Pflügers Archiv - European Journal of Physiology

, Volume 455, Issue 4, pp 627–636 | Cite as

A new methodological approach to assess cardiac work by pressure–volume and stress–length relations in patients with aortic valve stenosis and dilated cardiomyopathy

  • P. Alter
  • H. Rupp
  • M. B. Rominger
  • K. J. Klose
  • B. Maisch
Cardiovascular System

Abstract

In experimental animals, cardiac work is derived from pressure–volume area and analyzed further using stress–length relations. Lack of methods for determining accurately myocardial mass has until now prevented the use of stress–length relations in patients. We hypothesized, therefore, that not only pressure–volume loops but also stress–length diagrams can be derived from cardiac volume and cardiac mass as assessed by cardiac magnetic resonance imaging (CMR) and invasively measured pressure. Left ventricular (LV) volume and myocardial mass were assessed in seven patients with aortic valve stenosis (AS), eight with dilated cardiomyopathy (DCM), and eight controls using electrocardiogram (ECG)-gated CMR. LV pressure was measured invasively. Pressure–volume curves were calculated based on ECG triggering. Stroke work was assessed as area within the pressure–volume loop. LV wall stress was calculated using a thick-wall sphere model. Similarly, stress–length loops were calculated to quantify stress–length-based work. Taking the LV geometry into account, the normalization with regard to ventricular circumference resulted in “myocardial work.” Patients with AS (valve area 0.73 ± 0.18 cm2) exhibited an increased LV myocardial mass when compared with controls (P < 0.05). LV wall stress was increased in DCM but not in AS. Stroke work of AS was unchanged when compared with controls (0.539 ± 0.272 vs 0.621 ± 0.138 Nm, not significant), whereas DCM exhibited a significant depression (0.367 ± 0.157 Nm, P < 0.05). Myocardial work was significantly reduced in both AS and DCM when compared with controls (129.8 ± 69.6, 200.6 ± 80.1, 332.2 ± 89.6 Nm/m2, P < 0.05), also after normalization (7.40 ± 5.07, 6.27 ± 3.20, 14.6 ± 4.07 Nm/m2, P < 0.001). It is feasible to obtain LV pressure–volume and stress–length diagrams in patients based on the present novel methodological approach of using CMR and invasive pressure measurement. Myocardial work was reduced in patients with DCM and noteworthy also in AS, while stroke work was reduced in DCM only. Most likely, deterioration of myocardial work is crucial for the prognosis. It is suggested to include these basic physiological procedures in the clinical assessment of the pump function of the heart.

Keywords

Cardiac work Stroke work Myocardial work Pressure–volume diagram Stress–length diagram Cardiac MRI Wall stress 

References

  1. 1.
    Alter P, Grimm W, Vollrath A, Czerny F, Maisch B (2006) Heart rate variability in patients with cardiac hypertrophy—relation to left ventricular mass and etiology. Am Heart J 151(4):829–836PubMedCrossRefGoogle Scholar
  2. 2.
    Alter P, Rupp H, Czerny F, Vollrath A, Rominger MB, Maisch B (2006) Relation of ventricular wall stress and autonomic tone in patients with dilated cardiomyopathy assessed by cardiac magnetic resonance imaging. Eur Heart J 27Supp:P4039Google Scholar
  3. 3.
    Alter P, Rupp H, Maisch B (2006) Activated nuclear transcription factor kappaB in patients with myocarditis and dilated cardiomyopathy—relation to inflammation and cardiac function. Biochem Biophys Res Commun 339(1):180–187PubMedCrossRefGoogle Scholar
  4. 4.
    Alter P, Rupp H, Maisch B (2007) Depression of cardiac working capacity in dilated cardiomyopathy. Eur J Heart Fail 6(Supp 1):83CrossRefGoogle Scholar
  5. 5.
    Alter P, Rupp H, Rominger MB, Klose KJ, Maisch B (2006) Relation of B-type natriuretic peptide to left ventricular wall stress in patients with dilated cardiomyopathy assessed by cardiac magnetic resonance imaging. Eur J Heart Fail 5(Supp 1):106CrossRefGoogle Scholar
  6. 6.
    Araki J, Shimizu J, Mikane T, Mohri S, Matsubara H, Yamaguchi H, Sano S, Ohe T, Takaki M, Suga H (1998) Ventricular pressure-volume area (PVA) accounts for cardiac energy consumption of work production and absorption. Adv Exp Med Biol 453:491–497PubMedGoogle Scholar
  7. 7.
    Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352(3):225–237PubMedCrossRefGoogle Scholar
  8. 8.
    Brilla CG, Funck RC, Rupp H (2000) Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation 102(12):1388–1393PubMedGoogle Scholar
  9. 9.
    Brilla CG, Pick R, Tan LB, Janicki JS, Weber KT (1990) Remodeling of the rat right and left ventricles in experimental hypertension. Circ Res 67(6):1355–1364PubMedGoogle Scholar
  10. 10.
    Brilla CG, Rupp H, Funck R, Maisch B (1995) The renin-angiotensin-aldosterone system and myocardial collagen matrix remodelling in congestive heart failure. Eur Heart J 16(Suppl O):107–109PubMedGoogle Scholar
  11. 11.
    Burkhoff D, Mirsky I, Suga H (2005) Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. Am J Physiol Heart Circ Physiol 289(2):H501–H512PubMedCrossRefGoogle Scholar
  12. 12.
    Carroll JD, Hess OM (2004) Assessment of normal and abnormal cardiac function. In: Zipes DP, Libby P, Bonow RO, Braunwald E (eds) Braunwald’s heart disease. A textbook of cardiovascular medicine. Elsevier, Pennsylvania, pp 491–507Google Scholar
  13. 13.
    Clement DL, De Buyzere M, Duprez D (1993) Left ventricular function and regression of left ventricular hypertrophy in essential hypertension. Am J Hypertens 6(3 Pt 2):14S–19SPubMedGoogle Scholar
  14. 14.
    Depre C, Wang Q, Yan L, Hedhli N, Peter P, Chen L, Hong C, Hittinger L, Ghaleh B, Sadoshima J, Vatner DE, Vatner SF, Madura K (2006) Activation of the cardiac proteasome during pressure overload promotes ventricular hypertrophy. Circulation 114(17):1821–1828PubMedCrossRefGoogle Scholar
  15. 15.
    Frank O (1895) Zur Dynamik des Herzmuskels. Z Biol 32:370–382Google Scholar
  16. 16.
    Grimm D, Kromer EP, Bocker W, Bruckschlegel G, Holmer SR, Riegger GA, Schunkert H (1998) Regulation of extracellular matrix proteins in pressure-overload cardiac hypertrophy: effects of angiotensin converting enzyme inhibition. J Hypertens 16(9):1345–1355PubMedCrossRefGoogle Scholar
  17. 17.
    Grimm W, Alter P, Maisch B (2004) Arrhythmia risk stratification with regard to prophylactic implantable defibrillator therapy in patients with dilated cardiomyopathy. Results of MACAS, DEFINITE, and SCD-HeFT. Herz 29(3):348–352PubMedCrossRefGoogle Scholar
  18. 18.
    Huisman RM, Elzinga G, Westerhof N, Sipkema P (1980) Measurement of left ventricular wall stress. Cardiovasc Res 14(3):142–153PubMedCrossRefGoogle Scholar
  19. 19.
    Huisman RM, Sipkema P, Westerhof N, Elzinga G (1980) Comparison of models used to calculate left ventricular wall force. Med Biol Eng Comput 18(2):133–144PubMedCrossRefGoogle Scholar
  20. 20.
    Jacob R, Vogt M, Noma K (1987) Chronic cardiac reactions. I. Assessment of ventricular and myocardial work capacity in the hypertrophied and dilated ventricle. Basic Res Cardiol 82(Suppl 2):137–145PubMedGoogle Scholar
  21. 21.
    Janz RF, Kubert BR, Pate EF, Moriarty TF (1980) Effect of shape on pressure–volume relationships of ellipsoidal shells. Am J Physiol 238(6):H917–H926PubMedGoogle Scholar
  22. 22.
    Kamkin A, Kiseleva I, Isenberg G (2003) Ion selectivity of stretch-activated cation currents in mouse ventricular myocytes. Pflugers Arch 446(2):220–231PubMedGoogle Scholar
  23. 23.
    Krayenbuehl HP, Kako K, Luethy E (1964) Relation between mechanical systole duration and frequency in the anesthesized rabbits, with special reference to various bradycardias. Pflugers Arch Gesamte Physiol Menschen Tiere 279:60–66PubMedCrossRefGoogle Scholar
  24. 24.
    Mandawat MK, Wallbridge DR, Pringle SD, Riyami AA, Latif S, Macfarlane PW, Lorimer AR, Cobbe SM (1995) Heart rate variability in left ventricular hypertrophy. Br Heart J 73(2):139–144PubMedCrossRefGoogle Scholar
  25. 25.
    Mirsky I (1969) Left ventricular stresses in the intact human heart. Biophys J 9(2):189–208PubMedCrossRefGoogle Scholar
  26. 26.
    Mirsky I (1984) Assessment of diastolic function: suggested methods and future considerations. Circulation 69(4):836–841PubMedGoogle Scholar
  27. 27.
    Mirsky I, Parmley WW (1973) Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res 33(2):233–243PubMedGoogle Scholar
  28. 28.
    Noma K, Brandle M, Jacob R (1988) Evaluation of left ventricular function in an experimental model of congestive heart failure due to combined pressure and volume overload. Basic Res Cardiol 83(1):58–64PubMedCrossRefGoogle Scholar
  29. 29.
    Roten L, Nemoto S, Simsic J, Coker ML, Rao V, Baicu S, Defreyte G, Soloway PJ, Zile MR, Spinale FG (2000) Effects of gene deletion of the tissue inhibitor of the matrix metalloproteinase-type 1 (TIMP-1) on left ventricular geometry and function in mice. J Mol Cell Cardiol 32(1):109–120PubMedCrossRefGoogle Scholar
  30. 30.
    Rupp H, Benkel M, Maisch B (2000) Control of cardiomyocyte gene expression as drug target. Mol Cell Biochem 212(1–2):135–142PubMedCrossRefGoogle Scholar
  31. 31.
    Rupp H, Rupp TP, Alter P, Maisch B (2006) Acute heart failure-basic pathomechanism and new drug targets. Herz 31(8):727–735PubMedCrossRefGoogle Scholar
  32. 32.
    Rupp H, Rupp TP, Maisch B (2005) Fatty acid oxidation inhibition with PPARalpha activation (FOXIB/PPARalpha) for normalizing gene expression in heart failure? Cardiovasc Res 66(3):423–426PubMedCrossRefGoogle Scholar
  33. 33.
    Sandler H, Dodge HT (1963) Left ventricular tension and stress in man. Circ Res 13:91–104PubMedGoogle Scholar
  34. 34.
    Schipke JD, Alexander J Jr, Harasawa Y, Schulz R, Burkhoff D (1988) Interrelation between end-systolic pressure-volume and pressure-wall thickness relations. Am J Physiol 255(3 Pt 2):H679–H684PubMedGoogle Scholar
  35. 35.
    Schipke JD, Burkhoff D, Kass DA, Alexander J Jr, Schaefer J, Sagawa K (1990) Hemodynamic dependence of myocardial oxygen consumption indexes. Am J Physiol 258(5 Pt 2):H1281–H1291PubMedGoogle Scholar
  36. 36.
    Starling EH (1921) The law of the heart. Lancet 1:212CrossRefGoogle Scholar
  37. 37.
    Steendijk P, Tulner SA, Schreuder JJ, Bax JJ, van Erven L, van der Wall EE, Dion RA, Schalij MJ, Baan J (2004) Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients. Am J Physiol Heart Circ Physiol 286(2):H723–H730PubMedCrossRefGoogle Scholar
  38. 38.
    Strauer BE, Beer K, Heitlinger K, Hofling B (1977) Left ventricular systolic wall stress as a primary determinant of myocardial oxygen consumption: comparative studies in patients with normal left ventricular function, with pressure and volume overload and with coronary heart disease. Basic Res Cardiol 72(2–3):306–313PubMedCrossRefGoogle Scholar
  39. 39.
    Turcani M, Rupp H (1997) Etomoxir improves left ventricular performance of pressure-overloaded rat heart. Circulation 96(10):3681–3686PubMedGoogle Scholar
  40. 40.
    Turcani M, Rupp H (1999) Modification of left ventricular hypertrophy by chronic etomixir treatment. Br J Pharmacol 126(2):501–507PubMedCrossRefGoogle Scholar
  41. 41.
    Wanderman KL, Hayek Z, Ovsyshcher I, Loutaty G, Cantor A, Gussarsky Y, Gueron M (1981) Systolic time intervals in adolescents. Normal standards for clinical use and comparison with children and adults. Circulation 63(1):204–209PubMedGoogle Scholar
  42. 42.
    Yin FC (1981) Ventricular wall stress. Circ Res 49(4):829–842PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • P. Alter
    • 1
  • H. Rupp
    • 1
  • M. B. Rominger
    • 2
  • K. J. Klose
    • 2
  • B. Maisch
    • 1
  1. 1.Internal Medicine—CardiologyPhilipps UniversityMarburgGermany
  2. 2.RadiologyPhilipps UniversityMarburgGermany

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