Affiliation:
1. Cardiology Department and Cardiology Intensive Care Unit, “Agios Georgios” General Hospital of Chania, p.c. 73100 Chania, Greece
2. Department of Microbiology, “Iuliu-Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, p.c. 400349 Cluj-Napoca, Romania
Abstract
Introduction: The evaluation of myocardial contractility is essential in cardiology practice. The gold standard for this evaluation is the end-systolic elastance, but it the method involved is complex. Echocardiographic measurement of the ejection fraction (EF) is the most commonly used parameter in clinical practice, but it has significant limitations, especially in patients with afterload mismatch. In this study, the area under the curve (AUC) of the isovolumetric contraction was measured to evaluate the myocardial contractility in patients with pulmonary arterial hypertension and severe aortic stenosis. Methods: 110 patients with severe aortic stenosis and pulmonary arterial hypertension were included in this study. The AUC of the isovolumetric contraction was measured using pressure curves of the right ventricle–pulmonary artery and left ventricle–aorta ascendens. This AUC was then correlated with the echocardiographically measured EF, stroke volume (SV), and total ventricular work. Results: The AUC of the isovolumetric contraction showed a statistically significant correlation with the EF of the corresponding ventricle (p < 0.0001). Both the AUC of the isovolumetric contraction and the EF showed a statistically significant correlation with the total work of the ventricle (AUC: R2 0.49, p < 0.001; EF: R2 0.51, p < 0.001). However, the SV only showed a statistically significant correlation with the EF. A statistically significant one-sample t-test could be found for the EF (decreased, p < 0.001) and for the AUC of the isovolumetric contraction (increased, p < 0.001), but not for the total work of the ventricle. Conclusion: The AUC space of the isovolumetric contraction is a useful marker of ventricular performance in patients with afterload mismatch, showing a statistically significant correlation with the EF and the total ventricular work. This method may have potential for use in clinical practice, especially in challenging cardiological cases. However, further studies are needed to evaluate its usefulness in healthy individuals and in other clinical scenarios.
Funder
General Hospital of Chania
Reference25 articles.
1. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure;McDonagh;Eur. Heart J.,2021
2. Kosaraju, A., Goyal, A., and Grigorova, Y. (2022). StatPearls, StatPearls Publishing.
3. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction;Moss;N. Engl. J. Med.,2002
4. MADIT-I and MADIT-II;Moss;J. Cardiovasc. Electrophysiol.,2003
5. Mechanisms for increasing stroke volume during static exercise with fixed heart rate in humans;Williamson;J. Appl. Physiol.,1997