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Non-Invasive Technique for LV Pressure-Volume Curves in the Works

A non-invasive echocardiographic technique generated left ventricular (LV) pressure strain-volume loop curves for people with aortic regurgitation and other cardiac conditions, one group confirmed.

The pilot study had 10 people undergo strain echocardiography along with software for evaluating myocardial work to assess cardiac structure and function. Blood pressure was obtained at the time of imaging to create pressure-volume curves.

Different curves were generated for patients whose clinical indications for echocardiography included congestive heart failure, hypertrophic cardiomyopathy, amyloid heart disease, diabetic cardiomyopathy, and breast cancer undergoing chemotherapy, according to Siu-Hin Wan, MD, of UT Southwestern Medical Center in Dallas, and colleagues reporting in a poster at this year’s virtual Heart Failure Society of America meeting.

The group highlighted the potential application of the technique in aortic regurgitation in particular.

To illustrate their point, the authors compared the LV pressure curve for a 77-year-old man with chronic asymptomatic severe aortic regurgitation with that for a control, a 64-year-old woman with no valvular disease who had preserved ejection fraction and normal LV dimensions.

“Compared to the control curve, there is evidence of loss of the early isovolumic phase of the curve due to aortic regurgitation, and evidence of increased stroke volume and end diastolic volume. In systole, early rapid generation of pressure is consistent with normal systolic function,” according to Wan’s team.

U.S. valve guidelines currently recommend intervention for severe aortic regurgitation when there is evidence of symptomatic structural end organ effect or cardiac functional impairment, which are assessed by left ventricular end diastolic diameter and left ventricular ejection fraction, the authors noted.

“A novel strain echocardiographic technique based on myocardial work may be a fast, accurate, and noninvasive method to better elucidate the cardiac hemodynamics associated with severe aortic regurgitation and understand the natural history prior to patient deterioration,” they said. “Further study and prospective application may result in the accurate, efficient, and non-invasive characterization of the pathophysiology of different cardiovascular conditions.”

For now, the non-invasive technique “has potential” but relies on several assumptions, such as cuff pressure as a surrogate of LV pressure, cautioned Anirban Banerjee, MD, of The Children’s Hospital of Philadelphia and University of Pennsylvania.

“It will be years before it is accepted clinically,” he told MedPage Today.

The ten people in the study averaged 63 years of age. Half were women.

This study is a continuation of prior work in the field of myocardial strain analysis, said Rebecca Hahn, MD, of NewYork-Presbyterian/Columbia University Medical Center in New York City, who was not a part of Wan’s team.

Another group had previously described and validated a non-invasive method for regional LV pressure-strain loop generation based on brachial artery cuff pressure.

This technique has since been used to derive references ranges for echocardiographic indices of myocardial work.

Last Updated October 01, 2020

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    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

Wan and colleagues had no disclosures.

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Houston Methodist offers new reconstruction technique for breast cancer survivors

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Some women no longer feel like they ever had breast cancer when they look in the mirror, thanks to a complex new procedure available at Houston Methodist in The Woodlands.

Breast Cancer does not run in Tana Key’s family. The occupational therapist had a normal mammogram. But not even a full year later, she began to feel what was only suspected to be a small, flared-up lymph node.


A thorough investigation in the dense tissue eventually resulted in the discovery of a small spot of Ductal carcinoma in situ — breast cancer, stage 0. But the diagnosis was not a death sentence.

After deciding to remove both breasts, a bilateral mastectomy, Key, 48, learned that precancerous cells were found in her other breast as well. She believes the early detection made it possible to prevent the potentially fatal spread.



“I chose the more aggressive surgical route because I didn’t want to have to worry anymore,” Key said.

Following the emotional experience, she turned to the Houston Methodist Institute for Reconstructive Surgery at the hospital off Texas 242 in The Woodlands, where she became the first patient there to undergo a less commonly performed, profunda artery perforator flaps procedure, also known as a PAP flap surgery with “ReSensation” technique.


The procedure involves taking excess fat tissue and small blood vessels from deep within the back of the patient’s thigh, along with donated nerve grafts, to give the woman innervated breasts that not only look but feel natural.


Now Key has not only defeated cancer, but regained sensation, confidence and peace of mind.

She praises the Houston Methodist team for their care and skill, which inspired her to return to work for the hospital system’s outpatient therapy clinic and gave her a chance