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Prediction of circulatory equilibrium in response to changes in stressed blood volume

¹Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita; ²Pharmaceuticals and Medical Devices Agency, Tokyo; ³Japan Association for the Advancement of Medical Equipment, Tokyo; and ⁴Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan

Submitted 7 December 2004 ; accepted in final form 4 February 2005

Accurate prediction of cardiac output (CO), left atrial pressure (P_LA), and right atrial pressure (P_RA) is a prerequisite for management of patients with compromised hemodynamics. In our previous study (Uemura et al. Am J Physiol Heart Circ Physiol 286: H2376–H2385, 2004), we demonstrated a circulatory equilibrium framework, which permits the prediction of CO, P_LA, and P_RA once the venous return surface and integrated CO curve are known. Inasmuch as we also showed that the surface can be estimated from single-point CO, P_LA, and P_RA measurements, we hypothesized that a similar single-point estimation of the CO curve would enable us to predict hemodynamics. In seven dogs, we measured the P_LA-CO and P_RA-CO relations and derived a standardized CO curve using the logarithmic function CO = S_L[ln(P_LA – 2.03) + 0.80] for the left heart and CO = S_R[ln(P_RA – 2.13) + 1.90] for the right heart, where S_L and S_R represent the preload sensitivity of CO, i.e., pumping ability, of the left and right heart, respectively. To estimate the integrated CO curve in each animal, we calculated S_L and S_R from single-point CO, P_LA, and P_RA measurements. Estimated and measured CO agreed reasonably well. In another eight dogs, we altered stressed blood volume (–8 to +8 ml/kg of reference volume) under normal and heart failure conditions and predicted the hemodynamics by intersecting the surface and the CO curve thus estimated. We could predict CO [y = 0.93x + 6.5, r² = 0.96, standard error of estimate (SEE) = 7.5 ml·min^–1·kg^–1], P_LA (y = 0.90x + 0.5, r² = 0.93, SEE = 1.4 mmHg), and P_RA (y = 0.87x + 0.4, r² = 0.91, SEE = 0.4 mmHg) reasonably well. In conclusion, single-point estimation of the integrated CO curve enables accurate prediction of hemodynamics in response to extensive changes in stressed blood volume.

logarithmic function; venous return surface; heart failure

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