Key result
Isovolumetric contraction AUC correlates with ventricular ejection fraction and explains ~49% of ventricular work.
Why the study?
End-systolic elastance is complex to evaluate, while ejection fraction has significant limitations in afterload mismatch, prompting evaluation of the isovolumetric contraction area under the curve to assess myocardial contractility.
Does the area under the curve of isovolumetric contraction correlate with established markers of ventricular performance in patients with afterload mismatch?
Observational (n=110)
No
Does the area under the curve of isovolumetric contraction correlate with established markers of ventricular performance in patients with afterload mismatch?
The area under the curve of isovolumetric contraction may serve as a useful surrogate marker for ventricular performance in patients with afterload mismatch, correlating well with ejection fraction and total ventricular work.
Answers are grounded in this paper and cite their sources.
May support isovolumetric contraction AUC as a ventricular performance surrogate in afterload mismatch; leaves open prospective validation before clinical use.
Introduction: The evaluation of myocardial contractility is essential in cardiology practice. The gold standard for this evaluation is the end-systolic elastance, but it the method involved is complex. Echocardiographic measurement of the ejection fraction (EF) is the most commonly used parameter in clinical practice, but it has significant limitations, especially in patients with afterload mismatch. In this study, the area under the curve (AUC) of the isovolumetric contraction was measured to evaluate the myocardial contractility in patients with pulmonary arterial hypertension and severe aortic stenosis. Methods: 110 patients with severe aortic stenosis and pulmonary arterial hypertension were included in this study. The AUC of the isovolumetric contraction was measured using pressure curves of the right ventricle–pulmonary artery and left ventricle–aorta ascendens. This AUC was then correlated with the echocardiographically measured EF, stroke volume (SV), and total ventricular work. Results: The AUC of the isovolumetric contraction showed a statistically significant correlation with the EF of the corresponding ventricle (p < 0.0001). Both the AUC of the isovolumetric contraction and the EF showed a statistically significant correlation with the total work of the ventricle (AUC: R2 0.49, p < 0.001; EF: R2 0.51, p < 0.001). However, the SV only showed a statistically significant correlation with the EF. A statistically significant one-sample t-test could be found for the EF (decreased, p < 0.001) and for the AUC of the isovolumetric contraction (increased, p < 0.001), but not for the total work of the ventricle. Conclusion: The AUC space of the isovolumetric contraction is a useful marker of ventricular performance in patients with afterload mismatch, showing a statistically significant correlation with the EF and the total ventricular work. This method may have potential for use in clinical practice, especially in challenging cardiological cases. However, further studies are needed to evaluate its usefulness in healthy individuals and in other clinical scenarios.
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Sinanis et al. (2023) conducted an observational in Severe aortic stenosis and pulmonary arterial hypertension (afterload mismatch) (n=110). Area under the curve (AUC) of isovolumetric contraction vs. Echocardiographically measured ejection fraction (EF) was evaluated on Correlation with total ventricular work and ejection fraction of the corresponding ventricle (R² 0.49 (with total ventricular work), p=<0.001). The AUC of isovolumetric contraction correlated with both ventricular ejection fraction and total ventricular work in patients with afterload mismatch.
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