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Basic hemodynamic principles viewed through pressure volume relations
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Cardiovascular Physiology
and Hemodynamics
Daniel Burkhoff MD PhD
Adjunct Associate Professor
Columbia University
4
If your research involves studying the effects of altered
genes, cells, extracellular matrix, drugs, etc, on
cardiovascular properties, there are several key
concepts, indexes and measurement techniques you
should be aware of:
PRELOAD
AFTERLOAD
CONTRACTILITY
LUSITROPY
5
Resources
Harvi
Interactive, simulation-based
textbook for the iPad
iPad 2, 3 and mini (iOS 7)
6
Foundations in Cellular
Physiology
7
The Sarcomere
8
Sarcomere F-L Relation
9
Muscle Heart
Force - Length
Pressure - Volume
10
Integrated Cardiovascular Physiology
Ventricular-Vascular Interactions
Cardiac Output
Arterial Blood Pressures
Venous Blood Pressures
11
Physiology of the
Intact Heart
The Cardiac Cycle:
The Classic “Wiggers” Diagram
12
0 25 50 75 100 125 150
0
25
50
75
100
125
150
LV Volume (ml)
LVPressure(mmHg)
MV Closes
AoV Opens
AoV
Closes
MV
Opens
Isovolumic
Contraction
Isovolumic
Relaxation
Filling
Ejection
The Cardiac Cycle
Pressures-Volumes Loop
13
LV Volume (ml)
LVPressure(mmHg)
SV
Stroke Volume
End Diastolic Volume
End Systolic Volume
SV = ESV-EDV
EF = SV/EDV
CO=SV.HR
Volumes Retrievable from the PV Loop
ESV EDV
14
0 75 150
0
75
150
LV Volume (ml)
LVPressure(mmHg)
DBP
SBP
Pes
EDP
LAP
Systolic Blood Pressure
End Systolic Pressure
Diastolic Blood Pressure
End Diastolic Pressure
Left Atrial Pressure
15
Pressures Retrievable from the PV Loop
16
Pressure-Volume Relations
The Basics
0 25 50 75 100 125 150
0
25
50
75
100
125
150
LV Volume (ml)
LVPressure(mmHg)
17
Pressure-Volume Loops and Relationships
0 75 150
0
LV Volume (ml)
LVPressure
(mmHg)
10
20
30
End-Diastolic Pressure-Volume Relationship
18
Vo
P = β(eα(V-Vo)-1)
0 25 50 75 100 125 150
0
25
50
75
100
125
150
LV Volume (ml)
LVPressure(mmHg)
Vo
Ees
End-Systolic Pressure-Volume
Relationship
(ESPVR)
Pes = Ees(Ves-Vo)
19
End-Systolic Pressure-Volume Relationship
20
EDPVR and ESPVR define the boundaries within
which the PV Loop sits, independent
of “preload” and “afterload”
21
Preload
22
Sarcomere Isometric F-L Relation
0 50 100 150
0
50
100
150
LV Volume (ml)
LVPressure(mmHg)
Preload:
The load imposed on the ventricle
at the end of diastole. The most
common measures of preload
include end-diastolic volume (EDV)
and end-diastolic pressure (EDP).
23
Preload: Ventricular Level
EDV, EDP
0 50 100 150
0
50
100
150
LVPressure(mmHg)
Increased
Preload
Preload:
The load imposed on the ventricle
at the end of diastole. The most
common measures of preload
include end-diastolic volume (EDV)
and end-diastolic pressure (EDP).
24
Preload: Ventricular Level
LV Volume (ml)
0 50 100 150
0
50
100
150
LVPressure(mmHg)
Decreased
Preload
Preload:
The load imposed on the ventricle
at the end of diastole. The most
common measures of preload
include end-diastolic volume (EDV)
and end-diastolic pressure (EDP).
25
Preload: Ventricular Level
LV Volume (ml)
0 50 100 150
0
50
100
150
LVPressure(mmHg)
Decreased
Preload
Increased
Preload
The different loops are
obtained with different
preloads, but constant
contractility and afterload.
26
Preload: Ventricular Level
LV Volume (ml)
27
Afterload
28
Afterload: Intact Ventricle
• There are several different indexes of
ventricular afterload, each with its own
merits and drawbacks:
• Myocardial wall stress
• Arterial Pressure
• Arterial Resistance
• Arterial Impedance
29
Afterload: Total Peripheral Resistance
• Conceptually, for the intact LV, a measure of afterload should
provide a quantitative index that uniquely characterizes the
arterial system independent of preload and contractility
• Such an index can be derived from the
relationship between pressure and flow
through the system
• One index, total peripheral resistance
(TPR), is based on Ohms law and is
simply the ratio between mean pressure
across the system and mean flow:
TPR = (MAP-CVP)/CO
MAP
CVP
Flow
0 50 100 150
0
50
100
150
LV Volume (ml)
LVPressure(mmHg)
Afterload: The mechanical load
on the ventricle during ejection.
Under normal physiological
conditions, this is determined by
the arterial system. The most
common index of afterload is total
peripheral resis-tance (TPR):
TPR = (MAP-CVP)/CO
30
Afterload: Impact on LV Performance
0 50 100 150
0
50
100
150
LV Volume (ml)
LVPressure(mmHg)
Increased
TPR
31
Afterload: Impact on LV Performance
Despite constant preload
and contractility:
Increased TPR
• Increased pressure
• Decreased SV
0 50 100 150
0
50
100
150
LV Volume (ml)
LVPressure(mmHg)
Decreased
TPR
32
Afterload: Impact on LV Performance
Despite constant preload
and contractility:
Increased TPR
• Increased pressure
• Decreased SV
Decreased TPR
• Decreased SV
• Increased pressure
0 50 100 150
0
50
100
150
LV Volume (ml)
LVPressure(mmHg)
Decreased
TPR
Increased
TPR
33
Afterload: Impact on LV Performance
Despite constant preload
and contractility:
The pressure-volume loop
falls within the boundaries
established by the
ESPVR and EDPVR
34
Contractility
35
Contractility:
The concept applied to Isolated Muscle
36
Contractility:
The concept applied to the Left Ventricle
0 50 100 150
0
25
50
75
100
125
150
LV Volume (ml)
LVPressure(mmHg)
Ees
Ees
37
Contractility
38
Lusitropy
Diastole
The EDPVR is
nonlinear and
defines the boundary
for the position of the
end-diastolic
pressure-volume
point of the PV loop:
Ped= β(eα(Ved-Vo)-1)
39
Lusitropy:
Passive Diastolic Properties
40
Lusitropy:
Passive Diastolic Properties
41
Lusitropy:
Passive Diastolic Properties
42
Lusitropy:
Passive Diastolic Properties
The EDPVR shifts leftward:
• Hypertrophic cardiomyopathies
• Infiltrative diseases (amyloid, sarcoid)
• Restrictive cardiomyopathy
43
Lusitropy:
The Rate of Relaxation
The decay of pressure during
the isovolumic relaxation phase
of diastole follows a roughly
exponential time course.
P = e-t/τ
Active relaxation can therefore
be characterized by τ, the time
constant of relaxation.
Isovolumic
Relaxation
LVP
44
Lusitropy:
The Rate of Relaxation
Isovolumic
Relaxation
τLVP
The decay of pressure during
the isovolumic relaxation phase
of diastole follows a roughly
exponential time course.
P = e-t/τ
Active relaxation can therefore
be characterized by τ, the time
constant of relaxation.
45
τ is influenced by:
• Contractile element isoforms
• Heart Rate
• τ decreases significantly as heart rate increases
• Energy Supply
• τ increases significantly during myocardial
ischemia
• β Stimulation
• τ decreases significantly with β-adrenergic
stimulation or any drugs that increase ATP
Lusitropy:
The Rate of Relaxation
46
Lusitropy
• Passive diastolic properties: the extent of
relaxation
• Characterized by the EDPVR
• Compliance
• Stiffness
• Capacitance
• Active relaxation: the rate of relaxation
• Indexed by τ
• Impact on cardiac performance highly
dependent on heart rate
• Concept of “incomplete relaxation”
47
Cardiac Performance
cardiac output, blood pressure, etc
Determined by the interaction between
the heart and vascular systems
48
SUMMARY
PRELOAD
AFTERLOAD
CONTRACTILITY
LUSITROPY
49
Harvi
Interactive, simulation-based
textbook for the iPad
iPad 2, 3 and mini (iOS 7)
Thank you for taking part in this event.We encourage all attendees to
register at www.insidescientific.com for notifications about future webinars.
Hemodynamic Assessment Series– Part 1: PV Loop Case Study
by Transonic
Improve PV Loop Results by Heating & Monitoring During Surgery
by Indus Instruments
Understanding the Translational Value of PV Loops from Mouse to Man
by Millar
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Basic hemodynamic principles viewed through pressure volume relations

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Basic hemodynamic principles viewed through pressure volume relations

  • 2. InsideScientific is an online educational environment designed for life science researchers. Our goal is to aid in the sharing and distribution of scientific information regarding innovative technologies, protocols, research tools and laboratory services.
  • 3. Cardiovascular Physiology and Hemodynamics Daniel Burkhoff MD PhD Adjunct Associate Professor Columbia University
  • 4. 4 If your research involves studying the effects of altered genes, cells, extracellular matrix, drugs, etc, on cardiovascular properties, there are several key concepts, indexes and measurement techniques you should be aware of: PRELOAD AFTERLOAD CONTRACTILITY LUSITROPY
  • 9. 9 Muscle Heart Force - Length Pressure - Volume
  • 10. 10 Integrated Cardiovascular Physiology Ventricular-Vascular Interactions Cardiac Output Arterial Blood Pressures Venous Blood Pressures
  • 12. The Cardiac Cycle: The Classic “Wiggers” Diagram 12
  • 13. 0 25 50 75 100 125 150 0 25 50 75 100 125 150 LV Volume (ml) LVPressure(mmHg) MV Closes AoV Opens AoV Closes MV Opens Isovolumic Contraction Isovolumic Relaxation Filling Ejection The Cardiac Cycle Pressures-Volumes Loop 13
  • 14. LV Volume (ml) LVPressure(mmHg) SV Stroke Volume End Diastolic Volume End Systolic Volume SV = ESV-EDV EF = SV/EDV CO=SV.HR Volumes Retrievable from the PV Loop ESV EDV 14
  • 15. 0 75 150 0 75 150 LV Volume (ml) LVPressure(mmHg) DBP SBP Pes EDP LAP Systolic Blood Pressure End Systolic Pressure Diastolic Blood Pressure End Diastolic Pressure Left Atrial Pressure 15 Pressures Retrievable from the PV Loop
  • 17. 0 25 50 75 100 125 150 0 25 50 75 100 125 150 LV Volume (ml) LVPressure(mmHg) 17 Pressure-Volume Loops and Relationships
  • 18. 0 75 150 0 LV Volume (ml) LVPressure (mmHg) 10 20 30 End-Diastolic Pressure-Volume Relationship 18 Vo P = β(eα(V-Vo)-1)
  • 19. 0 25 50 75 100 125 150 0 25 50 75 100 125 150 LV Volume (ml) LVPressure(mmHg) Vo Ees End-Systolic Pressure-Volume Relationship (ESPVR) Pes = Ees(Ves-Vo) 19 End-Systolic Pressure-Volume Relationship
  • 20. 20 EDPVR and ESPVR define the boundaries within which the PV Loop sits, independent of “preload” and “afterload”
  • 23. 0 50 100 150 0 50 100 150 LV Volume (ml) LVPressure(mmHg) Preload: The load imposed on the ventricle at the end of diastole. The most common measures of preload include end-diastolic volume (EDV) and end-diastolic pressure (EDP). 23 Preload: Ventricular Level EDV, EDP
  • 24. 0 50 100 150 0 50 100 150 LVPressure(mmHg) Increased Preload Preload: The load imposed on the ventricle at the end of diastole. The most common measures of preload include end-diastolic volume (EDV) and end-diastolic pressure (EDP). 24 Preload: Ventricular Level LV Volume (ml)
  • 25. 0 50 100 150 0 50 100 150 LVPressure(mmHg) Decreased Preload Preload: The load imposed on the ventricle at the end of diastole. The most common measures of preload include end-diastolic volume (EDV) and end-diastolic pressure (EDP). 25 Preload: Ventricular Level LV Volume (ml)
  • 26. 0 50 100 150 0 50 100 150 LVPressure(mmHg) Decreased Preload Increased Preload The different loops are obtained with different preloads, but constant contractility and afterload. 26 Preload: Ventricular Level LV Volume (ml)
  • 28. 28 Afterload: Intact Ventricle • There are several different indexes of ventricular afterload, each with its own merits and drawbacks: • Myocardial wall stress • Arterial Pressure • Arterial Resistance • Arterial Impedance
  • 29. 29 Afterload: Total Peripheral Resistance • Conceptually, for the intact LV, a measure of afterload should provide a quantitative index that uniquely characterizes the arterial system independent of preload and contractility • Such an index can be derived from the relationship between pressure and flow through the system • One index, total peripheral resistance (TPR), is based on Ohms law and is simply the ratio between mean pressure across the system and mean flow: TPR = (MAP-CVP)/CO MAP CVP Flow
  • 30. 0 50 100 150 0 50 100 150 LV Volume (ml) LVPressure(mmHg) Afterload: The mechanical load on the ventricle during ejection. Under normal physiological conditions, this is determined by the arterial system. The most common index of afterload is total peripheral resis-tance (TPR): TPR = (MAP-CVP)/CO 30 Afterload: Impact on LV Performance
  • 31. 0 50 100 150 0 50 100 150 LV Volume (ml) LVPressure(mmHg) Increased TPR 31 Afterload: Impact on LV Performance Despite constant preload and contractility: Increased TPR • Increased pressure • Decreased SV
  • 32. 0 50 100 150 0 50 100 150 LV Volume (ml) LVPressure(mmHg) Decreased TPR 32 Afterload: Impact on LV Performance Despite constant preload and contractility: Increased TPR • Increased pressure • Decreased SV Decreased TPR • Decreased SV • Increased pressure
  • 33. 0 50 100 150 0 50 100 150 LV Volume (ml) LVPressure(mmHg) Decreased TPR Increased TPR 33 Afterload: Impact on LV Performance Despite constant preload and contractility: The pressure-volume loop falls within the boundaries established by the ESPVR and EDPVR
  • 36. 36 Contractility: The concept applied to the Left Ventricle
  • 37. 0 50 100 150 0 25 50 75 100 125 150 LV Volume (ml) LVPressure(mmHg) Ees Ees 37 Contractility
  • 39. The EDPVR is nonlinear and defines the boundary for the position of the end-diastolic pressure-volume point of the PV loop: Ped= β(eα(Ved-Vo)-1) 39 Lusitropy: Passive Diastolic Properties
  • 42. 42 Lusitropy: Passive Diastolic Properties The EDPVR shifts leftward: • Hypertrophic cardiomyopathies • Infiltrative diseases (amyloid, sarcoid) • Restrictive cardiomyopathy
  • 43. 43 Lusitropy: The Rate of Relaxation The decay of pressure during the isovolumic relaxation phase of diastole follows a roughly exponential time course. P = e-t/τ Active relaxation can therefore be characterized by τ, the time constant of relaxation. Isovolumic Relaxation LVP
  • 44. 44 Lusitropy: The Rate of Relaxation Isovolumic Relaxation τLVP The decay of pressure during the isovolumic relaxation phase of diastole follows a roughly exponential time course. P = e-t/τ Active relaxation can therefore be characterized by τ, the time constant of relaxation.
  • 45. 45 τ is influenced by: • Contractile element isoforms • Heart Rate • τ decreases significantly as heart rate increases • Energy Supply • τ increases significantly during myocardial ischemia • β Stimulation • τ decreases significantly with β-adrenergic stimulation or any drugs that increase ATP Lusitropy: The Rate of Relaxation
  • 46. 46 Lusitropy • Passive diastolic properties: the extent of relaxation • Characterized by the EDPVR • Compliance • Stiffness • Capacitance • Active relaxation: the rate of relaxation • Indexed by τ • Impact on cardiac performance highly dependent on heart rate • Concept of “incomplete relaxation”
  • 47. 47 Cardiac Performance cardiac output, blood pressure, etc Determined by the interaction between the heart and vascular systems
  • 49. 49 Harvi Interactive, simulation-based textbook for the iPad iPad 2, 3 and mini (iOS 7)
  • 50. Thank you for taking part in this event.We encourage all attendees to register at www.insidescientific.com for notifications about future webinars. Hemodynamic Assessment Series– Part 1: PV Loop Case Study by Transonic Improve PV Loop Results by Heating & Monitoring During Surgery by Indus Instruments Understanding the Translational Value of PV Loops from Mouse to Man by Millar COMING SOON…