Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug;10(4):2607-2620.
doi: 10.1002/ehf2.14339. Epub 2023 Jun 21.

Pressure-strain loops unveil haemodynamics behind mechanical circulatory support systems

Federico Landra  1 , Giulia Elena Mandoli  1 , Carlotta Sciaccaluga  1 , Guglielmo Gallone  2 , Francesco Bruno  2 , Chiara Fusi  1 , Maria Barilli  1 , Marta Focardi  1 , Luna Cavigli  1 , Flavio D'Ascenzi  1 , Sonia Bernazzali  3 , Massimo Maccherini  3 , Matteo Cameli  1 , Serafina Valente  1
Affiliations
Review

Pressure-strain loops unveil haemodynamics behind mechanical circulatory support systems

Federico Landra et al. ESC Heart Fail. 2023 Aug.

Abstract

Aims: Mechanical circulatory support (MCS) systems are increasingly employed in cardiogenic shock and advanced heart failure. A thorough understanding of the complex interactions occurring among heart, vasculature, and device is essential to optimize patient's management. The aim of this study is to explore non-invasive haemodynamic profiling of patients undergoing MCS based on pressure-strain (PS) analysis.

Methods: Clinical and echocardiographic data from consecutive patients undergoing different MCS systems positioning/implantation admitted to the third level cardiological intensive care unit of Siena Hospital from August 2021 to November 2021 were retrospectively reviewed. Patients without a useful echocardiographic exam or without arterial blood pressure recording at the time of echocardiography were excluded. Myocardial work analysis was performed in the included patients.

Results: We reviewed 18 patients, of which nine were excluded. Included patients were three patients with intra-aortic balloon pump (IABP), two patients with durable left ventricular assist device (dLVAD), two patients with Impella®, one patient with extracorporeal membrane oxygenation (ECMO), and one patient with ECMO and IABP. Myocardial work analysis was feasible in each included patient. The use of IABP shifted the PS curve rightward and downward. Global work index (GWI) and global wasted work (GWW) decreased after IABP positioning, whereas global work efficiency (GWE) increased. The use of continuous-flow pumps, whether temporaneous (Impella®) or long term (dLVAD), induced a change in the PS loop morphology, with a shift towards a triangular shape. ECMO positioning alone resulted in a narrowing of the PS loop, with a decrease in GWI and GWE and an increase in GWW and mean arterial pressure. The combined used of IABP with ECMO widened the PS loop and improved GWI and GWE.

Conclusions: PS loops analysis in patients undergoing MCS seems to be feasible and may unveil MCS-induced haemodynamic variations. Myocardial work could be used to monitor ventricular-arterial-device coupling and guide tailored MCS management.

Keywords: Advanced heart failure; Cardiogenic shock; Mechanical circulatory support; Myocardial work; Pressure-strain loop; Ventricular-arterial coupling.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Pre‐positioning and during IABP support pressure–strain loops and global work index bull's eyes of the first patient with IABP. (A) The red curve represents the pressure–strain loop before IABP positioning, the yellow one the pressure–strain loop during IABP support. (B) Global work index bull's eye before IABP positioning. (C) Global work index bull's eye during IABP support. LVP, left ventricular pressure.
Figure 2
Figure 2
Pre‐positioning and during Impella® support pressure–strain loops and global work index bull's eyes of the first patient with Impella®. (A) The red curve represents the pressure‐strain loop before Impella® positioning, the yellow one the pressure–strain loop during Impella® support. (B) Global work index bull's eye before Impella® positioning. (C) Global work index bull's eye during Impella® support. LVP, left ventricular pressure.
Figure 3
Figure 3
Pre‐implantation and during HeartMate® III support pressure–strain loops and global work index bull's eyes of the first patient with durable left ventricular assist device. (A) The red curve represents the pressure–strain loop before HeartMate® III positioning, the yellow one the pressure–strain loop during HeartMate® III support. (B) Global work index bull's eye before HeartMate® III implantation. (C) Global work index bull's eye during HeartMate® III support. LVP, left ventricular pressure.
Figure 4
Figure 4
Pre‐positioning and during ECMO and IABP support pressure–strain loops and myocardial work bull's eyes of the first patient with ECMO. (A) The red curve represents the pressure–strain loop before ECMO and IABP positioning, the yellow one the pressure–strain loop during ECMO and IABP support. (B) Global work index and global work efficiency bull's eye before ECMO and IABP positioning. (C) Global work index and global work efficiency bull's eye during ECMO and IABP support. LVP, left ventricular pressure.
Figure 5
Figure 5
Pre‐positioning and during ECMO support pressure–strain loops and global work index bull's eyes of the second patient with ECMO. (A) The red curve represents the pressure–strain loop before ECMO positioning, the yellow one the pressure–strain loop during ECMO support. (B) Global work index bull's eye before ECMO positioning. (C) Global work index bull's eye during ECMO support. LVP, left ventricular pressure.
See this image and copyright information in PMC

References

    1. Rihal CS, Naidu SS, Givertz MM, Szeto WY, Burke JA, Kapur NK, Kern M, Garratt KN, Goldstein JA, Dimas V, Tu T, Society for Cardiovascular Angiography and Interventions (SCAI) , Heart Failure Society of America (HFSA) , Society of Thoracic Surgeons (STS) , American Heart Association (AHA) , American College of Cardiology (ACC) . 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care: endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino America. J Am Coll Cardiol. 2015; 65: e7–e26. - PubMed
    1. Van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017; 136: e232–e268. - PubMed
    1. Chioncel O, Parissis J, Mebazaa A, Thiele H, Desch S, Bauersachs J, Harjola VP, Antohi EL, Arrigo M, Ben Gal T, Celutkiene J, Collins SP, DeBacker D, Iliescu VA, Jankowska E, Jaarsma T, Keramida K, Lainscak M, Lund LH, Lyon AR, Masip J, Metra M, Miro O, Mortara A, Mueller C, Mullens W, Nikolaou M, Piepoli M, Price S, Rosano G, Vieillard‐Baron A, Weinstein JM, Anker SD, Filippatos G, Ruschitzka F, Coats AJS, Seferovic P. Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020; 22: 1315–1341. - PubMed
    1. Tehrani BN, Truesdell AG, Psotka MA, Rosner C, Singh R, Sinha SS, Damluji AA, Batchelor WB. A standardized and comprehensive approach to the management of cardiogenic shock. JACC Hear Fail. 2020; 8: 879–891. - PMC - PubMed
    1. Molina EJ, Shah P, Kiernan MS, Cornwell WK III, Copeland H, Takeda K, Fernandez FG, Badhwar V, Habib RH, Jacobs JP, Koehl D, Kirklin JK, Pagani FD, Cowger JA. The Society of Thoracic Surgeons Intermacs 2020 annual report. Ann Thorac Surg. 2021; 111: 778–792. - PubMed