Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-05-24T13:58:39.740Z Has data issue: false hasContentIssue false

2363

Ventriculo-arterial coupling and left ventricular mechanical work in systolic and diastolic heart failure

Published online by Cambridge University Press:  10 May 2018

Leo Buckley
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Justin Canada
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Salvatore Carbone
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Cory Trankle
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Michele Mattia Viscusi
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Jessica Regan
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Dave Dixon
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Nayef Abouzaki
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Sanah Christopher
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Hayley Billingsley
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Dinesh Kadariya
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Ross Arena
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Antonio Abbate
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Benjamin Van Tassell
Affiliation:
Virginia Commonwealth University, Richmond, VA, USA
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

OBJECTIVES/SPECIFIC AIMS: Our goal was to compare the ventriculo-arterial coupling and left ventricular mechanical work of patients with systolic and diastolic heart failure (SHF and DHF). METHODS/STUDY POPULATION: Patients with New York Heart Association Functional Class II-III HF symptoms were included. SHF was defined as left ventricular (LV) ejection fraction<50% and DHF as >50%. Analysis of the fingertip arterial blood pressure tracing captured with a finger plethysmography cuff according to device-specific algorithms provided brachial artery blood pressure and stroke volume. LV end-systolic volume was measured separately via transthoracic echocardiography. Arterial elastance (Ea), a measure of pulsatile and nonpulsatile LV afterload, was calculated as LV end-systolic pressure (ESP)/end-diastolic volume. End-systolic elastance (Ees), a measure of load-independent LV contractility, was calculated as LV ESP/end-systolic volume. Ventriculo-arterial coupling (VAC) ratio was defined as Ea/Ees. Stroke work (SWI) was calculated as stroke volume index×LV end-systolic pressure×0.0136 and potential energy index (PEI) as 1/2×(LV end-systolic volume×LV end-systolic pressure×0.0136). Total work index (TWI) was the sum of SWI+PEI. RESULTS/ANTICIPATED RESULTS: Patients with SHF (n=52) and DHF (n=29) were evaluated. Median (IQR) age was 57 (51–64) years. There were 48 (58%) and 59 (71%) patients were male and African American, respectively. Cardiac index was 2.8 (2.2–3.2) L/minute and 3.0 (2.8–3.3) L/minute in SHF and DHF, respectively (p=0.12). Self-reported activity levels (Duke Activity Status Index, p=0.48) and heart failure symptoms (Minnesota Living with Heart Failure Questionnaire, p=0.55) were not different between SHF and DHF. Ea was significantly lower in DHF compared with SHF patients [1.3 (1.2–1.6) vs. 1.7 (1.4–2.0) mmHg; p<0.001] whereas Ees was higher in DHF vs. SHF [2.8 (2.1–3.1) vs. 0.9 (0.7-1.3) mmHg; p<0.001). VAC was 1.8 (1.3–2.8) in SHF Versus 0.5 (0.4–0.7) in DHF (p<0.001). Compared with SHF, DHF patients had higher SWI [71 (57–83) vs. 48 (39–68) gm×m; p<0.001) and lower PEI [19 (12–26) vs. 44 (36–57) gm×m; p<0.001]. TWI did not differ between SHF and DHF (p=0.14). Work efficiency was higher in DHF than SHF [0.80 (0.74–0.84) vs. 0.53 (0.46–0.64); p<0.001]. DISCUSSION/SIGNIFICANCE OF IMPACT: The results underscore the differences in pathophysiology between SHF and DHF patients with similar symptom burden and exercise capacity. These results highlight the difference in myocardial energy utilization between SHF and DHF.

Type
Clinical Trial
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Association for Clinical and Translational Science 2018