• J. Cardiothorac. Vasc. Anesth. · Nov 2024

    Introduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration.

    • Michael Vandenheuvel, Stefaan Bouchez, Jakob Labus, Patrick Wouters, and Eckhard Mauermann.
    • Department of Anesthesiology, University Hospital of Ghent, Ghent, Belgium. Electronic address: michael.vandenheuvel@uzgent.be.
    • J. Cardiothorac. Vasc. Anesth. 2024 Nov 26.

    ObjectivesIn the dynamic perioperative setting, changing fluid states complicate determination of ventricular function. This study evaluated the feasibility of clinical ventricular pressure-volume loop (PVL) construction using routine monitoring (echocardiography and invasive pressure monitoring). An application was developed and tested with biventricular simulated data and right ventricular (RV) clinical data.DesignProspective observational study.SettingSingle center, university teaching hospital.ParticipantsAdults requiring cardiac surgery.InterventionsAfter code development, a simulated dataset (Harvi simulator) was used to test the application. Next, RV data from 12 consenting adult elective cardiac surgery patients were analyzed in 4 distinct physiologic settings, comparing supine baseline condition with a passive leg raise setting, during maintained elevated positive end-expiratory pressure (PEEP), and after chest wall opening.Measurements And Main ResultsOverall PVL feasibility combining 3 acquisitions was 97.6%. Derived PVL parameters followed expected patterns: during leg raise, end-diastolic volume (+36 ± 23%; p = 0.0054) and stroke volume (+32 ± 27%; p = 0.017) augmented with stable heart rate (HR), resulting in a trend toward increased cardiac output (+34 ± 33%; p = 0.06). PEEP resulted in a marked increase in arterial elastance (+126 ± 80%; p = 0.0000068) compared to the other conditions. Chest opening resulted in minor effects.ConclusionsThis study introduces a vendor-independent application to generate PVLs from routinely available clinical data. The results highlight the potential application of the pressure-volume framework in cardiovascular research and patient care. A lack of external validation must be taken into account. Further research is warranted to validate the application. The app can be accessed at https://michael-vandenheuvel.shinyapps.io/eMv_Looper/.Copyright © 2024 Elsevier Inc. All rights reserved.

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