title: Noninvasive single-beat determination of left ventricular end-systolic elastance in humans.
abstract: OBJECTIVE
  The goal of this study was to develop and validate a method to estimate left ventricular end-systolic elastance (E(es)) in humans from noninvasive single-beat parameters.
  
  
  BACKGROUND
  Left ventricular end-systolic elastance is a major determinant of cardiac systolic function and ventricular-arterial interaction. However, its use in heart failure assessment and management is limited by lack of a simple means to measure it noninvasively. This study presents a new noninvasive method and validates it against invasively measured E(es).
  
  
  METHODS
  Left ventricular end-systolic elastance was calculated by a modified single-beat method employing systolic (P(s)) and diastolic (P(d)) arm-cuff pressures, echo-Doppler stroke volume (SV), echo-derived ejection fraction (EF) and an estimated normalized ventricular elastance at arterial end-diastole (E(Nd)): E(es(sb)) = [P(d) - (E(Nd(est)) x P(s) x 0.9)[/(E(Nd(est)) x SV). The E(Nd) was estimated from a group-averaged value adjusted for individual contractile/loading effects; E(es(sb)) estimates were compared with invasively measured values in 43 patients with varying cardiovascular disorders, with additional data recorded after inotropic stimulation (n = 18, dobutamine 5 to 10 microg/kg per min). Investigators performing noninvasive analysis were blinded to the invasive results.
  
  
  RESULTS
  Combined baseline and dobutamine-stimulated E(es) ranged 0.4 to 8.4 mm Hg/ml and was well predicted by E(es(sb)) over the full range: E(es) = 0.86 x E(es(sb)) + 0.40 (r = 0.91, SEE = 0.64, p < 0.00001, n = 72). Absolute change in E(es(sb)) before and after dobutamine also correlated well with invasive measures: E(es(sb)): DeltaE(es) = 0.86 x DeltaE(es(sb)) + 0.67 (r = 0.88, p < 0.00001). Repeated measures of E(es(sb)) over two months in a separate group of patients (n = 7) yielded a coefficient of variation of 20.3 +/- 6%.
  
  
  CONCLUSIONS
  The E(es) can be reliably estimated from simple noninvasive measurements. This approach should broaden the clinical applicability of this useful parameter for assessing systolic function, therapeutic response and ventricular-arterial interaction.
authors.affiliation: Division of Cardiology, Taipei Veterans General Hospital, R.O.C., Taipei, Taiwan, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Chen
authors.forename: B
authors.initials: B
authors.lastname: Fetics
authors.forename: E
authors.initials: E
authors.lastname: Nevo
authors.forename: C E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: K R
authors.initials: KR
authors.lastname: Chiou
authors.forename: P A
authors.initials: PA
authors.lastname: Ding
authors.forename: M
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: D A
authors.initials: DA
authors.lastname: Kass
mesh_terms: D000328:Adult; D000368:Aged; D003971:Diastole / Q000502:physiology*; D004280:Dobutamine; D015150:Echocardiography, Doppler; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D004280:Dobutamine