U. Herberg 1, D. Ladage 2, E. Gatzweiler 1, O. Dewald 3, J. Dörner 4, K. Linden 1, M. Seehase 1, D. Dörr 3, C. Nähle 4, J.
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1 Pressure volume relations obtained by 3D-real-time echocardiography and mini-pressure wire - multimodal validation-studies with MRI and conductancecatheter in piglets U. Herberg 1, D. Ladage 2, E. Gatzweiler 1, O. Dewald 3, J. Dörner 4, K. Linden 1, M. Seehase 1, D. Dörr 3, C. Nähle 4, J. Breuer 1 1 Pediatric Cardiology, 3 Cardiac Surgery, 3 Radiology, University of Bonn, 2 Cardiology, University of Cologne Supported by Deutschen Herzstiftung F29/08
2 Pressure-Volume Relation Pressure-Volume-Relation (PVR) systol. und diastol. function work load ventriculo-arterial coupling quantification of interventions - medical - caths - operations
3 Introduction» Gold Standard Conductance-Technology 4F Conductance-catheter Disadvantage: - Calibration with a 2nd methode - >= 5F sheath - additional radiation limited use in small children
4 3D-Volumetry Volume-Time-Curve 3D-Echocardiography
5 Instantaneous Pressure Mini pressure wire with micromanometer 4F Conductance Mini-Pressure wire 0.014`` RADI, St. Jude Online pressure time curves
6 3DE-derived PVR 3DE: Volume-time curve Synchronization 5ms (Herberg et al, 2013) 3D-derived PV-loop simultaneously pressure-time curve
7 Aim & Methods Volumetry: 3DE vs CMR Accuracy of 3DE volume measurements in small hearts vs CMR as gold standard for volume analysis Pressure Volume Analysis: 3DE vs Conductance Validation of accuracy and reliability of PVR obtained by 3D-echocardiography & mini pressure wire vs gold standard conductance-technology using identical anesthesia, animal preparation & monitoring
8 Volumetry 3DE vs CMR 8 piglets weight 5.5kg ± 0.54 BSA 0.32 ± 0.03 m 2 3D-Echocardiography Philips IE 33, X7-2 Full Volume Datasets using 4 cardiac cycles Volume rate 35-50/s Analysis: LV QLab Adv 7.0 und 8.1 RV TomTec RV Fct 1.1 CMR 3 Tesla Ingenia, Philips 1.25mmx1.25mm mit 4mm slice thickness Frame rate 50/s Analysis: View Forum Philips LV short axis RV axial cine
![Comparison 3DE CMR Bland-Altman-Analysis SV LV CMR vrs 3D Bias 95% Limits of Agreement Parameter LV RV EDV [ml] -0.03 [-1.2; 1.1] 0.01 [-3.](/docs-images/95/124612731/images/9-3.jpg "1;3.1] SV RV ESV [ml] -0.12 [-1.1; 0.9] SV [ml] -0.01 [-2.4; 2.2] EF % 2.71 [-5.6; 11.0] -0.6 [-3.1; 1.9] 0.57 [-0.7; 1.9] 5.4 [-8.0; 18.")
9 Comparison 3DE CMR Bland-Altman-Analysis SV LV CMR vrs 3D Bias 95% Limits of Agreement Parameter LV RV EDV [ml] [-1.2; 1.1] 0.01 [-3.1;3.1] SV RV ESV [ml] [-1.1; 0.9] SV [ml] [-2.4; 2.2] EF % 2.71 [-5.6; 11.0] -0.6 [-3.1; 1.9] 0.57 [-0.7; 1.9] 5.4 [-8.0; 18.9]
10 Volumen ml Volume-Time-Curves MRT 3D Time ms Volume-Time-Curves
11 Pressure-Volume-Relation 20 Piglets Weight: 6.17 [ ] kg BSA 0.34 [ ] m 2 Simultaneous comparison of PVR 3D + mini-pressure-wire conductance technology various pharmacologic conditions Baseline Phenylephrin 10-40µg/kg/min Esmolol 1mg/kg
12 Pressure-Volume-Relation Parameter: Systolic Function dp/dt max maximal rate of pressure change over time Ees Endsystolic Elastance 1, contractility Ea Effective Arterial Elastance, art. resistance Ees/Ea ventriculoarterial coupling 1 single beat calculation Ten Brinke, 2008 and 2010 ESP=endsystolic pressure
13 Systolic PVR under various conditions * * * * 3D-Echo (3D)-derived pressure-volume relations compared to parameters obtained by conductance technology (Cond) under various conditions (mean and 95% CI), n=16. *=significant from baseline Ees load independent contractility; Ea load independent vascular resistance
14 Systolic PVR under various conditions * * * * 3D-Echo (3D)-derived pressure-volume relations compared to parameters obtained by conductance technology (Cond) under various conditions (mean and 95% CI), n=16. *=significant from baseline Baseline Ees mmhg/ml; Phenyl Ees 27 mmhg/ml Cassidy, 1997; Bakhtiary, 2007
15 Pressure-Volume-Relation Parameter: Diastolic Function dp/dt min - minimal rate of pressure change over time EDV 10 EDV at a common enddiastolic pressure of 10 mmhg 1 τ isovolumic relaxation constant 1 Klotz, 2006 and 2007
16 Diastolic PVR under various conditions Dp/dt min * * 3D-Echo (3D)-derived pressure-volume relations compared to parameters obtained by conductance technology (Cond) under various conditions (mean and 95% CI), n=16. *=significant from baseline Baseline dp/dt min mmhg/s Phenyle dp/dt min 2400mmHg/s Cassidy, 1997; Klautz 1997 Tau 27.4 ms Tau 25.7 ms
17 Comparison 3DE Cond Bland-Altman-Analysis Ees Variation Coefficient Mean +/- SD in % Intraobserver EDV 10 Ees 2.79 ± 3.53 Ees/Ea 3.07 ± 3.60 Tau 0.07 ± 0.16 EDV ± 2.18 Interobserver Ees 2.61 ± 3.34 Ees/Ea 2.83 ± 3.49 Tau 0.75 ± 1.42 EDV ± 0.79 Intra- and Interobserver variation < 10%
18 Conclusion I 3DE volume calculations in small hearts good agreement to CMR volume changes over time are comparable to CMR PVR generated by 3DE & pressure wire good agreement to results obtained by the gold standard conductance technology feasible and reliable to assess different conditions of cardiac function in small hearts
19 Conclusion II Limitations Single beat algorithms Less invasive applicable in neonates and small children (Herberg, Gatzweiler et al, 2013)
20 Thank you for your attention Acknowledgements House for experimental therapy: Andrea Lohmer, med. vet. Ute Lohmer, Study Nurse Dr. Wolfgang Eichelkraut, med. vet. Assistance Nicola Rieder, Katharina Czeczar, Anna Hoppe Statistics Eva Gatzweiler Deutsche Herzstiftung
21 Clin Res Cardiol Jun;102(6): PVR obtained by 3DE + simultaneous pressure measurements using a mini pressure wire is feasible and reproducible
22 Clin Res Cardiol Jun;102(6): N=31 Alter Gewicht 3 Tage - 22,7 Jahre Median 1,8 Jahre 2,8-80 kg Median 11 kg
23 Clin Res Cardiol Jun;102(6):
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