Background
Methods
Study population and design
Left heart catheterization
Right heart catheterization
Transpulmonary thermodilution measurements
Echocardiography examination
Statistical analysis
Results
Patient characteristics
Control
n = 11 | AS
n = 10 | DCM
n = 8 |
p
| |
---|---|---|---|---|
Age [a] | 62 ± 7 | 78 ± 11a
| 56 ± 14b
| <0.001 |
Sex (male) | 9/11 | 7/10 | 7/8 | 0.64 |
BSA predicted [m2] | 1.80 ± 0.15 | 1.74 ± 0.16 | 1.82 ± 0.11 | 0.46 |
NYHA class [1] | 1.5 ± 0.5 | 2.4 ± 0.7 | 2.0 ± 1.2 | 0.07 |
Hb [g l−1] | 139 ± 18 | 133 ± 9 | 132 ± 15 | 0.51 |
Lactate [mmol l−1] | 0.8 ± 0.3 | 0.5 ± 0.2 | 0.9 ± 0.3b
| 0.02 |
N-terminal B-type natriuretic peptide [ng l−1] | 177 ± 216 | 882 ± 994 | 1423 ± 1132a
| 0.01 |
Echocardiography, left ventricle (LV) | ||||
LV end-diastolic volume [ml] | 98 ± 35 | 97 ± 21 | 181 ± 25ab
| <0.0001 |
LV myocardial mass index [g m−2] | 96 ± 16 | 116 ± 21a
| 145 ± 19ab
| <0.001 |
LV ejection fraction [%] | 64 ± 7 | 60 ± 13 | 32 ± 9ab
| <0.0001 |
9.4 ± 3.3 | 12.0 ± 2.3 | 11.0 ± 3.4(*)
| 0.21 | |
Echocardiography, right ventricle (RV) | ||||
RV transversal diameter (D2) [mm] | 27 ± 6 | 26 ± 5 | 29 ± 11 | 0.73 |
RV longitudinal diameter (D3) [mm] | 68 ± 5 | 66 ± 10 | 78 ± 12b
| 0.04 |
Tricuspid annular plane systolic excursion [mm] | 23 ± 4 | 23 ± 6 | 19 ± 5 | 0.23 |
RV fractional area change [%] | 47 ± 11 | 52 ± 12 | 50 ± 17 | 0.74 |
Echocardiography, aortic valve | ||||
Aortic valve area [mm2] | 3.0 ± 1.5 | 1.0 ± 0.4a
| 2.5 ± 0.4b
| <0.0001 |
Aortic valve peak instantaneous pressure gradient [mmHg] | 3.8 ± 3.4 | 48.9 ± 26.2a
| 5.4 ± 2.2b
| <0.0001 |
Aortic valve mean pressure gradient [mmHg] | 2.3 ± 2.1 | 26.2 ± 17.8a
| 3.4 ± 1.2b
| <0.001 |
Echocardiography, mitral valve | ||||
Secondary, moderate-to-severe mitral regurgitation | 0/11 | 0/10 | 3/8 | 0.07 |
Cardiac output and contractility
Control
n = 11 | AS
n = 10 | DCM
n = 8 |
p
| |
---|---|---|---|---|
Heart rate [min−1] | 70 ± 9 | 67 ± 6 | 71 ± 13 | 0.62 |
Cardiac output (pulmonary artery catheter) [l min−1] | 5.0 ± 0.9 | 4.3 ± 1.4 | 4.0 ± 0.9 | 0.13 |
Left ventricular peak systolic pressure (sPlv) [mmHg] | 145 ± 29 | 160 ± 34 | 126 ± 19 | 0.06 |
Mean aortic pressure (mPa) [mmHg] | 103 ± 20 | 91 ± 14 | 90 ± 12 | 0.15 |
Left ventricular stroke work index (LVSWI) [g m s−2 m−2] | 82 ± 12 | 100 ± 28 | 63 ± 23b
| <0.01 |
Transaortic peak-to-peak pressure gradient (sPlv–sPa) [mmHg] | 1 ± 8 | 19 ± 14a
| 1 ± 4b
| <0.001 |
Right ventricular end-diastolic pressure (edPrv) [mmHg] | 6 ± 4 | 6 ± 6 | 9 ± 6 | 0.27 |
Right atrial pressure (Pra) [mmHg] | 4 ± 3 | 4 ± 2 | 7 ± 5 | 0.14 |
Mean pulmonary artery pressure (mPpa) [mmHg] | 16 ± 6 | 16 ± 7 | 24 ± 11 | 0.08 |
Pulmonary artery occlusion pressure (Ppao) [mmHg] | 8 ± 3 | 10 ± 5 | 14 ± 7a
| 0.05 |
Transpulmonary pressure gradient (mPpa–Ppao) [mmHg] | 8 ± 4 | 6 ± 3 | 9 ± 6 | 0.38 |
Pulmonary vascular resistance [dyn s cm−5] | 108 ± 55 | 93 ± 50 | 173 ± 174 | 0.23 |
Biplanar left ventricular angiography | ||||
Stroke volume [ml] | 64 ± 26 | 77 ± 20 | 76 ± 32 | 0.46 |
Left ventricular end-diastolic volume [ml] | 104 ± 37 | 135 ± 63 | 234 ± 24ab
| <0.0001 |
Left ventricular ejection fraction [%] | 62 ± 11 | 63 ± 16 | 32 ± 12ab
| <0.0001 |
Transpulmonary thermodilution (PiCCO2) | ||||
Cardiac output [l min−1] | 5.6 ± 0.9 | 5.5 ± 0.7 | 5.0 ± 1.0 | 0.35 |
Stroke volume [ml] | 81 ± 15 | 84 ± 15 | 75 ± 25 | 0.57 |
Global end-diastolic volume index (GEDVI) [ml m−
2] | 823 ± 106 | 909 ± 170 | 870 ± 252 | 0.54 |
Global ejection fraction (GEF) [%] | 22 ± 4 | 22 ± 4 | 20 ± 7 | 0.54 |
Cardiac function index (CFI) [min−1] | 3.9 ± 0.8 | 3.6 ± 0.7 | 3.3 ± 0.8 | 0.32 |
Extravascular lung water index (EVLWI) [ml kg−1] | 9 ± 2 | 12 ± 4a
| 11 ± 3 | 0.04 |
Pulmonary vascular permeability index (PVPI) [1] | 2 ± 0 | 2 ± 0 | 2 ± 1 | 0.12 |
Normal left ventricular end-diastolic volume
n = 14 | Enlarged left ventricular end-diastolic volume
n = 15 | p | |
---|---|---|---|
Left ventricular end-diastolic volume [ml] (left ventricular angiography) | 94 ± 28 | 203 ± 52 | <0.0001 |
Global end-diastolic volume index (GEDVI) [ml m−2] | 848 ± 128 | 882 ± 213 | 0.60 |
Normal left ventricular ejection fraction
n = 18 | Reduced left ventricular ejection fraction
n = 11 | ||
---|---|---|---|
Left ventricular ejection fraction [%] (left ventricular angiography) | 67 ± 7 | 33 ± 13 | <0.0001 |
Global ejection fraction (GEF) [%] | 22 ± 4 | 21 ± 6 | 0.66 |
Cardiac function index (CFI) [min−1] | 3.7 ± 0.7 | 3.5 ± 0.9 | 0.61 |
Cardiac volumes
Control
n = 11 | AS
n = 10 | DCM
n = 8 | p | |
---|---|---|---|---|
Mean transit time (MTt) [s] | 442.9 ± 91.0 | 497.9 ± 88.7 | 570.8 ± 199.2 | 0.12 |
Exponential downslope time (DSt) [s] | 173.1 ± 41.1 | 211.2 ± 47.2 | 246.0 ± 107.0 | 0.08 |
Thermal indicator volumetric parameters | ||||
Intrathoracic thermovolume (ITTV) [ml] | 2439 ± 470 | 2759 ± 662 | 2744 ± 754 | 0.43 |
Pulmonary thermovolume (PTV) [ml] | 956 ± 230 | 1176 ± 355 | 1159 ± 320 | 0.20 |
Estimated dye indicator volumetric parameters | ||||
Intrathoracic blood volume (ITBV) [ml] | 1854 ± 327 | 1979 ± 441 | 1982 ± 594 | 0.77 |
Pulmonary blood volume (PBV) [ml] | 371 ± 65 | 396 ± 88 | 396 ± 119 | 0.77 |