Cardiac Pressure Volume Relationship

The Theory and Significance of PV Loop Measurements

Scisense Inc. (Canada)

OVERVIEW

1. Background on Pressure-Volume (PV) Loops 2. Critical Analyses that can be performed

3. Application examples
4. Conductance technique as a method of measuring volume

Background on Scisense
Founded in 2002 to develop high fidelity pressure and pressure-volume sensors Products are manufactured in Canada and sold worldwide

Minimally invasive tools for hemodynamic research:

catheters for ventricular pressure, volume and ECG amplifiers & acquisition systems analysis software

Pressure Volume Loop

What the Reviewers Say:

When perusing the literature.if the ESPVR was not measured, I would personally ignore the article

Source: William J. Mazzei, M.D. Lecture notes, Cardiac Physiology and Monitoring, July 18, 1999 (www.imhotep.net/lecture3.html)

Requirements for PV Loops

High fidelity pressure measurements
Ability to alter pre-load or after-load LV volume measurements (choose one:)
Conductance catheter (real time, load independent) Sonomicrometer (invasive, for larger animals) Echocardiography (cost, off-line, time resolution, operator dependent) MRI (cost, difficult, off-line analysis)

Data Acquisition & Analysis Software

Typical PV Catheter

Millar 1.4F

Scisense 1.2F
Photo Courtesy of: Dr. Marc Feldman, M.D., University of Texas at San Antonio

PV Loop Parameters
Variable HR Description Heart Rate Variable Vmax Description Maximum Volume Variable CO Description Cardiac Output

Pmax
Pmin Pdev ESP EDP

Maximum Pressure
Minimum Pressure Developed Pressure End-Systolic Pressure End-Diastolic Pressure

Vmin
ESV EDV SV SW

Minimum Volume
End-Systolic Volume End-Diastolic Volume Stroke Volume Stroke Work

EF
dP/dt max dP/dt min dV/dt max dV/dt min

Ejection Fraction
Maximum dP/dt Minimum dP/dt Maximum dV/dt Minimum dV/dt

PV Loop Parameters
Stroke Work = Area in PV Loop
o

Work done by the ventricle to eject a volume of blood

Stroke Volume (SV) = EDV - ESV

o
o o

Amount of blood ejected by the ventricle during each beat Affected by changes in preload, afterload, inotropy Failing hearts - SV highly sensitive to afterload changes

PV Loop Parameters
Cardiac Output (CO) = SV x heart rate
o

Amount of blood pumped out by the LV in unit time

Ejection Fraction (EF) = (SV/EDV) x100

o o o o o

Fraction of the End Diastolic Volume that is ejected Used as a clinical indicator of cardiac contractility Normal EF > 60% Severe heart failure - EF < 20% Low EF usually indicates systolic dysfunction

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PV Loop Parameters
dP/dtmin & dP/dtmax
o

Min and max rate of pressure change in LV o Requires high fidelity LV pressure measurements o Increase in contractility - increased dP/dtmax during isovolumic contraction o dP/dtmin used in the calculation of Tau
Index of diastolic function that is relatively load independent o Used in evaluation of heart failure o Requires high fidelity LV pressure measurements
o

Isovolumic Relaxation Constant (au)

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Types of PV Loop Analysis

ESPVR End Systolic Pressure-Volume Relationship EDPVR End Diastolic Pressure-Volume Relationship

Frank Starling Curve

PRSW Preload Recruitable Stroke Work Pressure-Volume Area (PVA) Analysis Effective Arterial Elastance (Ea)

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End Systolic Pressure Volume Relationship (ESPVR)

ESPVR = Maximal pressure developed by the ventricle for any given LV volume:
changes in load alter the slope of the ESPVR Provides an index of myocardial contractility and systolic function Load independent, therefore better index than EF, CO or SV curve becomes steeper and shifts to the left as inotropy increases.

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End Diastolic Pressure Volume Relationship (EDPVR)

EDPVR = Passive Filling Curve for the Ventricle
Slope of EDPVR line is the reciprocal of Ventricular Compliance Decreased Compliance = Ventricular Hypertrophy

Increased Compliance = Dilated Cardiomyopathy

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Frank Starling Curves

Ability of the heart to change force of contraction in response to changes in venous return If EDV increases, there is a corresponding increase in stroke volume, suggesting heart failure and inotropy Reduced stroke volume suggests increased preload and decreased ejection fraction

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Preload Recruitable Stroke Work (PRSW)

Describes the relationship between stroke work and end-diastolic volume.

Slope of PRSW line is a highly linear index of myocardial contractility

NOT SENSITIVE to preload and afterload

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Pressure Volume Area Analysis

Represents total mechanical energy generated by ventricular contraction PVA = PE + SW

Correlates with myocardial oxygen consumption (MVO2) Used to calculate cardiac efficiency and the energy requirements of the heart

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Effective Arterial Elastance

A measure of Arterial Load (Ea = ESP/SV) Study of the interaction between the heart and the arterial system ventriculoarterial coupling Ea characterizes both the ventricular and arterial systems in terms of pressure and stroke volume

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Application Example Cardiomyopathies

Restrictive
ESPVR:
LVP (mmHg)
Slope maintained Rightward Shift

Dilated
SW
Decreased

ESPVR:

EDPVR:
Increased Slope

Decreased Slope Rightward Shift

LVP (mmHg)

Hypertrophic
ESPVR:
SW
Decreased/ Normal

Increased Slope Leftward Shift

LVV (uL)

Rightward Shift

LVP (mmHg)

EDPVR:

SW
Decreased

EDPVR:
Leftward Shift

LVV (uL)

LVV (uL)

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PV loop Measurement Technique

Miniature catheter advanced through the carotid artery into the Ventricle. Four metal rings on the catheter used for volume measurement
Constant current applied across outside 2 electrodes Voltage change across inside electrodes corresponds to conductance change

Baans equation (1980s) used to calculate volume

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Volume Cuvettes for Calibration

Alternate method to determine true volume from conductance Conductance measurements made in known volumes of saline Saline conductivity matched to blood conductivity Directly relates measured conductance to absolute volume

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Volume Measurement - Theory

Gmeas = Gblood + Gp

Gp is parallel conductance of muscle and must be removed to estimate volume

Hypertonic saline bolus injection Conductance signal increases Gb-ED & Gb-ES both increase Conductivity of blood changes but not the conductivity of the muscle

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Hypertonic Saline Injection

GEDV & GESV graphed on X-Y scatter plot Slope line superimposed on line of identity Point of intersection of both lines indicates parallel conductance (Gp) This technique can be difficult in small animals like mice and rats
GESV

Gp

GEDV

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NEW!! ADVantageTM System (only from Scisense Inc.)

No more saline bolus No volume cuvette calibration Real time feedback on catheter position in the LV Parallel conductance is subtracted in real time for more accurate volumes Absolute Lower Fewer Saves blood volumes are obtained standard deviation animals required time and money

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Conclusion
The Study of PV Loops is an extremely useful method of assessing cardiac function and is being demanded by Peer Reviewers around the world
ESPVR End Systolic Pressure-Volume Relationship EDPVR End Diastolic Pressure-Volume Relationship Frank Starling Curve PRSW Preload Recruitable Stroke Work PVA - Pressure-Volume Area Analysis Ea - Effective Arterial Elastance

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