Journal
HEART LUNG AND CIRCULATION
Volume 23, Issue 11, Pages 1059-1069Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hlc.2014.04.130
Keywords
Pressure-volume conductance catheter; Pressure volume loop; Dobutamine infusion; Max dP/dt; End-systolic pressure volume relationship
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Funding
- American Heart Association [09SDG2060320]
- Society for Cardiovascular Anesthesiologists Starter Grant
- Department of Anesthesiology and Pain Medicine, Steward St. Elizabeth's Medical Center, Brighton, MA, NIH [R01 GM 49039]
- Deshpande Center for Technical Innovation at the Massachusetts Institute of Technology, Cambridge, MA
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Background Most applications of pressure-volume conductance catheter measurements assess cardiovascular function at a single point in time after genetic, pharmacologic, infectious, nutritional, or toxicologic manipulation. Use of these catheters as a continuous monitor, however, is fraught with complexities and limitations. Methods Examples of the limitations and optimal use of conductance catheters as a continuous, real-time monitor of cardiovascular function are demonstrated during inotropic drug infusion in anesthetised rats. Results Inotropic drug infusion may alter ventricular dimensions causing relative movement of a well-positioned catheter, generating artifacts, including an abrupt pressure rise at end-systole that leads to over estimation of indices of contractility (max dP/dt) and loss of stroke volume signal. Simple rotation of the catheter, echocardiography-guided placement to the centre of the ventricle, or ventricular expansion through crystalloid infusion may correct for these artifacts. Fluid administration, however, alters left ventricular enddiastolic pressure and volume and therefore stroke volume, thereby obscuring continuous real-time haemodynamic measurements. Conclusions Pressure-volume artifacts during inotropic infusion are caused by physical contact of the catheter with endocardium. Repeated correction of catheter position may be required to use pressure volume catheters as a continuous real-time monitor during manipulations that alter ventricular dimensions, such as inotropic therapy.
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