was derived from digital subtraction contrast ventriculograms obtained at 30-ms intervals. Transient occlusion of the inferior vena cava with a balloon-tipped catheter was employed to obtain beat to beat reductions in left ventricular pressure and Volume over 8.7 ± 1.7 cardiac cycles. Stroke work declined by 49 ± 13% during vena caval occlusion, but End-systolic pressure fell by only 26 ± 11%, and changes in dpdtmax were small and inconsistent (12 ± 22%). Consequently, the range of data available for determination of the preload recruitable stroke work relation greatly exceeded that for the End-systolic pressure-Volume relation and the dpdtmax-End-Diastolic Volume relation, and much less linear extrapolation from the measured data was required to determine the Volume-axis intercept. Preload recruitable stroke work relations were highly linear (r = 0.95 ± 0.07), and much more so than End-systolic pressure-Volume relations (r = 0.79 ± 0.23). The correlation between dpdtmax and End-Diastolic Volume was very poor over the limited range examined (r = 0.30 ± 0.48). The slopes and Volume-axis intercepts of the End-systolic pressure-Volume relations in normal hearts were more variable; SD/mean values = 78% and 183%, respectively, compared with 40% and 46% for the preload recruitable stroke work relations. The Volume-axis intercepts of the End-systolic pressure-Volume relations were spuriously negative in six of seven subjects, but those of the preload recruitable stroke work relations were positive in all cases. Thus, with the limited range of pressure-Volume data obtainable during cardiac catheterization in human subjects, the preload recruitable stroke work relation appears to have greater clinical utility than the End-systolic pressure-Volume relation or the dpdtmax-End-Diastolic Volume relation as a linear index of left ventricular contractile performance.

William C Little - One of the best experts on this subject based on the ideXlab platform.

Roland M Schmid - One of the best experts on this subject based on the ideXlab platform.

  • comparison of global End Diastolic Volume index derived from jugular and femoral indicator injection a prospective observational study in patients equipped with both a picco 2 and an ev 1000 device
    Scientific Reports, 2020
    Co-Authors: Alexander Herner, Roland M Schmid, Markus Heilmaier, Ulrich Mayr, Wolfgang Huber
    Abstract:

    Transpulmonary thermodilution (TPTD)-derived global End-Diastolic Volume index (GEDVI) is a static marker of preload which better predicted Volume responsiveness compared to filling pressures in several studies. GEDVI can be generated with at least two devices: PiCCO and EV-1000. Several studies showed that uncorrected indicator injection into a femoral central venous catheter (CVC) results in a significant overestimation of GEDVI by the PiCCO-device. Therefore, the most recent PiCCO-algorithm corrects for femoral indicator injection. However, there are no systematic data on the impact of femoral indicator injection for the EV-1000 device. Furthermore, the correction algorithm of the PiCCO is poorly validated. Therefore, we prospectively analyzed 14 datasets from 10 patients with TPTD-monitoring undergoing central venous catheter (CVC)- and arterial line exchange. PiCCO was replaced by EV-1000, femoral CVCs were replaced by jugular/subclavian CVCs and vice-versa. For PiCCO, jugular and femoral indicator injection derived GEDVI was comparable when the correct information about femoral catheter site was given (p = 0.251). By contrast, GEDVI derived from femoral indicator injection using the EV-1000 was obviously not corrected and was substantially higher than jugular GEDVI measured by the EV-1000 (846 ± 250 vs. 712 ± 227 ml/m2; p = 0.001). Furthermore, measurements of GEDVI were not comparable between PiCCO and EV-1000 even in case of jugular indicator injection (p = 0.003). This is most probably due to different indexations of the raw value GEDV. EV-1000 could not be recommEnded to measure GEDVI in case of a femoral CVC. Furthermore, different indexations used by EV-1000 and PiCCO should be considered even in case of a jugular CVC when comparing GEDVI derived from PiCCO and EV-1000.

  • consistency of cardiac function index and global ejection fraction with global End Diastolic Volume in patients with femoral central venous access for transpulmonary thermodilution a prospective observational study
    Journal of Clinical Monitoring and Computing, 2017
    Co-Authors: Analena Beitz, Sebastian Mair, Roland M Schmid, Helena Berbara, Benedikt Henschel, Tobias Lahmer, Sebastian Rasch, W Huber
    Abstract:

    Global ejection fraction (GEF) and cardiac function index (CFI) are transpulmonary thermodilution (TPTD)-derived indices of the systolic function. Their validity relies on an accurate determination of the global End-Diastolic Volume (GEDV). Due to an overestimation of GEDV using a femoral central venous catheter (CVC) a correction formula for indexed GEDV (GEDVI) has been implemented in the latest PiCCO™-algorithm. However, a recent study demonstrated that correction for femoral CVC does not pertain to pulmonary vascular permeability index PVPI, which is calculated of extravascular lung water EVLW and GEDV. Therefore, it was the aim of our study to evaluate, if GEF and CFI are corrected for femoral CVC. In ten adult ICU-patients with PiCCO™-monitoring, ten triplicate TPTDs were performed within 30 h. 95 complete data sets were analyzed, if a GEDV corrected for CVC site was applied to derive CFI and GEF. Therefore, we compared displayed values CFIdisplayed and GEFdisplayed to CFIcalculated and GEFcalculated, which were calculated from displayed GEDV, cardiac output and stroke Volume. GEDVcalculated derived from division of GEDVI by predicted body surface area did not substantially differ from GEDVdisplayed (1448 ± 414 ml vs. 1447 ± 416 ml), which suggests a correction of GEDV for CVC site. However, CFIdisplayed was significantly lower than CFIcalculated (3.8 ± 1.6/min vs. 5.1 ± 1. 8/min: p < 0.001), suggesting that CFIdisplayed is based on an uncorrected GEDV. By contrast, GEFcalculated (23.1 ± 8.7 %) was not substantially different from GEFdisplayed (22.4 ± 8.6 %). Although GEDV and GEF are corrected for femoral CVC site, this does not apply to CFI. However, all indices derived from GEDV should be calculated consistently.

  • a systematic database derived approach to improve indexation of transpulmonary thermodilution derived global End Diastolic Volume
    Journal of Clinical Monitoring and Computing, 2017
    Co-Authors: W Huber, Sebastian Mair, Bernd Saugel, Veit Phillip, Roland M Schmid, Simon Q Gotz, Julia Tschirdewahn, Johanna Frank, Josef Hollthaler
    Abstract:

    Global End-Diastolic Volume (GEDV) has been indexed to body surface area (BSA). However, data validating this indexation of GEDV are scarce. Furthermore, it has been suggested to index GEDV to "predicted BSA" based on predicted body weight. Therefore, we aimed to identify biometric parameters indepEndently associated with GEDV. We analyzed a database including 3812 TPTD measurements in 234 patients treated in the ICU of a German university hospital. GEDVI indexed to actual BSA was significantly lower than GEDVI indexed to predicted BSA (748 ± 179 vs. 804 ± 190 mL/m2; p < 0.001). GEDV was indepEndently associated with older age, male sex, height, and actual body weight. In a regression model for the estimation of GEDV, age and height were the most important parameters: Each year in age and each cm in height increased GEDV by 9 and 15 mL, respectively. In addition to height and weight also age and sex should be considered for indexation of GEDV.

  • pulmonary vascular permeability index and global End Diastolic Volume are the data consistent in patients with femoral venous access for transpulmonary thermodilution a prospective observational study
    BMC Anesthesiology, 2014
    Co-Authors: Helena Berbara, Sebastian Mair, Roland M Schmid, Analena Beitz, Benedikt Henschel, W Huber
    Abstract:

    Transpulmonary thermodilution (TPTD) derived parameters are used to direct fluid management in ICU-patients. Extravascular lung water EVLW and its ratio to pulmonary blood Volume (pulmonary vascular permeability index PVPI) have been associated with mortality. In single indicator TPTD pulmonary blood Volume (PBV) is estimated to be 25% of global End-Diastolic Volume (GEDV). A recent study demonstrated marked overestimation of GEDV indexed to body-surface area (BSA; GEDVI) when using a femoral central venous catheter (CVC) for indicator injection due to the additional Volume measured in the vena cava inferior. Therefore, a correction formula derived from femoral TPTD and biometric data has been suggested. Consequence, one of the commercially available TPTD-devices (PiCCO; Pulsion Medical Systems, Germany) requires information about CVC site. Correction of GEDVI for femoral CVC can be assumed. However, there is no data if correction also pertains to unindexed GEDV, which is used for calculation of PBV and PVPI. Therefore, we investigated, if also GEDV, PBV and PVPI are corrected by the new PiCCO-algorithm. In this prospective study 110 triplicate TPTDs were performed within 30 hours in 11 adult ICU-patients with PiCCO-monitoring and femoral CVC. We analyzed if the femoral TPTD correction formula for GEDVI was also applied to correct GEDV. Furthermore, we compared PVPIdisplayed to PVPIcalculated which was calculated as EVLWdisplayed/(0.25*GEDVdisplayed). Multiplication of GEDVIdisplayed by BSA resulted in GEDVcalculated which was not significantly different to GEDVdisplayed (1459 ± 365 mL vs. 1459 ± 366 mL) suggesting that correction for femoral indicator injection also pertains to GEDVdisplayed. However, PVPIdisplayed was significantly lower than PVPIcalculated (1.64 ± 0.57 vs. 2.27 ± 0.72; p < 0.001). In addition to a bias of -0.64 ± 0.22 there was a percentage error of 22%. Application of the correction formula suggested for GEDVI to PVPIdisplayed reduced the bias of PVPIdisplayed compared to EVLW/PBV from -0.64 ± 0.22 to -0.10 ± 0.05 and the percentage error from 22% to 4%. Correction for femoral CVC in the PiCCO-device pertains to both GEDVIdisplayed and GEDVdisplayed, but not to PVPIdisplayed. To provide consistent information, PVPI should be calculated based on GEDVcorrected in case of femoral CVC.

  • global End Diastolic Volume and its correlation to cardiac index inside and outside normal values
    Critical Care, 2010
    Co-Authors: W Huber, Sebastian Mair, Bernd Saugel, Veit Phillip, H Einwaechter, Roland M Schmid
    Abstract:

    Transpulmonary thermodilution (TPTD)-derived Volumetric parameters such as global End-Diastolic Volume (GEDI) and ELWI have been established as hemodynamic cornerstones for assessment of preload (GEDI) and pulmonary hydration. Normal values of GEDI have been created more than a decade ago based on studies in pre-selected patients. Therefore, it was the aim of our prospective study to investigate the correlation of GEDI to cardiac index (CI) in clinical routine.

Urs Bauersfeld - One of the best experts on this subject based on the ideXlab platform.

  • remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of fallot assessment by cardiovascular magnetic resonance
    European Heart Journal, 2005
    Co-Authors: Emanuela Valsangiacomo R Buechel, Hitendu Dave, Christian J Kellenberger, Ali Dodgekhatami, Rene Pretre, Felix Berger, Urs Bauersfeld
    Abstract:

    Aims Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR). Methods and results Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9+3 years underwent CMR evaluation 5.6+ 1.8 months before and 5.9+ 0.6 months after PVR. PVR was performed when the RV End-Diastolic Volume exceeded 150 mL/m 2 , as measured by CMR. The time interval between primary repair and PVR was 12 + 3 years. Post-operative CMR demonstrated a significant reduction of the RV End-Diastolic Volume from 189.8+ 33.4 to 108.7+ 25.8 mL/m 2 (P , 0.0001), of the RV End-systolic Volume from 102.4+ 27.3 to 58.2+ 16.3 mL/m 2 (P , 0.0001), and of the RV mass from 48.7+ 12.3 to 35.8+ 7.7 g/m 2 (P , 0.0001). The RV ejection fraction did not change significantly. Conclusion Prompt RV remodelling, with reduction of RV Volume and mass, is observed after performing PVR if the RV End-Diastolic Volume exceeds 150 mL/m 2 . Early PVR may prevent the detrimental

  • remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of fallot assessment by cardiovascular magnetic resonance
    European Heart Journal, 2005
    Co-Authors: Emanuela Valsangiacomo R Buechel, Hitendu Dave, Christian J Kellenberger, Ali Dodgekhatami, Rene Pretre, Felix Berger, Urs Bauersfeld
    Abstract:

    AIMS: Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9 +/- 3 years underwent CMR evaluation 5.6 +/- 1.8 months before and 5.9 +/- 0.6 months after PVR. PVR was performed when the RV End-Diastolic Volume exceeded 150 mL/m(2), as measured by CMR. The time interval between primary repair and PVR was 12 +/- 3 years. Post-operative CMR demonstrated a significant reduction of the RV End-Diastolic Volume from 189.8 +/- 33.4 to 108.7 +/- 25.8 mL/m(2) (P < 0.0001), of the RV End-systolic Volume from 102.4 +/- 27.3 to 58.2 +/- 16.3 mL/m(2) (P < 0.0001), and of the RV mass from 48.7 +/- 12.3 to 35.8 +/- 7.7 g/m(2) (P < 0.0001). The RV ejection fraction did not change significantly. CONCLUSION: Prompt RV remodelling, with reduction of RV Volume and mass, is observed after performing PVR if the RV End-Diastolic Volume exceeds 150 mL/m(2). Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.

T Noda - One of the best experts on this subject based on the ideXlab platform.