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Non-Invasive Quantification of Ventricular Contractility, Arterial Elastic Function and Ventriculo-Arterial Coupling from a Single Diagnostic Encounter Using Simultaneous Arterial Tonometry and Magnetic Resonance Imaging

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Abstract

Purpose

Optimal assessment of cardiovascular performance requires simultaneous measurement of load independent left ventricular (LV) contractility, arterial function and LV/arterial coupling. We aimed to demonstrate feasibility of non-invasive ventricular pressure–volume and aortic pressure-flow-impedance measurements using simultaneous arterial tonometry (AT) and cardiovascular magnetic resonance imaging (CMRI).

Methods

21 consecutive patients referred for CMRI were enrolled to undergo a simultaneous AT and CMRI protocol. A CMRI compatible AT apparatus provided aortic end-systolic pressure, taken to be equivalent to LV end-systolic pressure in the absence of aortic stenosis. CMRI provided LV volume and aortic flow at the time of pressure acquisition. Pressure–volume relationships were determined and correlated to traditional parameters of LV function including ejection fraction and circumferential strain. Aortic pressure-flow relationships were used to determine aortic characteristic impedance and systemic vascular resistance.

Results

Simultaneous AT and CMRI permitted measurement of LV end-systolic elastance, preload recruitable stroke work, arterial elastance, aortic characteristic impedance and systemic vascular resistance. Absolute values were within the expected range for our cohort, were highly reproducible and showed appropriately directed correlation to traditional parameters.

Conclusion

Non-invasive assessment of LV pressure–volume and aortic pressure-flow relationships are both feasible and reproducible using simultaneous AT and CMRI. Methods permit assessment of load independent LV contractility, arterial function and LV/arterial coupling from a single non-invasive diagnostic encounter.

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Acknowledgments

The authors thank Kirsten Moffat and the MRI radiography team, St. Vincent’s Hospital, Sydney, for their assistance with CMRI data acquisition. The authors also thank Dr. Mark Butlin and colleagues from Macquarie University for the use of the MRI compatible arterial tonometer.

Funding

This work was supported by a St. Vincent’s Clinic Foundation Research Grant. Dr. Mayooran Namasivayam is supported by an Australian Government Research Training Program Scholarship and received the Cardiac Society of Australia and New Zealand Travelling Fellowship Award for presentation of the preliminary results of this work at the 2018 American College of Cardiology Annual Scientific Sessions, Orlando, FL, USA.

Disclosures

Dr. Michael F. O’Rourke is a founding director of AortaMate and AtCor Medical, companies formed to aid measurement of central aortic pressure, development of software for pulse wave analyses and methods to reduce aortic stiffness. The other authors report no conflicts of interest.

Ethical Approval

All procedures performed in studies were in accordance with the ethical standards of the St Vincent’s Hospital Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

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Author notes

  1. Mayooran Namasivayam

    Present address: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

  2. Mayooran Namasivayam and Audrey Adji are joint first authors.

Authors and Affiliations

  1. Department of Cardiology, St. Vincent’s Hospital, 390 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia

    Mayooran Namasivayam, Audrey Adji, Linda Lin, Christopher S. Hayward, Michael P. Feneley, Michael F. O’Rourke, David W. M. Muller & Andrew Jabbour

  2. Faculty of Medicine, University of New South Wales, Sydney, Australia

    Mayooran Namasivayam, Christopher S. Hayward, Michael P. Feneley, Michael F. O’Rourke, David W. M. Muller & Andrew Jabbour

  3. Victor Chang Cardiac Research Institute, Sydney, Australia

    Mayooran Namasivayam, Audrey Adji, Christopher S. Hayward, Michael P. Feneley, Michael F. O’Rourke, David W. M. Muller & Andrew Jabbour

  4. Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

    Audrey Adji

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13239_2020_462_MOESM1_ESM.pdf

Supplemental Digital Content 1, Figure: Changes in aortic pulse pressure (panel A), pulse wave velocity (panel B), augmentation index (panel C), characteristic impedance (panel D) and systemic vascular resistance with age (panel E). p and r values as follows: age vs aortic pulse pressure p = 0.003 r = 0.618; age vs pulse wave velocity p = 0.305 r = 0.248; age vs augmentation index p < 0.0001 r = 0.843; age vs characteristic impedance p = 0.055 r = 0.425; age vs systemic vascular resistance p = 0.169 r = 0.312. Supplementary material 1 (PDF 486 kb)

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Namasivayam, M., Adji, A., Lin, L. et al. Non-Invasive Quantification of Ventricular Contractility, Arterial Elastic Function and Ventriculo-Arterial Coupling from a Single Diagnostic Encounter Using Simultaneous Arterial Tonometry and Magnetic Resonance Imaging. Cardiovasc Eng Tech 11, 283–294 (2020). https://doi.org/10.1007/s13239-020-00462-2

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