Association between speckle tracking echocardiography and pressure-volume loops during cardiogenic shock development

Author:

Frederiksen Peter HartmundORCID,Linde Louise,Gregers Emilie,Udesen Nanna Louise Junker,Helgestad Ole K,Banke Ann,Dahl Jordi Sanchez,Povlsen Amalie L,Jensen Lisette Okkels,Larsen Jeppe P,Lassen Jens,Schmidt Henrik,Ravn Hanne Berg,Moller Jacob EiferORCID

Abstract

BackgroundThe relationship between speckle tracking assessed global longitudinal strain (GLS) and Doppler-based echocardiography with basic physiological markers of cardiac function derived from pressure-volume loops is poorly elucidated.ObjectiveWe aimed to describe the association between LS and Doppler-based echocardiography and direct measurements of central haemodynamic parameters from conductance catheter-based pressure-volume loops in an animal model with increasing left ventricular (LV) dysfunction.Methods12 Danish landrace female pigs (75–80 kg) were used. All instrumentations were performed percutaneously, including the conductance catheter in the LV. Progressive LV dysfunction was induced by embolisation through the left main coronary artery with microspheres every 3 min until a >50% reduction in cardiac output (CO) or mixed venous saturation (SvO2), compared with baseline, or SvO2<30%. Echocardiography was performed at baseline and 90 s after each injection.ResultsWith progressive LV dysfunction, mean CO decreased from 5.6±0.9 L/min to 2.1±0.9 L/min, and mean SvO2deteriorated from 61.1±7.9% to 35.3±6.1%. Mean LS and LV outflow tract velocity time integral (LVOT VTI) declined from −13.8±3.0% to −6.1±2.0% and 16.9±2.6 cm to 7.8±1.8 cm, respectively. LS and LVOT VTI showed the strongest correlation to stroke work in unadjusted linear regression (r2=0.53 and r2=0.49, respectively). LS correlated significantly with stroke volume, end-systolic elastance, systolic blood pressure, ventriculo-arterial coupling and arterial elastance.ConclusionIn an animal model of acute progressive LV dysfunction, echocardiographic and conductance catheter-based measurements changed significantly. LS and LVOT VTI displayed the earliest and the largest alterations with increased myocardial damage and both correlated strongest with stroke work.

Publisher

BMJ

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