Abstract
The stress velocity index, or the relationship of the rate-corrected mean velocity of circumferential shortening (VCFc) to the end systolic wall stress (ESWS), is a sensitive, load-independent measure of left ventricular contractility. ESWS is technically difficult to obtain and requires simultaneous blood pressure measurement, carotid artery tracing, and phonocardiogram. We report our comparison of two simpler methods of measuring ESWS and, therefore, stress velocity index. Patients with normal cardiac anatomy who had completed anthracycline chemotherapy were evaluated. ESWS as measured by the standard method using a carotid artery tracing (ESWScar) was compared to ESWS obtained using mean arterial pressure (ESWSmap) or systolic blood pressure (ESWSsbp). The cohort included 63 patients, with 37 (59%) males and a median age of 13.1 years. The mean (±SD) ESWScar was 53.3±15.3 g/cm2 (range, 26.3–94 g/cm2); ESWSmap, 53 ±13.4 g/cm2 (range, 27.1–86.1 g/cm2); and ESWSsbp, 72.9 ± 18.2 g/cm2 (range, 40.8–117.2 g/cm2). ESWSmap and ESWSsbp closely correlated with ESWScar (coefficient correlation r = 0.88 and r = 0.87, respectively). Using ESWSmap, all patients were correctly classified as having normal or abnormal contractility as defined by stress velocity index, whereas ESWSsbp detected only two of the six patients with impaired contractility. We conclude that ESWSmap is a simple, highly sensitive and specific method for assessing left ventricular contractility. ESWSmap correlates closely with ESWScar and can be incorporated into the monitoring of cardiac dysfunction in the anthracycline-treated population. Further studies are needed to determine if this simplified measure accurately assesses the ESWS in other cardiac disease states.
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Aggarwal S, Pettersen MD, Bhambhani K, Gurczynski J, Thomas R, L'Ecuyer T (2007) B-type natriuretic peptide as a marker for cardiac dysfunction in anthracycline-treated children. Pediatr Blood Cancer 49: 812–816
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Borow KM, Neumann A, Marcus RH, Sareli P, Lang RM (1992) Effects of simultaneous alterations in preload and afterload on measurements of left ventricular contractility in patients with dilated cardiomyopathy: comparisons of ejection phase, isovolumetric and end-systolic force-velocity indexes. J Am Coll Cardiol 20:787–795
Colan SD, Borow KM, Neumann A (1984) Left ventricular end-systolic wall stress-velocity of fiber shortening relation: a load-independent index of myocardial contractility. J Am Coll Cardiol 4:715–724
Courand JA, Marshall J, Chang Y, King ME (2001) Clinical applications of wall-stress analysis in the pediatric intensive care unit. Crit Care Med 29:526–533
Karr SS, Martin GR (1994) A simplified method for calculating wall stress in infants and children. J Am Soc Echocardiogr 7:646–651
Lipshultz SE, Orav EJ, Sanders SP, Hale AR, McIntosh K, Colan SD (1992) Cardiac structure and function in children with human immunodeficiency virus infection treated with zidovudine. N Engl J Med 327:1260–1265
Ross J Jr (1976) Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis 18:255–264
Rowland DG, Gutgesell HP (1994) Use of mean arterial pressure for noninvasive determination of left ventricular end-systolic wall stress in infants and children. Am J Cardiol 74:98–99
Sahn DJ, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1083
Sandor GG, Popov R, De Souza E, Morris S, Johnston B (1992) Rate-corrected mean velocity of fiber shortening-stress at peak systole as a load-independent measure of contractility. Am J Cardiol 69:403–407
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Aggarwal, S., Pettersen, M.D., Gurckzynski, J. et al. Measuring Stress Velocity Index Using Mean Blood Pressure: Simple yet Accurate?. Pediatr Cardiol 29, 108–112 (2008). https://doi.org/10.1007/s00246-007-9101-3
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DOI: https://doi.org/10.1007/s00246-007-9101-3