Published in:
01-07-2012 | Original Article
Noninvasive assessment of left ventricular contractility in pediatric patients using the maximum rate of pressure rise in peripheral arteries
Published in: Heart and Vessels | Issue 4/2012
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The maximum rate of left ventricular pressure rise (LV dp/dt
max) is a good indicator of ventricular contractility. However, its measurement requires invasive cardiac catheterization. By applying the relationship between the ratio of aorta (Ao) dp/dt
max to LV dp/dt
max and the mean artery pressure (MAP), we tested the possible noninvasive estimation of LV dp/dt
max by the maximum rate of pressure rise in peripheral arteries, as measured by tonometry. The study subjects were 31 children with cardiovascular disease. The LV and Ao pressures were measured during cardiac catheterization, with simultaneous recording of the brachial (BrA) or radial (RaA) artery pressure. The relationships between BrA dp/dt
max and Ao dp/dt
max and between RaA dp/dt
max and Ao dp/dt
max were determined (Ao dp/dt
max = 0.299 × BrA dp/dt
max + 210.6, n = 17, r = 0.78, SEE = 74.0, P = 0.0002, and Ao dp/dt
max = 1.442 × RaA dp/dt
max + 165.9, n = 14, r = 0.87, SEE = 66.1, P = 0.0001). Using these relationships and the equation Ao dp/dt
max/LV dp/dt
max = 0.694 − 4.00 × 10−3 × MAP, LV dp/dt
max was estimated from BrA dp/dt
max or RaA dp/dt
max. The estimated LV dp/dt
max correlated well with the measured LV dp/dt
max independent of the site of measurement (y = 0.912 × x + 112.9, r = 0.91, P < 0.0001). Furthermore, there was excellent correlation between the measured and estimated LV dp/dt
max after changes in contractility with dobutamine in 10 randomly selected patients (y = 0.86 × x + 34.2, r = 0.77, P = 0.01). It is possible to estimate LV dp/dt
max noninvasively in children using tonometry. This procedure can be useful for bedside assessment of LV contractility and the clinical management of patients with cardiovascular disease.