Effects of acute changes in canine LV-chamber volume and shape on accuracy of impedance catheter estimates of LV-chamber volume.

The accuracy with which a multiple-electrode impedance catheter (IC) tracks instantaneous global, in-situ left ventricular (LV) volumes was tested in 13 anesthetized dogs scanned in the Dynamic Spatial Reconstructor (DSR), a fast volumetric computed tomographic (CT) scanner. All dogs were scanned during control conditions and during an acute hemodynamic intervention. Hypertonic saline calibrations were performed for the IC prior to each DSR scan. In six of the dogs the IC-derived LV end-diastolic volume (Y) correlated with the DSR-derived global LV end-diastolic volume (X) as follows: end-diastolic volume, Y = 1.01X - 9.9, r = 0.812. The IC-derived LV end-diastolic volume, under control conditions, correlated with the DSR-derived truncated (i.e., that region of the LV chamber between the proximal and distal electrodes of the IC catheter) LV end-diastolic volume, Y = 1.00X + 17.4, r = 0.803. Under reduced preload the relation was Y = 1.3X - 15.26, r = 0.911. The segmental volume (between adjacent sensing electrodes on the IC) at the basal portion of the LV correlated poorly (Y = 1.88X + 3.3, r = 0.459 etc.), but correlated better at mid- and more apical LV levels (Y = 0.97X + 2.7, r = 0.762). Correlations between segmental stroke volumes were similar at basal (Y = 1.31X + 1.60, r = 0.815) and mid- and more apical levels (Y = 1.42X + 0.11, r = 0.763). Stroke volume during acute ischemia (two dogs) was Y = 1.33X - 1.41, r = 0.717; during acutely decreased preload (four dogs) it was Y = 1.24X - 2.88, r = 0.572). Thus, the IC tracks the changes in LV-chamber volume throughout a cardiac cycle quite well under a variety of conditions, but accuracy deteriorates as the shape of the LV chamber changes in response to changes in hemodynamic loading or local myocardial ischemia.

Hemodynamic results of percutaneous aortic balloon valvuloplasty as assessed by sequential Doppler echocardiographic studies.

We determined the sequential hemodynamic changes after percutaneous aortic balloon valvuloplasty by means of two-dimensional and Doppler echocardiographic examinations in 25 patients immediately before, immediately after, and 24 to 36 hours after valvuloplasty. An aortic valve area was determined at all three time periods by using the continuity equation from the Doppler velocity profiles. The aortic valve area by Doppler echocardiography immediately before valvuloplasty correlated with that determined by cardiac catheterization (r = 0.85, SEE = 0.08 cm2). The mean aortic valve gradient by Doppler echocardiography was 50 +/- 22 mm Hg before the procedure, decreasing to 29 +/- 12 mm Hg (P less than 0.001), with a small, but significant, increase 1 day later to 33 +/- 13 mm Hg (P less than 0.001). The mean subvalvular velocity increased from 0.44 +/- 0.13 to 0.52 +/- 0.15 m/sec immediately after valvuloplasty (P less than 0.001), increasing further to 0.60 +/- 0.16 m/sec 1 day later (P less than 0.001). The resultant aortic valve area increased from 0.45 +/- 0.11 to 0.73 +/- 0.18 cm2 immediately after (P less than 0.05). One day later, the aortic valve area increased further to 0.86 +/- 0.19 cm2 (P less than 0.05). Because of the dynamic changes occurring during the first 24 to 36 hours after balloon valvuloplasty, hemodynamic measurements taken immediately after the procedure may underestimate the efficacy of this technique.