Monitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography.

HomeCirculation: Heart FailureVol. 16, No. 1Monitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBMonitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography N. Kremer, Z. Rako, F. Glocker and K. Tello N. KremerN. Kremer https://orcid.org/0000-0002-5615-0214 Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.). Search for more papers by this author , Z. RakoZ. Rako https://orcid.org/0000-0003-0539-0362 Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.). Search for more papers by this author , F. GlockerF. Glocker https://orcid.org/0000-0002-7805-8961 emka medical GmbH, Aschaffenburg, Germany (F.G.). Search for more papers by this author and K. TelloK. Tello Correspondence to: K. Tello, MD, Department of Internal Medicine, Justus-Liebig- University Giessen, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Klinikstrasse 33, 35392 Giessen, Germany. Email E-mail Address: [email protected] https://orcid.org/0000-0002-5557-623X Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.). Search for more papers by this author Originally published14 Nov 2022https://doi.org/10.1161/CIRCHEARTFAILURE.122.010097Circulation: Heart Failure. 2023;16Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 14, 2022: Ahead of Print A 61-year-old patient with pulmonary hypertension due to chronic lung disease (chronic obstructive pulmonary disease) was admitted to our intensive care unit with decompensated right-sided heart failure. Right-sided heart catheterization showed severe pulmonary hypertension (pulmonary vascular resistance: 850 dyn·s/cm5; mean pulmonary arterial pressure: 53 mm Hg; pulmonary arterial wedge pressure: 7 mm Hg). B-type natriuretic peptide level was 1530 pg/mL.Patients with pulmonary hypertension due to chronic obstructive pulmonary disease who are severely hemodynamically compromised may benefit from targeted pulmonary hypertension therapy. We, therefore, initiated treatment with oral sildenafil 3×20 mg/d. To monitor the right ventricular (RV) response, we used a CorLog Probe 1P (EMKA Medical GmbH, Aschaffenburg, Germany), which is a high-fidelity pressure measurement system designed for long-term use in the right ventricle.1 The device is inserted through the subclavian vein and enables continuous pressure monitoring for ≤30 days with wireless data transfer to a smartphone application.Since RV function is best measured as RV–pulmonary arterial coupling derived from pressure volume (PV) loop analysis,2 we used custom software to combine volume data from 3-dimensional echocardiography with pressure data from the CorLog Probe to generate PV loops based on our previously published expertise.3 End-systolic elastance was calculated via the single-beat method with determination of the theoretical maximum isovolumic pressure.Sildenafil improved RV–pulmonary arterial coupling (calculated as single-beat end-systolic elastance/arterial elastance), ejection fraction, and stroke volume by decreasing afterload (arterial elastance) while contractility (end-systolic elastance) was preserved (Figure). end-systolic elastance/arterial elastance from PV loops showed good agreement with the coupling surrogate stroke volume/end-systolic volume. However, only PV loop analysis disentangles the relative contributions of afterload and contractility.Download figureDownload PowerPointFigure. Monitoring right ventricular (RV)–pulmonary arterial coupling with wireless pressure measurement in a patient with pulmonary hypertension due to chronic obstructive pulmonary disease. A, Volume signal from 3-dimensional echocardiography. B, RV pressure signal from CorLog Probe P1 placed in the RV via the subclavian vein. C, PV loops before and during treatment with sildenafil 3×20 mg/d. D, Parameters derived from pressure volume loop analysis. Theoretical maximal isovolumic pressure (Pmax) and end-systolic elastance (Ees) were calculated via the single-beat method. Ea indicates arterial elastance; EDP, end-diastolic pressure; EDV, end-diastolic volume; EF, ejection fraction; ESP, end-systolic pressure; ESV, end-systolic volume; SV, stroke volume; and V0, theoretical volume at 0 pressure.In our opinion, the described method is an elegant and promising approach for monitoring RV function and response to treatment by PV loop analysis. PV loops can be created at will by performing 3-dimensional echocardiography, avoiding further invasive procedures for the patient.Article InformationSources of FundingThis work was supported by Collaborative Research Center CRC 1213 and Sonderforschungsbereiche SFB Project B08.Disclosures F. Glocker is a shareholder of emka medical GmbH. The other authors report no conflicts.FootnotesFor Sources of Funding and Disclosures, see page 103.Correspondence to: K. Tello, MD, Department of Internal Medicine, Justus-Liebig- University Giessen, Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Klinikstrasse 33, 35392 Giessen, Germany. Email khodr.[email protected]med.uni-giessen.deReferences1. Gaertner M, Glocker R, Glocker F, Hopf H-B. Continuous long-term wireless measurement of right ventricular pressures and estimated diastolic pulmonary artery pressure in patients with severe COVID-19 acute respiratory distress syndrome.ESC Heart Fail. 2021; 8:5213–5221. doi: 10.1002/ehf2.13600CrossrefMedlineGoogle Scholar2. Tello K, Seeger W, Naeije R, Vanderpool R, Ghofrani HA, Richter M, Tedford RJ, Bogaard HJ. Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment.Br J Pharmacol. 2021; 178:90–107. doi: 10.1111/bph.14866CrossrefMedlineGoogle Scholar3. Richter MJ, Yogeswaran A, Husain-Syed F, Vadász I, Rako Z, Mohajerani E, Ghofrani HA, Naeije R, Seeger W, Herberg U, et al. A novel non-invasive and echocardiography- derived method for quantification of right ventricular pressure-volume loops.Eur Heart J Cardiovasc Imaging. 2022; 23:498–507. doi: 10.1093/ehjci/jeab038CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails January 2023Vol 16, Issue 1 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.122.010097PMID: 36373554 Originally publishedNovember 14, 2022 Keywordshypertensionarterial pressurevascular resistancestroke volumeheart failurepulmonary arterial hypertensionPDF download Advertisement SubjectsEchocardiographyHeart Failure