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Am J Physiol Heart Circ Physiol (February 11, 2005). doi:10.1152/ajpheart.01237.2004
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Submitted on December 8, 2004
Accepted on February 4, 2005

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

Kazunori Uemura1*, Toru Kawada1, Atsunori Kamiya1, Takeshi Aiba2, Ichiro Hidaka3, Kenji Sunagawa4, and Masaru Sugimachi1

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

* To whom correspondence should be addressed. E-mail: kuemura{at}ri.ncvc.go.jp.

Accurate prediction of cardiac output (CO), left atrial pressure (PLA) and right atrial pressure (PRA) is a prerequisite for the management of patients with compromised hemodynamics. In our previous study (Am J Physiol 286; H2376, 2004), we have demonstrated a circulatory equilibrium framework, which permits the prediction of CO, PLA and PRA once the venous return surface and integrated CO curve are known. As we have also shown that the surface can be estimated from single-point CO, PLA, and PRA measurements, we hypothesized that a similar single-point estimation of the CO curve would enable us to predict hemodynamics. In 7 dogs, we measured the PLA-CO and PRA-CO relationships and derived a standardized CO curve using the logarithmic function CO=SL[ln(PLA-2.03)+0.80] for the left heart and CO=SR[ln(PRA-2.13)+1.90] for the right heart, where SL and SR represent the preload sensitivity of CO, i.e., pumping ability, of the respective hearts. To estimate the integrated CO curve in each animal, we calculated SL and SR from single-point CO, PLA, and PRA measurements. Estimated and measured CO agreed reasonably well. In another 8 dogs, we altered stressed blood volume (-8 to +8 ml.kg of reference volume) under normal and heart-failing 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, SEE=7.5 ml[[rad]]min-1.kg-1), PLA (y=0.90x+0.5, r2=0.93, SEE=1.4 mmHg), and PRA (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.




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