Faculty Bibliography

Pressure volume (PV) based analysis, using classic hemodynamic principles, has served as a basis for our understanding of cardiac physiology and disease states for decades. However, PV analysis has been restricted to primarily the basic research setting and for preclinical testing and has not be widely applied in part because of the invasive nature of the procedure and the expertise required to obtain adequate data using the conductance catheter. Development of single beat methodologies that rely on echocardiographic measurements of ventricular volume and Doppler and peripheral estimates of ventricular pressure and timing of the cardiac cycle has enabled broader application of PV analysis. This review explores the physiologic background, basic methodology, and recent and potential future applications of noninvasive PV analysis.

The Heart Failure Survival Score (HFSS) and peak exercise oxygen consumption (VO2) predict survival in ambulatory patients with heart failure and are used for selection for cardiac transplantation. However, the populations tested have predominately been men. To investigate if peak VO2 and the HFSS predict prognosis in women, we derived HFSS and measured peak VO2 in 274 women referred for cardiac transplantation and in 278 men matched by referral year. Seven HFSS parameters were obtained, including presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, peak VO2, presence of intraventricular conduction defects, and serum sodium. Subjects were divided into high-, medium-, and low-risk strata for HFSS and VO2 based on previous cutpoints. Survival curves were derived using Kaplan-Meier analysis and compared by log-rank analysis. Follow-up averaged 929 days. For women, 1-year event-free survival in the low- (>14), medium- (10.1 to 14), and high-risk (<10 ml/kg/min) VO2 strata was 93%, 84%, and 80%, respectively. For the HFSS, 1-year event-free survival in the low- (>or=8.10), medium- (7.20 to 8.09), and high-risk (<or=7.19) strata was 90%, 87%, and 67%, respectively. Survival curves for VO2 (p <0.01) and HFSS (p <0.001) demonstrated significant differences. In both genders, the low-risk groups for HFSS and VO2 can safely have transplantation deferred. Women had better survival than men for a given peak VO2. The HFSS was consistent between genders. In conclusion, peak VO2 and the HFSS are excellent parameters to predict survival in women with congestive heart failure. THE HFSS is more consistent than the peak VO2 between the genders.

Data regarding the effects of beta blockers on left ventricular (LV) function after 12 months are scarce in ischemic and nonischemic cardiomyopathy. Echocardiograms of 72 patients with ischemic and nonischemic cardiomyopathy, who were free of clinical events susceptible to alter LV function while receiving carvedilol or metoprolol for at least 24 months, were prospectively reanalyzed. Twelve months after beta-blocker initiation, LV ejection fraction (EF) increased by > or = 5% in 75% of patients, whereas EF failed to increase by 5% or decreased in the remaining 25%. Over the subsequent 32 months, LVEF increased further in patients who had experienced an initial EF increase by > or = 5%, whereas EF tended to further decrease in patients who had experienced an initial EF increase of <5% or a decrease. Thus, the benefits of carvedilol or metoprolol on LV function are long lasting in patients with ischemic or nonischemic cardiomyopathy who are free of events susceptible to alter LV function while receiving beta blockade.