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Use of pressure-volume conductance catheters in real-time cardiovascular experimentation.

ABSTRACT: Most applications of pressure-volume conductance catheter measurements assess cardiovascular function at a single point in time after genetic, pharmacologic, infectious, nutritional, or toxicologic manipulation. Use of these catheters as a continuous monitor, however, is fraught with complexities and limitations.Examples of the limitations and optimal use of conductance catheters as a continuous, real-time monitor of cardiovascular function are demonstrated during inotropic drug infusion in anesthetised rats.Inotropic drug infusion may alter ventricular dimensions causing relative movement of a well-positioned catheter, generating artifacts, including an abrupt pressure rise at end-systole that leads to over estimation of indices of contractility (max dP/dt) and loss of stroke volume signal. Simple rotation of the catheter, echocardiography-guided placement to the centre of the ventricle, or ventricular expansion through crystalloid infusion may correct for these artifacts. Fluid administration, however, alters left ventricular end-diastolic pressure and volume and therefore stroke volume, thereby obscuring continuous real-time haemodynamic measurements.Pressure-volume artifacts during inotropic infusion are caused by physical contact of the catheter with endocardium. Repeated correction of catheter position may be required to use pressure volume catheters as a continuous real-time monitor during manipulations that alter ventricular dimensions, such as inotropic therapy.

SUBMITTER: Wei AE

PROVIDER: S-EPMC4241179 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Use of pressure-volume conductance catheters in real-time cardiovascular experimentation.

Wei Abraham E AE Maslov Mikhail Y MY Pezone Matthew J MJ Edelman Elazer R ER Lovich Mark A MA

Heart, lung & circulation 20140522 11

<h4>Background</h4>Most applications of pressure-volume conductance catheter measurements assess cardiovascular function at a single point in time after genetic, pharmacologic, infectious, nutritional, or toxicologic manipulation. Use of these catheters as a continuous monitor, however, is fraught with complexities and limitations.<h4>Methods</h4>Examples of the limitations and optimal use of conductance catheters as a continuous, real-time monitor of cardiovascular function are demonstrated dur ...[more]

PMID: 24954709

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Project description:BackgroundPressure-volume loops (PVL) provide vital information regarding ventricular performance and pathophysiology in cardiac disease. Unfortunately, acquisition of PVL by conductance technology is not feasible in neonates and small children due to the available human catheter size and resulting invasiveness. The aim of the study was to validate the accuracy of PVL in small hearts using volume data obtained by real-time three-dimensional echocardiography (3DE) and simultaneously acquired pressure data.MethodsIn 17 piglets (weight range: 3.6-8.0 kg) left ventricular PVL were generated by 3DE and simultaneous recordings of ventricular pressure using a mini pressure wire (PVL3D). PVL3D were compared to conductance catheter measurements (PVLCond) under various hemodynamic conditions (baseline, alpha-adrenergic stimulation with phenylephrine, beta-adrenoreceptor-blockage using esmolol). In order to validate the accuracy of 3D volumetric data, cardiac magnetic resonance imaging (CMR) was performed in another 8 piglets.ResultsCorrelation between CMR- and 3DE-derived volumes was good (enddiastolic volume: mean bias -0.03ml ±1.34ml). Computation of PVL3D in small hearts was feasible and comparable to results obtained by conductance technology. Bland-Altman analysis showed a low bias between PVL3D and PVLCond. Systolic and diastolic parameters were closely associated (Intraclass-Correlation Coefficient for: systolic myocardial elastance 0.95, arterial elastance 0.93, diastolic relaxation constant tau 0.90, indexed end-diastolic volume 0.98). Hemodynamic changes under different conditions were well detected by both methods (ICC 0.82 to 0.98). Inter- and intra-observer coefficients of variation were below 5% for all parameters.ConclusionsPVL3D generated from 3DE combined with mini pressure wire represent a novel, feasible and reliable method to assess different hemodynamic conditions of cardiac function in hearts comparable to neonate and infant size. This methodology may be integrated into clinical practice and cardiac catheterization programs and has the capability to contribute to clinical decision making even in small hearts.

Project description:Aim: Cardiac pressure-volume (PV loop) analysis under ?-adrenergic stimulation is a powerful method to simultaneously determine intrinsic cardiac function and ?-adrenergic reserve in mouse models. Despite its wide use, several key approaches of this method, which can affect murine cardiac function tremendously, have not been experimentally investigated until now. In this study, we investigate the impact of three lines of action during the complex procedure of PV loop analysis: (i) the ventilation with positive end-expiratory pressure, (ii) the time point of injecting hypertonic saline to estimate parallel-conductance, and (iii) the implications of end-systolic pressure-spikes that may arise under ?-adrenergic stimulation. Methods and Results: We performed pressure-volume analysis during ?-adrenergic stimulation in an open-chest protocol under Isoflurane/Buprenorphine anesthesia. Our analysis showed that (i) ventilation with 2 cmH2O positive end-expiratory pressure prevented exacerbation of peak inspiratory pressures subsequently protecting mice from macroscopic pulmonary bleedings. (ii) Estimations of parallel-conductance by injecting hypertonic saline prior to pressure-volume recordings induced dilated chamber dimensions as depicted by elevation of end-systolic volume (+113%), end-diastolic volume (+40%), and end-diastolic pressure (+46%). Further, using this experimental approach, the preload-independent contractility (PRSW) was significantly impaired under basal conditions (-17%) and under catecholaminergic stimulation (-14% at 8.25 ng/min Isoprenaline), the ?-adrenergic reserve was alleviated, and the incidence of ectopic beats was increased >5-fold. (iii) End-systolic pressure-spikes were observed in 26% of pressure-volume recordings under stimulation with 2.475 and 8.25 ng/min Isoprenaline, which affected the analysis of maximum pressure (+11.5%), end-diastolic volume (-8%), stroke volume (-10%), and cardiac output (-11%). Conclusions: Our results (i) demonstrate the advantages of positive end-expiratory pressure ventilation in open-chest instrumented mice, (ii) underline the perils of injecting hypertonic saline prior to pressure-volume recordings to calibrate for parallel-conductance and (iii) emphasize the necessity to be aware of the consequences of end-systolic pressure-spikes during ?-adrenergic stimulation.

Project description:Introduction: Functional magnetic resonance imaging (fMRI) often involves long scanning durations to ensure the associated brain activity can be detected. However, excessive experimentation can lead to many undesirable effects, such as from learning and/or fatigue effects, discomfort for the subject, excessive motion artifacts and loss of sustained attention on task. Overly long experimentation can thus have a detrimental effect on signal quality and accurate voxel activation detection. Here, we propose dynamic experimentation with real-time fMRI using a novel statistically driven approach that invokes early stopping when sufficient statistical evidence for assessing the task-related activation is observed. Methods: Voxel-level sequential probability ratio test (SPRT) statistics based on general linear models (GLMs) were implemented on fMRI scans of a mathematical 1-back task from 12 healthy teenage subjects and 11 teenage subjects born extremely preterm (EPT). This approach is based on likelihood ratios and allows for systematic early stopping based on target statistical error thresholds. We adopt a two-stage estimation approach that allows for accurate estimates of GLM parameters before stopping is considered. Early stopping performance is reported for different first stage lengths, and activation results are compared with full durations. Finally, group comparisons are conducted with both early stopped and full duration scan data. Numerical parallelization was employed to facilitate completion of computations involving a new scan within every repetition time (TR). Results: Use of SPRT demonstrates the feasibility and efficiency gains of automated early stopping, with comparable activation detection as with full protocols. Dynamic stopping of stimulus administration was achieved in around half of subjects, with typical time savings of up to 33% (4 min on a 12 min scan). A group analysis produced similar patterns of activity for control subjects between early stopping and full duration scans. The EPT group, individually, demonstrated more variability in location and extent of the activations compared to the normal term control group. This was apparent in the EPT group results, reflected by fewer and smaller clusters. Conclusion: A systematic statistical approach for early stopping with real-time fMRI experimentation has been implemented. This dynamic approach has promise for reducing subject burden and fatigue effects.

Project description:PurposeCatheters and guidewires are used extensively in cardiac catheterization procedures such as heart arrhythmia treatment (ablation), angioplasty, and congenital heart disease treatment. Detecting their positions in fluoroscopic X-ray images is important for several clinical applications, for example, motion compensation, coregistration between 2D and 3D imaging modalities, and 3D object reconstruction.MethodsFor the generalized framework, a multiscale vessel enhancement filter is first used to enhance the visibility of wire-like structures in the X-ray images. After applying adaptive binarization method, the centerlines of wire-like objects were extracted. Finally, the catheters and guidewires were detected as a smooth path which is reconstructed from centerlines of target wire-like objects. In order to classify electrode catheters which are mainly used in electrophysiology procedures, additional steps were proposed. First, a blob detection method, which is embedded in vessel enhancement filter with no additional computational cost, localizes electrode positions on catheters. Then the type of electrode catheters can be recognized by detecting the number of electrodes and also the shape created by a series of electrodes. Furthermore, for detecting guiding catheters or guidewires, a localized machine learning algorithm is added into the framework to distinguish between target wire objects and other wire-like artifacts. The proposed framework were tested on total 10,624 images which are from 102 image sequences acquired from 63 clinical cases.ResultsDetection errors for the coronary sinus (CS) catheter, lasso catheter ring and lasso catheter body are 0.56 ± 0.28 mm, 0.64 ± 0.36 mm, and 0.66 ± 0.32 mm, respectively, as well as success rates of 91.4%, 86.3%, and 84.8% were achieved. Detection errors for guidewires and guiding catheters are 0.62 ± 0.48 mm and success rates are 83.5%.ConclusionThe proposed computational framework do not require any user interaction or prior models and it can detect multiple catheters or guidewires simultaneously and in real-time. The accuracy of the proposed framework is sub-mm and the methods are robust toward low-dose X-ray fluoroscopic images, which are mainly used during procedures to maintain low radiation dose.

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Use of pressure-volume conductance catheters in real-time cardiovascular experimentation.

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Use of pressure-volume conductance catheters in real-time cardiovascular experimentation.

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