Modeling Cardiac Response to Transient Hemodynamic Changes: Beyond dp/dt Max and New Insights from IVCO and ES Point Analysis

Abstract

Traditional indices such as dp/dt max remain widely used in assessing ventricular contractility, yet their load-dependence limits clinical precision, particularly during dynamic hemodynamic shifts. This letter to the Editor advocates for a more physiologically grounded approach using dual pressure catheters equipped with two high-fidelity sensors, one in the left ventricle (LV) and one in the aorta, to capture real-time pressure gradients and valve events with high temporal resolution. When combined with transient inferior vena cava occlusion (IVCO), this setup enables accurate identification of the true end-systolic (ES) point, typically marked by dp/dt min or the dicrotic notch on the aortic pressure waveform. This method allows for the construction of more physiologically valid end-systolic pressure-volume relationships (ESPVR). It introduces the novel peak pressure end-systolic pressure-volume relationship (PPESPVR) model, which links peak LV pressure to the ES point within a single cardiac cycle. The resulting volume intercept (Vint) and end-systolic fraction (ESF) offer new insights into myocardial performance under varying preload and afterload conditions, without requiring extensive hemodynamic manipulation. This dual-sensor approach not only enhances diagnostic accuracy but also opens the door to real-time, patient-specific contractility assessment in both research and clinical settings.

Keywords

Cardiac contractility assessment / Pressure-volume loop (PVL) modeling / End-systolic elastance (Ees) / ESPVR (end-systolic pressure-volume relationship) / PPESPVR (peak pressure end-systolic pressure-volume relationship)

Statement of the Use of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this manuscript, the author used Microsoft 365 Copilot in order to assist with the organization and structuring of content and to ensure consistency in tone and formatting. After using this tool/service, the author reviewed and edited the content as needed and takes full responsibility for the content of the published article.

Ethics Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data will be available upon request.

Funding

This research received no external funding.

Declaration of Competing Interest

The author declare that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

[1] Burkhoff D, Mirsky I, Suga H. Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: A guide for clinical, translational, and basic researchers. Am. J. Physiol. Heart Circ. Physiol. 2005, 289, H501-H512. doi:10.1152/ajpheart.00138.2005.

[2] Kapur NK, Paruchuri V, Jagannathan A, Steinberg D, Chakrabarti AK, Pinto D, et al. Mechanical circulatory support for right ventricular failure. JACC Heart Fail. 2013, 1, 127-134. doi:10.1016/j.jchf.2013.01.007.

[3] Hamlin RL, del Rio C. dP/dt(max)--a measure of ‘baroinometry’. J. Pharmacol. Toxicol. Methods 2012, 66, 63-65. doi:10.1016/j.vascn.2012.01.001.

[4] Kass DA, Midei M, Graves W, Brinker JA, Maughan WL. Use of a conductance (volume) catheter and transient inferior vena caval occlusion for rapid determination of pressure-volume relationships in man. Cathet Cardiovasc. Diagn. 1988, 15, 192-202. doi:10.1002/ccd.1810150314.

[5] Konecny F. Systolic Indices of Cardiac Contractility: Modeling and Analysis using Pressure-Volume Loop. Eur. J. Med. Health Sci. 2023, 5, 5-12. doi:10.24018/ejmed.2023.5.4.1731.