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Effective arterial elastance as an index of pulmonary vascular load

¹Hemodynamics Research Laboratory (HemoLiege), University Hospital of Liege, ²Statistics Institute, University of Liege, and ³Cardiology Department, University Hospital of Liege, Liege, Belgium

Submitted 10 July 2007 ; accepted in final form 16 April 2008

The aim of this study was to test whether the simple ratio of right ventricular (RV) end-systolic pressure (Pes) to stroke volume (SV), known as the effective arterial elastance (E_a), provides a valid assessment of pulmonary arterial load in case of pulmonary embolism- or endotoxin-induced pulmonary hypertension. Ventricular pressure-volume (PV) data (obtained with conductance catheters) and invasive pulmonary arterial pressure and flow waveforms were simultaneously recorded in two groups of six pure Pietran pigs, submitted either to pulmonary embolism (group A) or endotoxic shock (group B). Measurements were obtained at baseline and each 30 min after injection of autologous blood clots (0.3 g/kg) in the superior vena cava in group A and after endotoxin infusion in group B. Two methods of calculation of pulmonary arterial load were compared. On one hand, E_a provided by using three-element windkessel model (WK) of the pulmonary arterial system [E_a(WK)] was referred to as standard computation. On the other hand, similar to the systemic circulation, E_a was assessed as the ratio of RV Pes to SV [E_a(PV) = Pes/SV]. In both groups, although the correlation between E_a(PV) and E_a(WK) was excellent over a broad range of altered conditions, E_a(PV) systematically overestimated E_a(WK). This offset disappeared when left atrial pressure (Pla) was incorporated into E_a [E_a * (PV) = (Pes – Pla)/SV]. Thus E_a * (PV), defined as the ratio of RV Pes minus Pla to SV, provides a convenient, useful, and simple method to assess the pulmonary arterial load and its impact on the RV function.

hemodynamics; pulmonary hypertension; right ventricle; ventriculo-arterial coupling