Assessment of single beat end-systolic elastance methods for quantifying ventricular contractility

Abstract

Multi-beat end-systolic elastance (EMB) is considered a gold-standard index of ventricular contractility. However, it is difficult to measure clinically due to the need for transient manipulation of ventricular preload or afterload. We compared the performance of 5 ‘single-beat’ methods that do not require loading interventions, for estimating the equivalent of EMB. In 7 sheep instrumented with a micromanometer/conductance catheter, single-beat methods were compared with EMB, obtained after transiently decreasing preload or increasing afterload under a broad range of heart rates and inotropic conditions. The single-beat elastance (ESB) method described by Shishido et al. (Circulation 102(16):1983–1989, 2000) had the highest correlation (R = 0.69, y = 0.52x + 0.43) with EMB, although the absolute accuracy was poor. Interestingly, for all methods tested, a higher correlation was observed when EMB was obtained with an afterload increase (R = 0.47 – 0.78) rather than a preload reduction (R = 0.07–0.57). Within-animal regression coefficients were higher than those obtained from pooled data, with excellent within-animal correlation observed for Shishido et al. method (0.73 ≤ R ≤ 0.96) when using afterload increase as the loading intervention. We conclude that (1) current methods perform better when using an afterload increase to obtain reference EMB, (2) intra-individual ESB comparisons may be more reliable than inter-individual comparisons and (3) Shishido et al.'s method demonstrated the strongest correlation with EMB. Current ESB methods have limited and variable accuracy, but may hold promise for tracking relative changes in ventricular contractility in individuals.

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Acknowledgements

J.P.M is supported by a co-funded Career Development Fellowship from the National Health and Medical Research Council of Australia and Future Leader Fellowship from the National Heart Foundation of Australia. The Heart Research group at MCRI is supported the Victorian Government’s Operational Infrastructure Support Program.

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Correspondence to Jonathan P. Mynard.

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Wo, N., Rajagopal, V., Cheung, M.M.H. et al. Assessment of single beat end-systolic elastance methods for quantifying ventricular contractility. Heart Vessels 34, 716–723 (2019). https://doi.org/10.1007/s00380-018-1303-5

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Keywords

  • Heart function
  • Cardiac
  • Contractility
  • End-systolic pressure–volume relationship