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| Test data | Link |
| PEEP Ramp 0 to 20 to 0 cmH2O – 250 Hz | REV00 |
| Sloped square wave – 1000 Hz | REV00 |
| Decreasing sloped square wave – 1000 Hz | REV00 |
| Sinus wave – 250 Hz | REV00 |
| Publication | Summary |
| Harvey, William. “Exercitatio anatomica de motu cordis et sanguinis in animalibus.” Frankfurt am Main 1628 (1928): 17. | Introduction of the theory of blood circulation. |
| Hales, Stephen. Statical essays... Vol. 2. W. Innys and R. Manby…; T. Woodward… and J. Peele, 1733. | First measurement of arterial blood pressure. |
| Young Thomas (1809). The Croonian Lecture: On the Functions of the Heart and Arteries. Philosophical Transactions of the Royal Society, 991–31. | This lecture examines the roles of the heart and arteries in the circulatory system, detailing how the heart pumps blood and how arteries transport it. It also highlights the relationship between heart function and blood flow, emphasizing key physiological mechanisms relevant to cardiovascular health. |
| Poiseuille, J. L. M. “Researches on the Force of the Aortal or Left Side of the Heart.” Edinburgh Medical and Surgical Journal 32.100 (1829): 28. | Description of the haemodynamometer (mercury pressure gauge). |
| Frank O (1895) Zur Dynamik des Herzmuskels. Z. Biol. 32: 370–447 See: 10.1016/0002-8703(59)90345-X | Introduction of the Frank-Starling mechanism. |
| Riva-Rocci, Scipione. “Un nuovo sfigmomanometro.” Gazz Med Torino 47 (1896): 981-1001. | Description of the sphygmomanometer. |
| Frank O (1899) Die Grundform des arteriellen Pulses. Z. Biol. 37: 483-526. See: 10.1016/0022-2828(90)91459-k | Introduction of pulse contour analysis. Introduction of the Wind-Kessel model for the the ventricular-arterial unit. |
| Korotkoff, N. “To the question of methods of determining the blood pressure.” Rep Imp Mil Acad 11 (1905): 365-367. | The author concludes that a compressed artery in normal conditions produces no sound and proposes an auscultatory method to measure blood pressure. By inflating a cuff to obstruct circulation and listening for sounds as the pressure decreases, the points at which sounds first appear and later disappear indicate maximal and minimal blood pressure, respectively. |
| von Anrep G. On the part played by the suprarenals in the normal vascular reactions of the body. J Physiol. 1912 Dec 9;45(5):307-17. doi: 10.1113/jphysiol.1912.sp001553. PMID: 16993158; PMCID: PMC1512890. | Introduction of the Anrep effect. |
| Patterson SW, Starling EH. On the mechanical factors which determine the output of the ventricles. J Physiol. 1914 Sep 8;48(5):357-79. doi: 10.1113/jphysiol.1914.sp001669. PMID: 16993262; PMCID: PMC1420422. | Rediscovery of the Frank-Starling mechanism as the “Law of the heart”. |
| Bramwell, J. Crighton, and Archibald Vivian Hill. “The velocity of pulse wave in man.” Proceedings of the Royal Society of London. Series B, Containing Papers of a Biological Character 93.652 (1922): 298-306. | Theory and measurements of the velocity of pulse wave in humans. |
| Wiggers, Carl J., and Louis N. Katz. “The contour of the ventricular volume curves under different conditions.” American Journal of Physiology-Legacy Content 58.3 (1922): 439-475. | The contour of the ventricular volume curves under different conditions. |
| Forssmann, W. (1929). Die sondierung des rechten herzens. (The catheterization of the right heart) | Werner Forssmann demonstrated the feasibility of cardiac catheterization by inserting a catheter into his own right atrium and documenting the procedure radiographically. This work contributed to the development of interventional cardiology by establishing a method for direct cardiac access. |
| Katz, Louis N. “The role played by the ventricular relaxation process in filling the ventricle.” American Journal of Physiology-Legacy Content 95.3 (1930): 542-553. | The role played by the ventricular relaxation process in filling the ventricle. Evidence of sucking action of the ventricle during diastole. |
| Johnson, Victor, et al. “Studies on the dynamics of the pulmonary circulation.” American Journal of Physiology-Legacy Content 120.3 (1937): 624-634. | Studies on the dynamics of the pulmonary circulation. |
| Cournand A. Recent Observations on the Dynamics of the Pulmonary Circulation. Bull N Y Acad Med. 1947 Jan;23(1):27-50. PMID: 19312508; PMCID: PMC1871320. | Effective physiological methods for studying the pulmonary circulation are made available to clinicians and can be used for diagnosis in selected cases of congenital heart defects. |
| Cournand A, Motley HL. Physiological studies of the effects of intermittent positive pressure breathing on cardiac output in man. Am J Physiol. 1948;152(1):162-174. doi:10.1152/ajplegacy.1947.152.1.162 | Variations in intrathoracic pressure significantly influence right heart filling pressure and cardiac output, with intermittent positive pressure breathing (IPPB) affecting these dynamics in different ways depending on the mask pressure curve. The most effective IPPB pattern for maintaining stable cardiac output features a gradual increase in inspiratory pressure, a rapid drop in expiratory pressure to near atmospheric levels, and an expiratory phase equal to or longer than inspiration, allowing full compensation of right ventricular filling pressure changes. |
| HELLEMS HK, HAYNES FW, DEXTER L. Pulmonary capillary pressure in man. J Appl Physiol. 1949 Jul;2(1):24-9. doi: 10.1152/jappl.1949.2.1.24. PMID: 18133124. | Measurement of pulmonary capillary wedge pressure in man. |
| BAXTER IG, PEARCE JW. Simultaneous measurement of pulmonary arterial flow and pressure using condenser manometers. J Physiol. 1951 Dec 28;115(4):410-29. doi: 10.1113/jphysiol.1951.sp004678. PMID: 14898519; PMCID: PMC1392033. | This study outlines a method to measure pulmonary arterial pressure and pulsatile volume flow at the same time in freely breathing animals. When vasomotor activity is stable, the effective incisural pressure has a roughly linear relationship with the beat volume flow in the artery. |
| FEGLER G. Measurement of cardiac output in anaesthetized animals by a thermodilution method. Q J Exp Physiol Cogn Med Sci. 1954;39(3):153-64. doi: 10.1113/expphysiol.1954.sp001067. PMID: 13194838. | Introduction of the thermodilution method. |
| KORNER P, SHILLINGFORD J. The right atrial pulse in congestive heart failure. Br Heart J. 1954 Oct;16(4):447-50. doi: 10.1136/hrt.16.4.447. PMID: 13208902; PMCID: PMC503906. | The right atrial pressure curves were examined in 48 patients, both with and without cardiac failure. As mean right atrial pressure increased, the shape of the pulse curve changed. Moderate increases in venous pressure led to impaired X descent, while higher mean pressures resulted in a positive systolic wave. |
| GUYTON AC. Determination of cardiac output by equating venous return curves with cardiac response curves. Physiol Rev. 1955 Jan;35(1):123-9. doi: 10.1152/physrev.1955.35.1.123. PMID: 14356924. | Determination of cardiac output by equating venous return curves with cardiac response curves. |
| McDONALD DA. The relation of pulsatile pressure to flow in arteries. J Physiol. 1955 Mar 28;127(3):533-52. doi: 10.1113/jphysiol.1955.sp005275. PMID: 14368547; PMCID: PMC1365739. | The relation of pulsatile pressure to flow in arteries. |
| WOMERSLEY JR. Method for the calculation of velocity, rate of flow and viscous drag in arteries when the pressure gradient is known. J Physiol. 1955 Mar 28;127(3):553-63. doi: 10.1113/jphysiol.1955.sp005276. PMID: 14368548; PMCID: PMC1365740. | Method for the calculation of velocity, rate of flow and viscous drag in arteries when the pressure gradient is known |
| BERGEL, D. H., CARO, C. G. & McDoNALD, D. A. (1960). The input impedance of the pulmonary vascular bed. J. Physiol. 154, 18-19P. | The input impedance of the pulmonary vascular bed. |
| FRY DL. Physiologic recording by modern instruments with particular reference to pressure recording. Physiol Rev. 1960 Oct;40:753-88. doi: 10.1152/physrev.1960.40.4.753. PMID: 13702320. | This review examines the significance, occurrence, and estimation methods of key measurement errors in selecting physiologic recording systems. |
| CARO CG, McDONALD DA. The relation of pulsatile pressure and flow in the pulmonary vascular bed. J Physiol. 1961 Aug;157(3):426-53. doi: 10.1113/jphysiol.1961.sp006734. PMID: 13690903; PMCID: PMC1359986. | Calculation of the input impedance of the pulmonary bed. |
| BERGEL DH, MILNOR WR. PULMONARY VASCULAR IMPEDANCE IN THE DOG. Circ Res. 1965 May;16:401-15. doi: 10.1161/01.res.16.5.401. PMID: 14289149. | The pulmonary bed functioned as a quasi-linear system within the methods’ accuracy and tested frequency range, justifying the use of input impedance to describe its characteristics and allowing reasonable analogies with linear models like simple transmission lines. |
| PATEL DJ, MASON DT, ROSS J Jr, BRAUNWALD E. HARMONIC ANALYSIS OF PRESSURE PULSES OBTAINED FROM THE HEART AND GREAT VESSELS OF MAN. Am Heart J. 1965 Jun;69:785-94. doi: 10.1016/0002-8703(65)90452-7. PMID: 14296644. | It is concluded that the majority of relevant information in pressure pulses lies within the range of 0 to 20 cycles per second (20 Hz). |
| Milnor WR, Conti CR, Lewis KB, O’Rourke MF. Pulmonary arterial pulse wave velocity and impedance in man. Circ Res. 1969 Dec;25(6):637-49. doi: 10.1161/01.res.25.6.637. PMID: 5364641. | The elasticity of the pulmonary arterial tree appears to be as important as the state of the arterioles and capillaries in determining the energy required for pulsatile pulmonary blood flow. |
| Gabe IT, Gault JH, Ross J Jr, Mason DT, Mills CJ, Schillingford JP, Braunwald E. Measurement of instantaneous blood flow velocity and pressure in conscious man with a catheter-tip velocity probe. Circulation. 1969 Nov;40(5):603-14. doi: 10.1161/01.cir.40.5.603. PMID: 5377202. | Measurement of instantaneous blood flow velocity and pressure in conscious man with a catheter-tip velocity probe. |
| Suga H. Time course of left ventricular pressure-volume relationship under various extents of aortic occlusion. Jpn Heart J. 1970 Jul;11(4):373-8. doi: 10.1536/ihj.11.373. PMID: 5311401. | Introduction of the time-varying elastance model. |
| Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970 Aug 27;283(9):447-51. doi: 10.1056/NEJM197008272830902. PMID: 5434111. | Introduction of the Swan-Ganz catheter. |
| Abel FL. Fourier analysis of left ventricular performance. Evaluation of impedance matching. Circ Res. 1971 Feb;28(2):119-35. doi: 10.1161/01.res.28.2.119. PMID: 4994209. | Impedance matching was studied, revealing that maximal efficiency occurs with optimal matching, and internal resistance serves as a measurable quantity that partially corresponds to more complex impedance measurements. |
| Suga H. Left ventricular time-varying pressure-volume ratio in systole as an index of myocardial inotropism. Jpn Heart J. 1971 Mar;12(2):153-60. doi: 10.1536/ihj.12.153. PMID: 5313690. | Introduction of the peak value of the time-varying elastance as index of the inotropic state of the left ventricle. |
| Elzinga, G. and Westerhof, N., 1974, January. End Diastolic Volume and Source Impedance of the Heart. In Ciba Foundation‐ Symposium 24 Physiological Basis of Starling’s Law of the Heart (pp. 241-255). Chichester, UK: John Wiley & Sons, Ltd. | Introduction of the hydromotive source pressure model for the left ventricle. |
| Bemis CE, Serur JR, Borkenhagen D, Sonnenblick EH, Urschel CW. Influence of right ventricular filling pressure on left ventricular pressure and dimension. Circ Res. 1974 Apr;34(4):498-504. doi: 10.1161/01.res.34.4.498. PMID: 4826926. | The data demonstrate that LV end-diastolic pressure and geometry are influenced by the dynamic interaction between the two ventricles. This interaction complicates the analysis of ventricular end-diastolic pressure and compliance, highlighting the need for caution in interpreting such data. |
| Weiss JL, Frederiksen JW, Weisfeldt ML. Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. J Clin Invest. 1976 Sep;58(3):751-60. doi: 10.1172/JCI108522. PMID: 956400; PMCID: PMC333234. | The studies show that the isovolumic pressure fall after maximum negative dP/dt follows an exponential course, independent of systolic stress, end-systolic fiber length, and minimally affected by heart rate. T may reflect the activity of the active cardiac relaxation system and seems dependent on systolic fiber shortening. |
| Santamore WP, Lynch PR, Heckman JL, Bove AA, Meier GD. Left ventricular effects on right ventricular developed pressure. J Appl Physiol. 1976 Dec;41(6):925-30. doi: 10.1152/jappl.1976.41.6.925. PMID: 1002647. | An isolated, flow-perfused, paced rabbit heart preparation was used to examine how left ventricular volume, ischemia, and structural integrity impact right ventricular function. This setup removed neural, humoral, pericardial, and pulmonary influences, allowing direct analysis of left ventricular effects on right ventricular performance. The results show that changes in left ventricular wall function and volume directly affect right ventricular isovolumic developed pressure. |
| Sagawa K, Suga H, Shoukas AA, Bakalar KM. End-systolic pressure/volume ratio: a new index of ventricular contractility. Am J Cardiol. 1977 Nov;40(5):748-53. doi: 10.1016/0002-9149(77)90192-8. PMID: 920611. | Introduction of the instantaneous pressure-volume relationship P(t) = E(t)*[V(t)-Vd]. |
| Sagawa K. The ventricular pressure-volume diagram revisited. Circ Res. 1978 Nov;43(5):677-87. doi: 10.1161/01.res.43.5.677. PMID: 361275. | Review of the pressure-volume diagram. |
| Glantz SA, Misbach GA, Moores WY, Mathey DG, Lekven J, Stowe DF, Parmley WW, Tyberg JV. The pericardium substantially affects the left ventricular diastolic pressure-volume relationship in the dog. Circ Res. 1978 Mar;42(3):433-41. doi: 10.1161/01.res.42.3.433. PMID: 624151. | These results prompted a shift from viewing the diastolic left ventricle as an unconstrained elastic shell to a model of the heart as a composite structure of stiff pericardium and compliant muscle, emphasizing the importance of considering the pericardium’s influence on the diastolic pressure-volume relationship. |
| Maughan WL, Shoukas AA, Sagawa K, Weisfeldt ML. Instantaneous pressure-volume relationship of the canine right ventricle. Circ Res. 1979 Mar;44(3):309-15. doi: 10.1161/01.res.44.3.309. PMID: 761311. | The key finding is that, despite the right ventricle’s complex geometry, variable wall thickness, and differing pressure-ejection dynamics, its pressure-volume relationship is as linear as in the left ventricle across a wide range. While the physiological basis remains unclear, this linearity offers a practical way to assess contractile state. |
| GLANTZ, STANTON A. Mathematics for Biomedical Applications. 1st ed., University of California Press, 1979. JSTOR, https://doi.org/10.2307/jj.8501534. | Transfer function of fluid filled catheters. „To obtain the most accurate pressure recordings from a fluid-filled catheter system, one should seek to use a well-flushed, stiff, short, narrow catheter to maximize the range of frequencies that it accurately transmits to the recorder.“ |
| Sunagawa K, Yamada A, Senda Y, Kikuchi Y, Nakamura M, Shibahara T, Nose Y. Estimation of the hydromotive source pressure from ejecting beats of the left ventricle. IEEE Trans Biomed Eng. 1980 Jun;27(6):299-305. doi: 10.1109/TBME.1980.326737. PMID: 7390526. | Estimation of the left ventricular hydromotive source pressure from non-linear regression. |
| Murgo JP, Westerhof N, Giolma JP, Altobelli SA. Aortic input impedance in normal man: relationship to pressure wave forms. Circulation. 1980 Jul;62(1):105-16. doi: 10.1161/01.cir.62.1.105. PMID: 7379273. | Input impedance and augmentation index for aortic pressure waveforms. |
| Baan J, Jong TT, Kerkhof PL, Moene RJ, van Dijk AD, van der Velde ET, Koops J. Continuous stroke volume and cardiac output from intra-ventricular dimensions obtained with impedance catheter. Cardiovasc Res. 1981 Jun;15(6):328-34. doi: 10.1093/cvr/15.6.328. PMID: 7296590. | Introduction of the conductance catheter. |
| Piene H, Sund T. Does normal pulmonary impedance constitute the optimum load for the right ventricle? Am J Physiol. 1982 Feb;242(2):H154-60. doi: 10.1152/ajpheart.1982.242.2.H154. PMID: 7065148. | Impedance matching between right ventricle and the lungs. |
| Pinsky MR. Determinants of pulmonary arterial flow variation during respiration. J Appl Physiol Respir Environ Exerc Physiol. 1984;56(5):1237-1245. doi:10.1152/jappl.1984.56.5.1237 | Pulmonary arterial flow (Qpa) variations during spontaneous (SPONT) and positive-pressure breathing (IPPB) are driven by phasic changes in venous return, affecting right ventricular filling and stroke volume. Despite differences in pressure dynamics, an invariant right ventricular function curve suggests minimal impact from pulmonary vascular resistance. |
| Baan J, van der Velde ET, de Bruin HG, Smeenk GJ, Koops J, van Dijk AD, Temmerman D, Senden J, Buis B. Continuous measurement of left ventricular volume in animals and humans by conductance catheter. Circulation. 1984 Nov;70(5):812-23. doi: 10.1161/01.cir.70.5.812. PMID: 6386218. | Measurement of left ventricular volume using the conductance catheter. |
| Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307-10. PMID: 2868172. | Introduction of the Bland-Altman plot. |
| Morris, James J., et al. “Dynamic right ventricular dimension: relation to chamber volume during the cardiac cycle.” The Journal of Thoracic and Cardiovascular Surgery 91.6 (1986): 879-887. | The study demonstrates that the RV free wall chord dimension is consistently linked to hydrodynamic events in the RV throughout the cardiac cycle, allowing for accurate assessment of various volumes and stroke work, despite challenges in directly measuring RV volume. |
| Burkhoff D, Sagawa K. Ventricular efficiency predicted by an analytical model. Am J Physiol. 1986 Jun;250(6 Pt 2):R1021-7. doi: 10.1152/ajpregu.1986.250.6.R1021. PMID: 3717375. | A simple analytic model was developed linking the vascular system and left ventricle to the heart’s mechanical work and chemical energy consumption. |
| Ventricular/Vascular Coupling: Clinical, Physiological, and Engineering Aspects. New York, NY: Springer New York, 1987. S. 210-239. | Ventricular/Vascular Coupling Clinical, Physiological, and Engineering Aspects |
| Peters J, Kindred MK, Robotham JL. Transient analysis of cardiopulmonary interactions. I. Diastolic events. J Appl Physiol (1985). 1988;64(4):1506-1517. doi:10.1152/jappl.1988.64.4.1506 | Negative intrathoracic pressure (NITP) during diastole reduces left ventricular stroke volume (LVSV), likely due to decreased preload from ventricular interdependence, while simultaneously increasing intrathoracic aortic dimensions and reducing antegrade arterial blood flow out of the thorax, sometimes causing transient retrograde flow. These findings suggest that the intrathoracic aorta functions as an elastic chamber influenced by intrathoracic pressure changes, independently affecting systemic arterial circulation. |
| Peters J, Kindred MK, Robotham JL. Transient analysis of cardiopulmonary interactions. II. Systolic events. J Appl Physiol (1985). 1988;64(4):1518-1526. doi:10.1152/jappl.1988.64.4.1518 | Negative intrathoracic pressure (NITP) during systole decreases left ventricular stroke volume (LVSV), likely due to increased afterload, as shown by an associated expansion of intrathoracic aortic diameters. When NITP extends into both systole and diastole, the reduction in LVSV is more pronounced, suggesting combined effects of increased afterload and altered preload. |
| Burkhoff D, Alexander J Jr, Schipke J. Assessment of Windkessel as a model of aortic input impedance. Am J Physiol. 1988 Oct;255(4 Pt 2):H742-53. doi: 10.1152/ajpheart.1988.255.4.H742. PMID: 3177666. | The analysis shows that the Windkessel model reasonably represents afterload for predicting stroke volume, stroke work, oxygen consumption, and aortic pressures. However, it underestimates peak aortic flow, slightly underestimates mean arterial pressure, and fails to accurately represent aortic pressure and flow waveforms. |
| Cigarroa RG, Lange RA, Williams RH, Bedotto JB, Hillis LD. Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. Am J Med. 1989 Apr;86(4):417-20. doi: 10.1016/0002-9343(89)90339-2. PMID: 2648822. | Underestimation of cardiac output by thermodilution in patients with tricuspid regurgitation. |
| Gilbert JC, Glantz SA. Determinants of left ventricular filling and of the diastolic pressure-volume relation. Circ Res. 1989 May;64(5):827-52. doi: 10.1161/01.res.64.5.827. PMID: 2523260. | When end-systolic volume falls below the left ventricle’s equilibrium volume, the myocardial wall compresses and stores elastic energy, which is released during relaxation, reducing ventricular pressure and increasing the atrioventricular pressure gradient for faster filling. Additionally, shifts in the diastolic pressure-volume relation help maintain stroke volume and end-diastolic volume during vasodilation, highlighting that end-diastolic pressure cannot reliably substitute for end-diastolic volume in assessing systolic function. |
| Goldstein JA, Barzilai B, Rosamond TL, Eisenberg PR, Jaffe AS. Determinants of hemodynamic compromise with severe right ventricular infarction. Circulation. 1990 Aug;82(2):359-68. doi: 10.1161/01.cir.82.2.359. PMID: 2372887. | Analysis of right atrial and right ventricular pressure waveforms in patients with right ventricular infarction. |
| Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990 Aug 15;66(4):493-6. doi: 10.1016/0002-9149(90)90711-9. PMID: 2386120. | IVC respiratory collapse on echocardiography is easily visualized and can help estimate RA pressure. A caval index of ≥50% suggests RA pressure is less than 10 mm Hg, while an index of <50% indicates RA pressure of 10 mm Hg or higher. |
| Takeuchi M, Igarashi Y, Tomimoto S, Odake M, Hayashi T, Tsukamoto T, Hata K, Takaoka H, Fukuzaki H. Single-beat estimation of the slope of the end-systolic pressure-volume relation in the human left ventricle. Circulation. 1991 Jan;83(1):202-12. doi: 10.1161/01.cir.83.1.202. PMID: 1898642. | Use of first derivative and end-diastolic pressure to define isovolumetric contraction and relaxation intervalls. |
| O’Rourke MF, Kelly RP. Wave reflection in the systemic circulation and its implications in ventricular function. J Hypertens. 1993 Apr;11(4):327-37. doi: 10.1097/00004872-199304000-00001. PMID: 8390498. | Editorial review about wave reflection in the systemic circulation and its implications in ventricular function. |
| Ohlsson A, Bennett T, Nordlander R, Rydén J, Aström H, Rydén L. Monitoring of pulmonary arterial diastolic pressure through a right ventricular pressure transducer. J Card Fail. 1995 Mar;1(2):161-8. doi: 10.1016/1071-9164(95)90018-7. PMID: 9420646. | Estimation of the diastolic pulmonary artery pressure from right ventricular pressure waveforms using the positive peak of the first derivative also known as dpdtmax. |
| Dickstein ML, Yano O, Spotnitz HM, Burkhoff D. Assessment of right ventricular contractile state with the conductance catheter technique in the pig. Cardiovasc Res. 1995 Jun;29(6):820-6. PMID: 7656285. | The conductance catheter offers a continuous measurement of right ventricular volume, which was utilized to detect changes in right ventricular contractile state in pigs. This technique represents a promising and essential method for assessing right ventricular function. |
| Senzaki H, Chen CH, Kass DA. Single-beat estimation of end-systolic pressure-volume relation in humans. A new method with the potential for noninvasive application. Circulation. 1996 Nov 15;94(10):2497-506. doi: 10.1161/01.cir.94.10.2497. PMID: 8921794. | ESPVRs can be reliably estimated in humans from single cardiac cycles by a new method that has a potential for noninvasive application. |
| Shih H, Hillel Z, Declerck C, Anagnostopoulos C, Kuroda M, Thys D. An algorithm for real-time, continuous evaluation of left ventricular mechanics by single-beat estimation of arterial and ventricular elastance. J Clin Monit. 1997 May;13(3):157-70. doi: 10.1023/a:1007387315948. PMID: 9234085. | Introduction of the tangent method to esimate the hydromotive source pressure from left ventricular waveforms. |
| Santamore WP, Dell’Italia LJ. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis. 1998 Jan-Feb;40(4):289-308. doi: 10.1016/s0033-0620(98)80049-2. PMID: 9449956. | This article examines diastolic and systolic ventricular interaction, as well as clinical pathophysiological conditions associated with it. |
| Shishido T, Hayashi K, Shigemi K, Sato T, Sugimachi M, Sunagawa K. Single-beat estimation of end-systolic elastance using bilinearly approximated time-varying elastance curve. Circulation. 2000 Oct 17;102(16):1983-9. doi: 10.1161/01.cir.102.16.1983. PMID: 11034949. | By approximating the load dependence of the E(t) waveform with a bilinear function, a method was developed to estimate Ees and V0 from a single beat without requiring instantaneous LV volume or loading condition changes. This approach demonstrated reasonable accuracy across varying contractilities and loading conditions, proving useful for assessing LV contractility in experimental studies and warranting further exploration in clinical settings. |
| Heerdt PM, Holmes JW, Cai B, Barbone A, Madigan JD, Reiken S, Lee DL, Oz MC, Marks AR, Burkhoff D. Chronic unloading by left ventricular assist device reverses contractile dysfunction and alters gene expression in end-stage heart failure. Circulation. 2000 Nov 28;102(22):2713-9. doi: 10.1161/01.cir.102.22.2713. PMID: 11094037. | LVAD support can enhance the contractile strength of intact myocardium and reverse the adverse force-frequency relationship (FFR) observed in end-stage heart failure. While gene expression related to Ca2+ cycling is upregulated, indicating reverse molecular remodeling, only the protein levels of SERCA2a show a significant increase. |
| Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002 Mar 19;105(11):1387-93. doi: 10.1161/hc1102.105289. PMID: 11901053. | This two-part article provides a perspective on diastolic heart failure, highlighting new research and emerging ideas. Part 1 covers diagnostic criteria, prognosis, and measurements of diastolic function, while Part 2 explores the mechanisms and treatment approaches. |
| Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part II: causal mechanisms and treatment. Circulation. 2002 Mar 26;105(12):1503-8. doi: 10.1161/hc1202.105290. PMID: 11914262. | This two-part article provides a perspective on diastolic heart failure, highlighting new research and emerging ideas. Part 1 covers diagnostic criteria, prognosis, and measurements of diastolic function, while Part 2 explores the mechanisms and treatment approaches. |
| Kjørstad KE, Korvald C, Myrmel T. Pressure-volume-based single-beat estimations cannot predict left ventricular contractility in vivo. Am J Physiol Heart Circ Physiol. 2002 May;282(5):H1739-50. doi: 10.1152/ajpheart.00638.2001. PMID: 11959639. | In conclusion, the current single-beat methods for estimating contractility were found to lack sufficient precision in predicting elastance. Additionally, none of the single-beat methods detected increased contractility, whereas dP/dtmax did, indicating that in vivo assessment of contractility requires further refinement. |
| Brimioulle S, Wauthy P, Ewalenko P, Rondelet B, Vermeulen F, Kerbaul F, Naeije R. Single-beat estimation of right ventricular end-systolic pressure-volume relationship. Am J Physiol Heart Circ Physiol. 2003 May;284(5):H1625-30. doi: 10.1152/ajpheart.01023.2002. Epub 2003 Jan 16. PMID: 12531727. | Estimation of the right ventricular hydromotive source pressure from non-linear regression. |
| Smith BW, Chase JG, Nokes RI, Shaw GM, Wake G. Minimal haemodynamic system model including ventricular interaction and valve dynamics. Med Eng Phys. 2004 Mar;26(2):131-9. doi: 10.1016/j.medengphy.2003.10.001. PMID: 15036180. | Characterizing circulatory dysfunction and selecting appropriate treatment is challenging, often leading to delays or incorrect therapy. This paper develops a stable, minimal cardiovascular system model that accurately captures circulatory trends with simple, robust equations, demonstrating physiological consistency and providing a practical tool for medical staff for on site modelling to assist in diagnosis and treatment. |
| Huez S, Brimioulle S, Naeije R, Vachiéry JL. Feasibility of routine pulmonary arterial impedance measurements in pulmonary hypertension. Chest. 2004 Jun;125(6):2121-8. doi: 10.1378/chest.125.6.2121. PMID: 15189931. | The assessment of pulmonary vascular impedance (PVZ) to quantify right ventricular (RV) afterload is practical during routine right heart catheterization and Doppler echocardiography, and it is sensitive to pharmacologic interventions. |
| Lambermont B, Segers P, Ghuysen A, Tchana-Sato V, Morimont P, Dogne JM, Kolh P, Gerard P, D’Orio V. Comparison between single-beat and multiple-beat methods for estimation of right ventricular contractility. Crit Care Med. 2004 Sep;32(9):1886-90. doi: 10.1097/01.ccm.0000139607.38497.8a. PMID: 15343017. | The current single-beat estimation method for assessing right ventricular contractility is ineffective, as it fails to detect changes—either increases or decreases—in contractility caused by pharmacologic interventions. |
| Soto, Francisco J., et al. “Performance of pulmonary capillary wedge pressure (PCWP) vs. left ventricular end diastolic pressure (LVEDP) in the diagnosis/classification of patients with suspect pulmonary arterial hypertension (PAH).” Chest 128.4 (2005): 137S. | The study highlights the limitations of using PCWP as the sole method for assessing LV filling pressures in patients with suspected PAH, particularly when PCWP is greater than 10. The findings underscore the importance of measuring LVEDP to accurately differentiate between PAH and PVH. |
| Gaynor SL, Maniar HS, Bloch JB, Steendijk P, Moon MR. Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation. 2005 Aug 30;112(9 Suppl):I212-8. doi: 10.1161/CIRCULATIONAHA.104.517789. PMID: 16159819. | In chronic RV pressure overload, systolic function is preserved while diastolic function is impaired. Increased RA contractility and distensibility help maintain ventricular filling, a crucial adaptation to prevent clinical failure in chronic pulmonary hypertension. |
| Burkhoff D, Mirsky I, Suga H. Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. Am J Physiol Heart Circ Physiol. 2005 Aug;289(2):H501-12. doi: 10.1152/ajpheart.00138.2005. PMID: 16014610. | This review covers the basics of pressure-volume analysis, common real-world deviations, appropriate analytical methods, and solutions to common issues. It provides practical guidelines for accurately applying and interpreting pressure-volume data to assess ventricular and myocardial properties in health and disease. |
| Karamanoglu M, Bennett TD. A right ventricular pressure waveform based pulse contour cardiac output algorithm in canines. Cardiovasc Eng. 2006 Sep;6(3):83-92. doi: 10.1007/s10558-006-9014-4. PMID: 16960760. | Application of the pulse contour method to right ventricular pressure waveforms. |
| Klotz S, Hay I, Dickstein ML, Yi GH, Wang J, Maurer MS, Kass DA, Burkhoff D. Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application. Am J Physiol Heart Circ Physiol. 2006 Jul;291(1):H403-12. doi: 10.1152/ajpheart.01240.2005. Epub 2006 Jan 20. PMID: 16428349. | The LV end-diastolic pressure-volume relationship can be estimated from a single pressure-volume point, with strong correlation to measured data. Accuracy is higher for groups than individual hearts, and the method holds promise for noninvasive applications, complementing single-beat ESPVR estimation. |
| Karamanoglu M, McGoon M, Frantz RP, Benza RL, Bourge RC, Barst RJ, Kjellström B, Bennett TD. Right ventricular pressure waveform and wave reflection analysis in patients with pulmonary arterial hypertension. Chest. 2007 Jul;132(1):37-43. doi: 10.1378/chest.06-2690. Epub 2007 May 15. PMID: 17505045. | Introduction of method to estimate cardiac output from right ventricular pressure waveforms in patients with pulmonary arterial hypertension. |
| Klotz S, Dickstein ML, Burkhoff D. A computational method of prediction of the end-diastolic pressure-volume relationship by single beat. Nat Protoc. 2007;2(9):2152-8. doi: 10.1038/nprot.2007.270. PMID: 17853871. | This protocol presents an algorithm to estimate the entire end-diastolic pressure–volume relation (EDPVR) in humans from a single measured pressure–volume point, leveraging volume-normalized EDPVRs (EDPVRn) that are nearly identical across patients. |
| Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: Anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation. 2008 Mar 18;117(11):1436-48. doi: 10.1161/CIRCULATIONAHA.107.653576. PMID: 18347220. | Understanding RV physiology requires knowledge of contractility, preload, afterload, interdependence, and pericardial constraint. Due to its complex shape and load dependence, studying the RV is challenging. Promising noninvasive contractility indices include tissue Doppler IVA and the RV myocardial performance index. Future advances in 3D echocardiography, strain imaging, diffusion tensor MRI, and tissue characterization may lead to new indices of contractility, chamber compliance, and a better understanding of ventricular remodeling. |
| Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008 Apr 1;117(13):1717-31. doi: 10.1161/CIRCULATIONAHA.107.653584. PMID: 18378625. | RV dysfunction is a key predictor of survival and exercise capacity in cardiopulmonary disease. RV failure begins with myocardial injury or stress, progressing through neurohormonal activation, cytokine release, altered gene expression, and ventricular remodeling. Ongoing research into its molecular, genetic, and neurohormonal underpinnings will aid in better management of RV failure. |
| Sharman JE, Davies JE, Jenkins C, Marwick TH. Augmentation index, left ventricular contractility, and wave reflection. Hypertension. 2009 Nov;54(5):1099-105. doi: 10.1161/HYPERTENSIONAHA.109.133066. Epub 2009 Aug 31. PMID: 19720955. | The findings expose a disparity between the traditional explanation for the shape of the augmented pressure wave, which attributes it to reflected pressure waves, and an emerging paradigm that accounts for the arterial reservoir and forward-traveling waves. Further studies are needed to resolve this disparity. |
| ten Brinke EA, Klautz RJ, Verwey HF, van der Wall EE, Dion RA, Steendijk P. Single-beat estimation of the left ventricular end-systolic pressure-volume relationship in patients with heart failure. Acta Physiol (Oxf). 2010 Jan;198(1):37-46. doi: 10.1111/j.1748-1716.2009.02040.x. Epub 2009 Sep 6. PMID: 19735484. | The findings, derived from hearts encompassing a wide range of sizes and conditions, support the application of the SB method. This approach enables less invasive ESPVR estimation, especially when combined with emerging noninvasive techniques for measuring LV pressures and volumes. |
| Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S. Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest. 2011 May;139(5):988-993. doi: 10.1378/chest.10-1269. Epub 2010 Sep 23. PMID: 20864617. | Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice |
| Tedford RJ, Hassoun PM, Mathai SC, Girgis RE, Russell SD, Thiemann DR, Cingolani OH, Mudd JO, Borlaug BA, Redfield MM, Lederer DJ, Kass DA. Pulmonary capillary wedge pressure augments right ventricular pulsatile loading. Circulation. 2012 Jan 17;125(2):289-97. doi: 10.1161/CIRCULATIONAHA.111.051540. Epub 2011 Nov 30. PMID: 22131357; PMCID: PMC3264431. | Increased pulmonary capillary wedge pressure seems to elevate net right ventricular afterload by raising pulsatile load in relation to resistive load, potentially contributing to right ventricular dysfunction. |
| Herberg U, Gatzweiler E, Breuer T, Breuer J. Ventricular pressure-volume loops obtained by 3D real-time echocardiography and mini pressure wire-a feasibility study. Clin Res Cardiol. 2013 Jun;102(6):427-38. doi: 10.1007/s00392-013-0548-3. Epub 2013 Feb 9. PMID: 23397593. | The calculation of pressure-volume relations (PVR) using 3DE volume curves and simultaneous pressure data from a mini pressure wire is a practical method for assessing cardiac function. The small size of the pressure wire allows PVR measurement even in neonates with congenital heart disease. |
| McCabe C, White PA, Hoole SP, Axell RG, Priest AN, Gopalan D, Taboada D, MacKenzie Ross R, Morrell NW, Shapiro LM, Pepke-Zaba J. Right ventricular dysfunction in chronic thromboembolic obstruction of the pulmonary artery: a pressure-volume study using the conductance catheter. J Appl Physiol (1985). 2014 Feb 15;116(4):355-63. doi: 10.1152/japplphysiol.01123.2013. Epub 2013 Dec 19. PMID: 24356516; PMCID: PMC3921352. | Conductance catheterization reveals novel alterations in pressure-volume loop morphology and prolonged right ventricular (RV) relaxation in patients with chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH), indicating functional adaptation in thromboembolic obstruction. While conductance provides useful insights into RV mechanics, its determination of absolute RV volume is suboptimal compared to cardiac magnetic resonance (CMR), necessitating further studies to evaluate its clinical implications. |
| Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, Torbicki A, Voelkel NF, Hassoun PM. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D22-33. doi: 10.1016/j.jacc.2013.10.027. PMID: 24355638. | This report highlights advancements in understanding RHF syndrome and identifies key research priorities, including defining normal right heart function, exploring molecular pathways, and improving management strategies. Testing new medications on pressure-overloaded right ventricles is advised before clinical trials, which should also include right heart size and function as secondary outcomes. |
| Vanderpool RR, Pinsky MR, Naeije R, Deible C, Kosaraju V, Bunner C, Mathier MA, Lacomis J, Champion HC, Simon MA. RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart. 2015 Jan;101(1):37-43. doi: 10.1136/heartjnl-2014-306142. Epub 2014 Sep 11. PMID: 25214501; PMCID: PMC4268056. | In conclusion, this study highlights the prognostic significance of RV-arterial coupling, assessed through ESV and EDV imaging, in patients evaluated for pulmonary hypertension (PH). Validation in larger PH patient cohorts is necessary to confirm these findings. |
| Thenappan T, Prins KW, Pritzker MR, Scandurra J, Volmers K, Weir EK. The Critical Role of Pulmonary Arterial Compliance in Pulmonary Hypertension. Ann Am Thorac Soc. 2016 Feb;13(2):276-84. doi: 10.1513/AnnalsATS.201509-599FR. PMID: 26848601; PMCID: PMC5461956. | PH is associated with an early decline in pulmonary artery compliance, increasing RV afterload through premature wave reflection and contributing to distal pulmonary artery vasculopathy. This loss of compliance, even with normal PVR, predicts mortality and may serve as both a therapeutic target and an early screening tool. |
| Secomb TW. Hemodynamics. Compr Physiol. 2016 Mar 15;6(2):975-1003. doi: 10.1002/cphy.c150038. PMID: 27065172; PMCID: PMC4958049. | Review that outlines the physical principles that govern the distribution of blood flow and blood pressure in the vascular system. |
| Magder S. Right Atrial Pressure in the Critically Ill: How to Measure, What Is the Value, What Are the Limitations? Chest. 2017 Apr;151(4):908-916. doi: 10.1016/j.chest.2016.10.026. Epub 2016 Nov 1. PMID: 27815151. | A wealth of information can also be obtained from the waveforms in the tracing and their variations throughout the respiratory cycle. |
| Bellofiore A, Vanderpool R, Brewis MJ, Peacock AJ, Chesler NC. A novel single-beat approach to assess right ventricular systolic function. J Appl Physiol (1985). 2018 Feb 1;124(2):283-290. doi: 10.1152/japplphysiol.00258.2017. Epub 2017 Oct 12. PMID: 29025899; PMCID: PMC5867365. | Use of second derivative to estimate isovolumetric contraction and relaxation intervalls. |
| Reddy YNV, Andersen MJ, Obokata M, Koepp KE, Kane GC, Melenovsky V, Olson TP, Borlaug BA. Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol. 2017 Jul 11;70(2):136-148. doi: 10.1016/j.jacc.2017.05.029. PMID: 28683960; PMCID: PMC5520668. | In HFpEF, abnormal pulsatile aortic loading during exercise occurs independently of hypertension and correlates with stress-induced hemodynamic derangements. Inorganic nitrite reduces arterial stiffening and improves hemodynamics, suggesting partial reversibility. Further research is needed to explore NO-targeting therapies for arterial stiffness in HFpEF. |
| Naeije R, Gerges M, Vachiery JL, Caravita S, Gerges C, Lang IM. Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure. Circ Heart Fail. 2017 Sep;10(9):e004082. doi: 10.1161/CIRCHEARTFAILURE.117.004082. PMID: 28912263. | Pulmonary hypertension (PH) from left heart conditions, marked by elevated pulmonary venous pressure, is classified into Cpc-PH and Ipc-PH based on clinical features, vascular pressure gradients, and RV function. Cpc-PH has a poor prognosis, and the impact of PAH-targeted therapies on its outcomes requires validation through multicenter randomized trials. |
| Heerdt PM, Korfhagen S, Ezz H, Oromendia C. Accuracy of a Simulation Algorithm for Modelling LV Contractility, Diastolic Capacitance, and Energetics Using Data Available From Common Hemodynamic Monitors and Echocardiography. J Cardiothorac Vasc Anesth. 2018 Feb;32(1):381-388. doi: 10.1053/j.jvca.2017.09.032. Epub 2017 Sep 27. PMID: 29153929. | In summary, the study supports the hypothesis that a simulation algorithm, utilizing data readily available from hemodynamic monitors and echocardiography, can accurately model LV contractility, diastolic capacitance, and energetics across various inotropic conditions. While these findings demonstrate potential in a large animal experimental model, their clinical application has yet to be established. |
| Tello K, Richter MJ, Axmann J, Buhmann M, Seeger W, Naeije R, Ghofrani HA, Gall H. More on Single-Beat Estimation of Right Ventriculoarterial Coupling in Pulmonary Arterial Hypertension. Am J Respir Crit Care Med. 2018 Sep 15;198(6):816-818. doi: 10.1164/rccm.201802-0283LE. PMID: 29756988. | Thus, mPAP cannot be a surrogate for RV ESP in the evaluation of RV contractility and RV–arterial coupling. Although the small sample size of our study must be considered, our results suggest that ESP can be cautiously estimated by the equation ESP = 1.65 × mPAP − 7.79 in the absence of direct measurements. |
| Tello K, Dalmer A, Axmann J, Vanderpool R, Ghofrani HA, Naeije R, Roller F, Seeger W, Sommer N, Wilhelm J, Gall H, Richter MJ. Reserve of Right Ventricular-Arterial Coupling in the Setting of Chronic Overload. Circ Heart Fail. 2019 Jan;12(1):e005512. doi: 10.1161/CIRCHEARTFAILURE.118.005512. PMID: 30616360. | In conclusion, the analysis of CMR, hemodynamic data, and single-beat pressure-volume loop measurements in 42 consecutive patients with pulmonary hypertension (PH) demonstrates that RV-PA coupling, defined by Ees/Ea, exhibits substantial reserve and is associated with indicators of RV maladaptation. The study suggests that SV/ESV may be at least as effective as Ees/Ea in identifying imminent RV failure in PH. |
| Wo N, Rajagopal V, Cheung MMH, Smolich JJ, Mynard JP. Assessment of single beat end-systolic elastance methods for quantifying ventricular contractility. Heart Vessels. 2019 Apr;34(4):716-723. doi: 10.1007/s00380-018-1303-5. Epub 2018 Nov 14. PMID: 30430293. | In sheep data across various heart rates and inotropic states, single-beat elastance estimation methods showed poor absolute accuracy. Correlations with EMB improved within individuals, especially during afterload increases. Shishido et al.’s method [2] performed best, with strong within-animal EMB correlations. |
| Raymond M, Grønlykke L, Couture EJ, Desjardins G, Cogan J, Cloutier J, Lamarche Y, L’Allier PL, Ravn HB, Couture P, Deschamps A, Chamberland ME, Ayoub C, Lebon JS, Julien M, Taillefer J, Rochon A, Denault AY. Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2019 Apr;33(4):1090-1104. doi: 10.1053/j.jvca.2018.08.198. Epub 2018 Aug 25. PMID: 30269893. | Analysis of right ventricular pressure waveforms for monitoring in cardiac surgery. |
| Vanderpool RR, Puri R, Osorio A, Wickstrom K, Desai A, Black S, Garcia JGN, Yuan J, Rischard F. EXPRESS: Surfing the Right Ventricular Pressure Waveform: Methods to assess Global, Systolic and Diastolic RV Function from a Clinical Right Heart Catheterization. Pulm Circ. 2019 Apr 29;10(1):2045894019850993. doi: 10.1177/2045894019850993. Epub ahead of print. PMID: 31032737; PMCID: PMC7031797. | When measured RV volumes are unavailable, RV diastolic stiffness and Eed can be estimated from clinical beat-to-beat pressure-volume curves. This is achieved by normalizing RV EDV to a constant volume and utilizing RHC-derived stroke volumes (SVs). The estimation of Eed is more sensitive to the measured SV and RAP than to the absolute values of ESV and EDV. |
| Samura T, Yoshioka D, Asanoi H, Toda K, Miyagawa S, Yoshikawa Y, Hata H, Kainuma S, Kawamura T, Kawamura A, Sakata Y, Sawa Y. Right Atrial Pressure Waveform Predicts Right Ventricular Failure After Left Ventricular Assist Device Implantation. Ann Thorac Surg. 2019 Nov;108(5):1361-1368. doi: 10.1016/j.athoracsur.2019.04.050. Epub 2019 Jun 5. PMID: 31175868. | Analysis of right atrial pressure waveform to predict right ventricular failure after implantation of left ventricular assist devices. |
| Westerhof N., Stergiopulos N., Noble M. I. M., Westerhof B. E. (2019). Snapshots of Hemodynamics: An Aid for Clinical Research and Graduate Education, Vol. 3rd eds Westerhof N., Stergiopulos N., Noble M. I. M., Westerhof B. E. (New York, NY: Springer International Publishing AG; ) | Snapshots of Hemodynamics: An Aid for Clinical Research and Graduate Education |
| Tello K, Wan J, Dalmer A, Vanderpool R, Ghofrani HA, Naeije R, Roller F, Mohajerani E, Seeger W, Herberg U, Sommer N, Gall H, Richter MJ. Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension. Circ Cardiovasc Imaging. 2019 Sep;12(9):e009047. doi: 10.1161/CIRCIMAGING.119.009047. Epub 2019 Sep 10. PMID: 31500448; PMCID: PMC7099862. | Validation of the Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure Ratio for the Assessment of Right Ventricular-Arterial Coupling in Severe Pulmonary Hypertension. |
| Heerdt PM, Kheyfets V, Charania S, Elassal A, Singh I. A pressure-based single beat method for estimation of right ventricular ejection fraction: proof of concept. Eur Respir J. 2020 Mar 12;55(3):1901635. doi: 10.1183/13993003.01635-2019. PMID: 31771999; PMCID: PMC7885179. | Introduction of method to estimate right ventricular ejection fraction from right ventricular pressure waveforms. |
| Bastos MB, Burkhoff D, Maly J, Daemen J, den Uil CA, Ameloot K, Lenzen M, Mahfoud F, Zijlstra F, Schreuder JJ, Van Mieghem NM. Invasive left ventricle pressure-volume analysis: overview and practical clinical implications. Eur Heart J. 2020 Mar 21;41(12):1286-1297. doi: 10.1093/eurheartj/ehz552. PMID: 31435675; PMCID: PMC7084193. | This review focuses on the principles of intra-cardiac left ventricular PV analysis, signal interpretation, and potential clinical applications. |
| Ogilvie LM, Edgett BA, Huber JS, Platt MJ, Eberl HJ, Lutchmedial S, Brunt KR, Simpson JA. Hemodynamic assessment of diastolic function for experimental models. Am J Physiol Heart Circ Physiol. 2020 May 1;318(5):H1139-H1158. doi: 10.1152/ajpheart.00705.2019. Epub 2020 Mar 27. PMID: 32216614; PMCID: PMC7472516. | In conclusion, these guidelines offer recommendations to enhance the quality and precision of hemodynamic data collection and streamline the derivation of diastolic parameters, advancing the understanding of diastolic function in health and cardiac or respiratory disease. |
| Bernardo RJ, Haddad F, Couture EJ, Hansmann G, de Jesus Perez VA, Denault AY, de Man FS, Amsallem M. Mechanics of right ventricular dysfunction in pulmonary arterial hypertension and heart failure with preserved ejection fraction. Cardiovasc Diagn Ther. 2020 Oct;10(5):1580-1603. doi: 10.21037/cdt-20-479. PMID: 33224775; PMCID: PMC7666917. | RV dysfunction independently predicts survival in all forms of PH. Understanding RV mechanics reveals changes in contraction, filling, load-independent factors, energetics, and flow dynamics. Future computational approaches may integrate RV mechanics into clinical practice, therapy, and research. |
| Lambrecht, A., Vandenheuvel, M., Mauermann, E. et al. Single-Beat Estimation of Ventricular Contractility. SN Compr. Clin. Med. 3, 1002–1017 (2021). https://doi.org/10.1007/s42399-021-00820-8 | The present findings indicate a need for external validation of the numerous existing SBE techniques of ventricular contractility. At present, SBE methods should be used with the utmost care in clinical research. |
| Bootsma IT, Boerma EC, de Lange F, Scheeren TWL. The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis. J Clin Monit Comput. 2022 Feb;36(1):5-15. doi: 10.1007/s10877-021-00662-8. Epub 2021 Feb 10. PMID: 33564995; PMCID: PMC8894225. | Proper catheter placement and understanding of PAC waveforms are essential for accurate physiological interpretation and clinical decisions. Part two of this review covers the technical aspects, applications, limitations, and complications of modern PACs. |
| Brener MI, Lurz P, Hausleiter J, Rodés-Cabau J, et al. Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair. J Am Coll Cardiol. 2022 Feb 8;79(5):448-461. doi: 10.1016/j.jacc.2021.11.031. PMID: 35115101. | RV-PA coupling, measured as the TAPSE/PASP ratio, is an independent predictor of all-cause mortality in patients with tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve repair or replacement (TTVR), with higher ratios (>0.406) associated with improved survival. A decline in RV-PA coupling post-TTVR was linked to increased mortality risk, while greater TR reduction correlated with better RV-PA coupling, suggesting its utility in patient selection and prognostication. |
| Bootsma IT, Boerma EC, Scheeren TWL, de Lange F. The contemporary pulmonary artery catheter. Part 2: measurements, limitations, and clinical applications. J Clin Monit Comput. 2022 Feb;36(1):17-31. doi: 10.1007/s10877-021-00673-5. Epub 2021 Mar 1. PMID: 33646499; PMCID: PMC7917533. | Modern PACs offer accurate, continuous monitoring of CO, RV function, and DO2/VO2 balance, integrating hemodynamic data for clinical use. Understanding these measurements and their limitations is essential for effective application. |
| Richter MJ, Hsu S, Yogeswaran A, Husain-Syed F, Vadász I, Ghofrani HA, Naeije R, Harth S, Grimminger F, Seeger W, Gall H, Tedford RJ, Tello K. Right ventricular pressure-volume loop shape and systolic pressure change in pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol. 2021 May 1;320(5):L715-L725. doi: 10.1152/ajplung.00583.2020. Epub 2021 Mar 3. PMID: 33655769; PMCID: PMC8174826. | The shape of pressure-volume (PV) loops, along with the RV systolic pressure differential, provides insight into how the right ventricle (RV) adapts to afterload in pulmonary hypertension (PH). |
| Oakland H, Joseph P, Naeije R, Elassal A, Cullinan M, Heerdt PM, Singh I. Arterial load and right ventricular-vascular coupling in pulmonary hypertension. J Appl Physiol (1985). 2021 Jul 1;131(1):424-433. doi: 10.1152/japplphysiol.00204.2021. Epub 2021 May 27. PMID: 34043473; PMCID: PMC8325619. | We demonstrate that characteristic impedance (Zc) and a wave reflection coefficient, λ, can be derived from RV pressure waveform analysis. |
| Singh I, Oakland H, Elassal A, Heerdt PM. Defining end-systolic pressure for single-beat estimation of right ventricle-pulmonary artery coupling: simple… but not really. ERJ Open Res. 2021 Aug 23;7(3):00219-2021. doi: 10.1183/23120541.00219-2021. PMID: 34435035; PMCID: PMC8381254. | Comparison of the most common single-beat methods to estimate end-systolic pressure against the multi-beat method. |
| Belkin MN, Kalantari S, Kanelidis AJ, Miller T, Smith BA, Besser SA, Tehrani D, Chung BB, Nguyen A, Sarswat N, Blair JEA, Burkhoff D, Sayer G, Pinney SP, Uriel N, Kim G, Grinstein J. Aortic Pulsatility Index: A Novel Hemodynamic Variable for Evaluation of Decompensated Heart Failure. J Card Fail. 2021 Oct;27(10):1045-1052. doi: 10.1016/j.cardfail.2021.05.010. Epub 2021 May 25. PMID: 34048919; PMCID: PMC9073373. | The Aortic Pulsatility Index is a new invasive hemodynamic measure independently associated with improved survival and freedom from advanced therapies at 30-day follow-up. |
| Brener MI, Masoumi A, Ng VG, Tello K, Bastos MB, Cornwell WK 3rd, Hsu S, Tedford RJ, Lurz P, Rommel KP, Kresoja KP, Nagueh SF, Kanwar MK, Kapur NK, Hiremath G, Sarraf M, Van Den Enden AJM, Van Mieghem NM, Heerdt PM, Hahn RT, Kodali SK, Sayer GT, Uriel N, Burkhoff D. Invasive Right Ventricular Pressure-Volume Analysis: Basic Principles, Clinical Applications, and Practical Recommendations. Circ Heart Fail. 2022 Jan;15(1):e009101. doi: 10.1161/CIRCHEARTFAILURE.121.009101. Epub 2021 Dec 29. PMID: 34963308; PMCID: PMC8766922. | A comprehensive review of contemporary advancements in pressure-volume analysis. |
| Shima H, Nakaya T, Tsujino I, Nakamura J, Sugimoto A, Sato T, Watanabe T, Ohira H, Suzuki M, Kato M, Yokota I, Konno S. Accuracy of Swan‒Ganz catheterization-based assessment of right ventricular function: Validation study using high-fidelity micromanometry-derived values as reference. Pulm Circ. 2022 Apr 18;12(2):e12078. doi: 10.1002/pul2.12078. PMID: 35514782; PMCID: PMC9063972. | In conclusion, this study evaluated the accuracy of SG-cath-derived RV function indices in PH patients, finding that key indices like Ees/Ea and β were similar and strongly correlated with Pressure-cath reference values. Proper use of these indices could enhance understanding, management, and outcomes in PH patients. |
| Fukumitsu M, Groeneveldt JA, Braams NJ, Bayoumy AA, Marcus JT, Meijboom LJ, de Man FS, Bogaard HJ, Vonk Noordegraaf A, Westerhof BE. When right ventricular pressure meets volume: The impact of arrival time of reflected waves on right ventricle load in pulmonary arterial hypertension. J Physiol. 2022 May;600(10):2327-2344. doi: 10.1113/JP282422. Epub 2022 Apr 27. PMID: 35421903; PMCID: PMC9321993. | Early reflected waves were linked to greater RV hypertrophy, PAH treatment reduced PVR and delayed these waves. |
| Couture EJ, Moses K, Monge García MI, Potes C, Haddad F, Grønlykke L, Garcia F, Paster E, Pibarot P, Denault AY. Longitudinal Validation of Right Ventricular Pressure Monitoring for the Assessment of Right Ventricular Systolic Dysfunction in a Large Animal Ischemic Model. Crit Care Explor. 2023 Jan 18;5(1):e0847. doi: 10.1097/CCE.0000000000000847. PMID: 36699251; PMCID: PMC9851694. | Stepwise decreases in RV Ees during acute ischemic RV dysfunction were accurately tracked by RV dP/dtmax derived from the RV pressure waveform. |
| Nicoara, Alina, et al. “Right Ventriculo-Arterial Coupling Assessment by High-Fidelity Hemodynamic Measurements in Patients Undergoing Left Ventricular Assist Device Implantation.” Circulation 148.Suppl_1 (2023): A14318-A14318. | The study demonstrates the feasibility of assessing RV function using conductance catheters and 3D echocardiography, effectively identifying individual RV-PA coupling responses after LVAD implantation. Ongoing data collection aims to define RV adaptation phenotypes and establish RV-PA uncoupling thresholds linked to RVF. |
| Seemann F, Bruce CG, Khan JM, Ramasawmy R, Potersnak AG, Herzka DA, Kakareka JW, Jaimes AE, Schenke WH, O’Brien KJ, Lederman RJ, Campbell-Washburn AE. Dynamic pressure-volume loop analysis by simultaneous real-time cardiovascular magnetic resonance and left heart catheterization. J Cardiovasc Magn Reson. 2023 Jan 16;25(1):1. doi: 10.1186/s12968-023-00913-4. PMID: 36642713; PMCID: PMC9841727. | Dynamic PV loops obtained during real-time CMR-guided preload reduction offer quantitative metrics of contractility and compliance while providing more reliable volumetric measurements compared to conductance PV loop catheters. |
| Houston BA, Brittain EL, Tedford RJ. Right Ventricular Failure. N Engl J Med. 2023 Mar 23;388(12):1111-1125. doi: 10.1056/NEJMra2207410. PMID: 36947468. | Review article mechanisms, clinical presentation, and evaluation of right ventricular failure, as well as its management. |
| Baratto C, Caravita S, Dewachter C, Faini A, Perego GB, Bondue A, Senni M, Muraru D, Badano LP, Parati G, Vachiéry JL. Right Heart Adaptation to Exercise in Pulmonary Hypertension: An Invasive Hemodynamic Study. J Card Fail. 2023 Sep;29(9):1261-1272. doi: 10.1016/j.cardfail.2023.04.009. Epub 2023 May 5. PMID: 37150503. | Patients with PH-HFpEF often show a steeper rise in RAP during exercise compared to those with PAH, despite similar CO, suggesting a more limited Frank–Starling reserve. Dysfunctional preload and pericardial constraint may contribute to this steep RAP increase in PH. |
| Grinstein J, Houston BA, Nguyen AB, Smith BA, Chinco A, Pinney SP, Tedford RJ, Belkin MN. Standardization of the Right Heart Catheterization and the Emerging Role of Advanced Hemodynamics in Heart Failure. J Card Fail. 2023 Nov;29(11):1543-1555. doi: 10.1016/j.cardfail.2023.08.009. Epub 2023 Aug 24. PMID: 37633442. | This review covers best practices in the cardiac catheterization lab and new findings on the prognostic value of advanced hemodynamic parameters. |
| Arvidsson PM, Green PG, Watson WD, Shanmuganathan M, Heiberg E, De Maria GL, Arheden H, Herring N, Rider OJ. Non-invasive left ventricular pressure-volume loops from cardiovascular magnetic resonance imaging and brachial blood pressure: validation using pressure catheter measurements. Eur Heart J Imaging Methods Pract. 2023 Oct 25;1(2):qyad035. doi: 10.1093/ehjimp/qyad035. PMID: 37969333; PMCID: PMC10631830. | PV loop analysis derived from standard cine CMR imaging and brachial cuff blood pressures is precise, accurate, and offers non-invasive access to unique physiological insights. It is well-suited for research applications to monitor outcomes or identify therapeutic targets. |
| J. Araos, C. Owyang, M. Martin-Flores, F. Teran, J. Kim, J.A. Retamal Montes, A. Notarianni, and P.M. Heerdt. Right Ventriculoarterial Coupling During Positive End-expiratory Pressure Titration Based on a Pressure-based Single Beat Method: A Proof-of-Concept Study (abstract). Am J Respir Crit Care Med 2024;209:A3477. | Single-beat RVP analysis with SV can help quantify PEEP-induced changes in RV:PA coupling, distinguishing effects of altered contractility or afterload to personalize treatment. The method identified distinct RV:PA coupling responses to PEEP in recruitable ARDS lungs versus overdistending healthy lungs. Future work should focus on automating the process for real-time, beat-to-beat measurements. |
| Ribic D, Remme EW, Smiseth OA, Massey RJ, Eek CH, Kvitting JE, Gullestad L, Broch K, Russell K. Non-invasive myocardial work in aortic stenosis: validation and improvement in left ventricular pressure estimation. Eur Heart J Cardiovasc Imaging. 2024 Jan 29;25(2):201-212. doi: 10.1093/ehjci/jead227. PMID: 37672652; PMCID: PMC10824486. | This study confirms the validity of non-invasive MWI in AS patients. Matching AVO to diastolic pressure improved LVP curve accuracy, aligning with the AS-specific model and potentially enhancing regional MWI assessment. |
| Brener MI, Kanwar MK, Lander MM, Hamid NB, Raina A, Sethi SS, Finn MT, Fried JA, Raikhelkar J, Masoumi A, Rosenblum HR, Maurer MS, Sayer G, Burkhoff D, Uriel N. Impact of Interventricular Interaction on Ventricular Function: Insights From Right Ventricular Pressure-Volume Analysis. JACC Heart Fail. 2024 Jul;12(7):1179-1192. doi: 10.1016/j.jchf.2023.12.001. Epub 2024 Jan 10. PMID: 38206234. | Interventricular interactions led to enhanced RV compliance, reduced afterload, and preserved RV contractility. These findings challenge the prevailing notion that interventricular interactions impair RV function, offering significant insights into RV-LV dynamics across various conditions, including post-LVAD RV dysfunction. |
| Ertugrul IA, Puspitarani RADA, Wijntjes B, Vervoorn MT, Ballan EM, van der Kaaij NP, van Goor H, Westenbrink BD, van der Plaats A, Nijhuis F, van Suylen V, Erasmus ME. Ex Situ Left Ventricular Pressure-Volume Loop Analyses for Donor Hearts: Proof of Concept in an Ovine Experimental Model. Transpl Int. 2024 Jul 11;37:12982. doi: 10.3389/ti.2024.12982. PMID: 39055346; PMCID: PMC11269103. | This study presents a reproducible method for DCD heart preservation and demonstrates functional assessment of ovine hearts using ex situ PV loop analyses with virtual afterload and preload during ESHP. Further validation is needed to optimize graft selection and improve outcomes in DBD and DCD heart transplants before clinical use |
| Kremer N, Glocker F, Schäfer S, Rako Z, Yogeswaran A, Seeger W, Hopf HB, Tello K. Precision cardiac monitoring: algorithmic real-time assessment of right ventricular function in pulmonary hypertension. ESC Heart Fail. 2024 Aug;11(4):2469-2472. doi: 10.1002/ehf2.14833. Epub 2024 Apr 30. PMID: 38689380; PMCID: PMC11287341. | Method for continuous estimation of hydromotive source pressure for continuous calculation of pressure-based ejection fraction. |
| Heerdt PM, Kheyfets VO, Oakland HT, Joseph P, Singh I. Right Ventricular Pressure Waveform Analysis-Clinical Relevance and Future Directions. J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2433-2445. doi: 10.1053/j.jvca.2024.06.022. Epub 2024 Jun 20. PMID: 39025682. | A comprehensive review of contemporary advancements in right ventricular waveform analysis. |
| Meinert-Krause JP, Mechelinck M, Hein M, Habigt MA. Intrinsic mechanisms of right ventricular autoregulation. Sci Rep. 2024 Apr 23;14(1):9356. doi: 10.1038/s41598-024-59787-w. PMID: 38654031; PMCID: PMC11039625. | In the experiment, an acute increase in right-ventricular afterload resulted in a biphasic ESPVR. It is hypothesized that SDA was the causative factor for the first phase, while FSM was responsible for the second phase. The Anrep effect showed significant interindividual variability and likely occurred early, inhibiting ventricular dilation. |
| Denault A, Couture EJ, Perry T, Saade E, Calderone A, Zeng YH, Scherb D, Moses K, Potes C, Hammoud A, Beaubien-Souligny W, Elmi-Sarabi M, Grønlykke L, Lamarche Y, Lebon JS, Rousseau-Saine N, Desjardins G, Rochon A. Continuous Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2024 Aug;38(8):1673-1682. doi: 10.1053/j.jvca.2024.04.025. Epub 2024 Apr 22. PMID: 38862285. | Elevated RVDPG and RVEDP are common in cardiac surgery. While RVDPG and RVEDP before CPB initiation do not indicate RV dysfunction and failure, they can be useful for diagnosing these conditions. |
| Bachmann KF, Moller PW, Hunziker L, Maggiorini M, Berger D. Mechanisms maintaining right ventricular contractility-to-pulmonary arterial elastance ratio in VA ECMO: a retrospective animal data analysis of RV-PA coupling. J Intensive Care. 2024 May 11;12(1):19. doi: 10.1186/s40560-024-00730-6. PMID: 38734616; PMCID: PMC11088130. | Under VA ECMO support, the RV demonstrates the ability to enhance contractility in response to afterload changes to maintain VA coupling. However, abrupt additional afterload increases, such as those from mechanical inspiration, exceed the RV’s adaptive capacity, particularly in low preload states. Assessing RV function and RV-PA coupling using readily available bedside tools is feasible and provides valuable physiological insights in VA ECMO-treated patients. |
| Lakatos BK, Rako Z, Szijártó Á, da Rocha BRB, Richter MJ, Fábián A, Gall H, Ghofrani HA, Kremer N, Seeger W, Zedler D, Yildiz S, Yogeswaran A, Merkely B, Tello K, Kovács A. Right ventricular pressure-strain relationship-derived myocardial work reflects contractility: Validation with invasive pressure-volume analysis. J Heart Lung Transplant. 2024 Jul;43(7):1183-1187. doi: 10.1016/j.healun.2024.03.007. Epub 2024 Mar 18. PMID: 38508504. | Similar to the LV, RV EF and GLS primarily reflect ventriculo-arterial coupling rather than myocardial contractility. However, integrating 3D echocardiography-derived GLS with instantaneous RV pressures enables the quantification of RV GMWI, which strongly correlates with the gold-standard measure of RV contractility. |
| Kiarad V, Mahmood F, Hedayat M, Yunus R, Nicoara A, Liu D, Chu L, Senthilnathan V, Kai M, Khabbaz K. Intraoperative right ventricular end-systolic pressure-volume loop analysis in patients undergoing cardiac surgery: A proof-of-concept methodology. JTCVS Open. 2024 Sep 26;22:225-234. doi: 10.1016/j.xjon.2024.09.020. PMID: 39780800; PMCID: PMC11704560. | This study demonstrates the feasibility of generating intraoperative right ventricular (RV) pressure-volume (PV) loops and analyzing the end-systolic PV relationship (ESPVR) using routinely available hemodynamic and echocardiographic data in cardiac surgery patients. The results show that patients with preserved RV function had higher Ees values and a larger Ees/Ea ratio, suggesting the potential for real-time intraoperative RV function monitoring with further validation. |
| Golbin JM, Shukla N, Nero N, Hockstein MA, Tonelli AR, Siuba MT. Non-invasive surrogates for right Ventricular-Pulmonary arterial coupling: a systematic review and Meta-Analysis. Pulm Circ. 2024 Oct 21;14(4):e70004. doi: 10.1002/pul2.70004. PMID: 39439999; PMCID: PMC11493845. | Non-invasive RV-PA coupling surrogates show moderate correlation with gold-standard PV loops and fail to clarify individual components, limiting their utility in managing RV dysfunction. |
| Ádám Szijártó, Alina Nicoara, Mihai Podgoreanu, Márton Tokodi, Alexandra Fábián, Béla Merkely, András Sárkány, Zoltán Tősér, Sergio Caravita, Claudia Baratto, Michele Tomaselli, Denisa Muraru, Luigi Paolo Badano, Bálint Lakatos, Attila Kovács, Artificial intelligence-enabled reconstruction of the right ventricular pressure curve using the peak pressure value: a proof-of-concept study, European Heart Journal – Imaging Methods and Practice, Volume 2, Issue 4, October 2024, qyae099, https://doi.org/10.1093/ehjimp/qyae099 | The proposed method facilitates the reconstruction of the RV pressure curve using only the peak value as input. This approach holds potential as a foundational element for the development of innovative echocardiographic tools aimed at afterload-adjusted assessment of RV function. |
| Kremer N, Schaefer S, Yogeswaran A, Rako Z, Ghofrani HA, Seeger W, Kojonazarov B, Heerdt PM, Tedford RJ, Tello K. Exercise Limitation in Pulmonary Hypertension – Physiological Insights into the Six-Minute Walk Test. Am J Respir Crit Care Med. 2024 Oct 15. doi: 10.1164/rccm.202407-1397RL. Epub ahead of print. PMID: 39404674. | The results highlight the importance of the heart’s adaptive ability under stress and suggest that pauses during the 6MWT may signal when the heart is struggling, indicating reduced capacity in severe PH. |
| Hemnes AR, Celermajer DS, D’Alto M, Haddad F, Hassoun PM, Prins KW, Naeije R, Vonk Noordegraaf A. Pathophysiology of the right ventricle and its pulmonary vascular interaction. Eur Respir J. 2024 Oct 31;64(4):2401321. doi: 10.1183/13993003.01321-2024. PMID: 39209482; PMCID: PMC11525331. | The right ventricle plays a crucial role in survival for patients with pulmonary hypertension. Building on the 2018 World Symposium on Pulmonary Hypertension’s framework, this review updates key mechanisms driving RV function, explores clinical metrics for assessment, and examines the roles of the right atrium and tricuspid regurgitation. It also discusses RV phenotypes in pulmonary vascular diseases, recent pharmacological studies, and future research directions. |
| Fudim M, Kittipibul V, Swavely A, Gray A, Mikitka J, Young E, Dobbin O, Radzom M, Fee J, Molinger J, Patterson B, Battista Perego G, Badano LP, Parati G, Vachiéry JL, Senni M, Lanzarone E, Previdi F, Paleari S, Baratto C, Caravita S. Discrepancy in the Diagnosis of Heart Failure With Preserved Ejection Fraction Between Supine Versus Upright Exercise Hemodynamic Testing. Circ Heart Fail. 2024 Nov 8:e012020. doi: 10.1161/CIRCHEARTFAILURE.124.012020. Epub ahead of print. PMID: 39513293. | Half of HFpEF patients meeting criteria in the supine position failed to do so upright. Discordant HFpEF cases showed fewer structural and hemodynamic abnormalities than concordant ones. Upright exercise right heart catheterization is feasible and warrants further study to assess its clinical relevance. |
| Wozolek, A., Soto, L., Couture, E., Perry, T., Cutler, J., Lahsaei, P., Leff, J., Moses, K., Potes, C., Scherb, D., Rochon, A., & Denault, A. Y. (2024). Successful perioperative monitoring of the right ventricular pressure: Development and evaluation of a new pulmonary artery catheter. Journal of Cardiothoracic and Vascular Anesthesia. https://doi.org/10.1053/j.jvca.2024.12.033 | A new pulmonary artery catheter with a right ventricular (RV) port positioned closer to the tip (13 cm) was tested in 149 patients undergoing cardiothoracic or abdominal surgery, achieving successful continuous RV pressure monitoring in all but three cases. The new design improved placement feasibility without complications, suggesting it may help overcome prior positioning challenges and enhance perioperative RV monitoring. |
| Lashin H, Olusanya O, Smith A, Bhattacharyya S. Association Between Right Ventricular Systolic Parameters Measured by Echocardiography and Stroke Volume Derived From Pulmonary Artery Catheter in Ischemic Cardiogenic Shock. J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2592-2600. doi: 10.1053/j.jvca.2024.07.024. Epub 2024 Jul 25. PMID: 39095212. | In STEMI with CS, the median age was 61 years (84% male). Median PAC-derived SV and LVEF were 57 mL and 31%. RVOT VTI (r = 0.42) and TAPSE (r = 0.37) correlated with PAC-derived SV. RVOT VTI <12.7 cm predicted low SV (AUC = 0.71) with 66% sensitivity and 72% specificity, making it the key echocardiographic parameter for guiding management. |
| Vandenheuvel M, Bouchez S, Labus J, Wouters P, Mauermann E. Introduction of a Vendor-Independent Application for Clinical Generation of Pressure-Volume Loops from Routine Hemodynamic Data: A Methodological Exploration. J Cardiothorac Vasc Anesth. 2025 Feb;39(2):420-428. doi: 10.1053/j.jvca.2024.11.024. Epub 2024 Nov 26. PMID: 39674737. | This study introduces a vendor-independent application for constructing ventricular pressure-volume loops (PVLs) using routine clinical monitoring data, demonstrating feasibility in both simulated and real-world perioperative settings. Results suggest that this approach could enhance cardiovascular research and patient care, though further external validation is required. |
| Thiel, J. N., Verhülsdonk, D., Steinseifer, U., Linden, K., Herberg, U., Friehs, I., … & Neidlin, M. (2025). An Interactive Computational Pipeline to Investigate Ventricular Hemodynamics with Real‐Time Three‐Dimensional Echocardiography and Computational Fluid Dynamics. Engineering Reports, 7(1), e13041 | This study introduces IP-HEART, an interactive open-source computational pipeline that streamlines geometry processing for patient-specific computational fluid dynamics (CFD) models of ventricular blood flow. By reducing preprocessing complexity and improving reproducibility, IP-HEART enables efficient integration of real-time echocardiography data, allowing for detailed hemodynamic analysis with validated clinical correlations. |
| Yuriditsky E, Mireles-Cabodevila E, Alviar CL. How I Teach: Heart-Lung Interactions during Mechanical Ventilation. Positive Pressure and the Right Ventricle. ATS Sch. 2024 Dec 10:atsscholar20240059HT. doi: 10.34197/ats-scholar.2024-0059HT. Epub ahead of print. PMID: 39909023. | Positive pressure ventilation can cause hemodynamic deterioration, particularly affecting the right heart, making heart-lung interactions a complex yet often misunderstood topic among clinicians. This article presents a teaching approach using two 30-minute didactic sessions—”How the right heart fills” and “How the right heart empties”—to clarify key physiological concepts and their clinical implications through lectures and simulated cases. |
| Baratto C, Dewachter C, Forton K, Muraru D, Gagliardi MF, Tomaselli M, Gavazzoni M, Perego GB, Senni M, Bondue A, Badano LP, Parati G, Vachiéry JL, Caravita S. Right ventricular reserve in cardiopulmonary disease: a simultaneous hemodynamic and three-dimensional echocardiographic study. J Heart Lung Transplant. 2024 Dec 25:S1053-2498(24)02036-9. doi: 10.1016/j.healun.2024.12.022. Epub ahead of print. PMID: 39730080. | Exhausted RV reserve, assessed by 3DE, was common in HFpEF and PVD, largely independent of classical afterload parameters, and linked to RV-PA decoupling, RV dilation, increased ventricular interdependence, and exercise limitation. Intrinsic RV dysfunction may play a role. |
| Ripollés-Melchor J, Tomé-Roca JL, Zorrilla-Vaca A, et al. Hemodynamic Management guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial. Anesthesiology. Published online January 2, 2025. doi:10.1097/ALN.0000000000005355 | A multicenter randomized trial evaluated whether Hypotension Prediction Index (HPI)-guided therapy reduces postoperative acute kidney injury (AKI) in moderate-to-high-risk elective abdominal surgery patients but found no significant difference in AKI incidence (6.1% vs. 7.0%, P=0.66), overall complications, renal replacement therapy, hospital stay, or 30-day mortality compared to standard care. These findings suggest that HPI-guided management does not improve postoperative renal outcomes or overall complications in this patient population. |
| Monnet X, Lai C, De Backer D. Why do we use transpulmonary thermodilution and pulmonary artery catheter in severe shock patients? Ann Intensive Care. 2025 Jan 14;15(1):7. doi: 10.1186/s13613-024-01400-4. PMID: 39808220; PMCID: PMC11732821. | In the management of the most severe and complex shock patients, a comprehensive understanding of haemodynamic status, including cardiac output (CO), is essential. Transpulmonary thermodilution (TPTD) and pulmonary artery catheterization (PAC) are considered the only methods that reliably measure CO and provide sufficient haemodynamic information to guide treatment in these cases. |
| Lo Giudice F, Escribano-Subias P, Tello K, Kopec G, Ghio S, Giannakoulas G, D’Alto M, Filomena D, Manzi G, Orlando A, Greco A, Recchioni T, Yildiz S, López-Guarch CJ, Cruz-Utrilla A, Psochias P, Patsiou V, Stępniewski J, Jonas K, Scelsi L, Kremer N, Vergara A, Vizza CD, Naeije R, Badagliacca R. Echocardiography of the right heart in pulmonary arterial hypertension: insights from the ULTRA RIGHT VALUE study. Eur Heart J Imaging Methods Pract. 2025 Jan 15;3(1):qyae121. doi: 10.1093/ehjimp/qyae121. PMID: 39816928; PMCID: PMC11733976. | This multicentric study collected echocardiographic data with centralized reading from 401 patients with prevalent PAH, along with clinical variables such as WHO functional class, 6MWD, BNP/NT-proBNP, invasive hemodynamics, ESC/ERS four-strata scores, and REVEAL 2.0 scores. The echocardiographic measurements, including right heart dimensions, systolic function indices (e.g., TAPSE/sPAP), and RV-PA coupling estimates, correlated with clinical and hemodynamic parameters, providing a foundation for evaluating the added value of echocardiography in PAH risk assessment. |
| Jian Z, Liu X, Kouz K, Settels JJ, Davies S, Scheeren TWL, Fleming NW, Veelo DP, Vlaar APJ, Sander M, Cannesson M, Berger D, Pinsky MR, Sessler DI, Hatib F, Saugel B. Deep learning model to identify and validate hypotension endotypes in surgical and critically ill patients. Br J Anaesth. 2025 Jan 8:S0007-0912(24)00712-8. doi: 10.1016/j.bja.2024.10.048. Epub ahead of print. PMID: 39788817. | Unsupervised deep learning identified four hypotension endotypes—vasodilation, hypovolemia, myocardial depression, and bradycardia—using haemodynamic data from surgical and critically ill patients. Validated across independent datasets, this approach could guide clinicians in tailoring treatments to the underlying causes of hypotension. |
| Association with Outcome of the Regurgitant-Volume Adjusted Right Ventricular Ejection Fraction in Secondary Tricuspid Regurgitation, Clement, Alexandra et al., Journal of the American Society of Echocardiography, January 21, 2025, DOI: 10.1016/j.echo.2025.01.008 | In 513 patients with STR, eRVEF, calculated as RV forward stroke volume divided by RV end-diastolic volume, showed a stronger association with the composite endpoint of all-cause mortality and heart failure hospitalization over a mean follow-up of 18 months than RVEF and other RV function indices. Patients with eRVEF <20% had a threefold higher risk of adverse events, highlighting its prognostic value in this population. |
| Grinstein, J, Blanco, P, Torii, R. et al. The Virtual Patient Simulator: Using Hemodynamics and the Cardioenergetic Profile to Optimize Heart Failure Care. J Am Coll Cardiol Basic Trans Science. null2025, 0 (0) .https://doi.org/10.1016/j.jacbts.2025.01.009 | Heart failure affects millions of patients, with many eligible for heart replacement therapy (HRT) never receiving it due to referral delays and limitations in current risk stratification methods. The Virtual Patient Simulator (VPS) integrates advanced hemodynamic and energetic modeling with machine learning to enhance risk prediction, improve clinical decision-making, and optimize patient outcomes by identifying the individual tipping point for disease progression and therapy response. |
| Conductance catheterization compared to cardiac MRI environment in acquisition of pressure and volume loops for the physiological assessment of ventricular functionality. Gusseva, Maria et al. Journal of Cardiovascular Magnetic Resonance, Volume 27, 101565. DOI: 10.1016/j.jocmr.2024.101565 | This study compares conductance catheterization (C-Cath), fluid-filled catheter with MRI (FFcath+MRI), and model-derived methods for obtaining Pressure-Volume Loops (PVLs) in patients with congenitally corrected transposition of the great arteries (ccTGA), assessing their accuracy in evaluating left ventricular (LV) preparedness for surgery. Results indicate that model-derived PVLs provide more reliable max(dP/dt) estimations than C-Cath or FFcath+MRI, suggesting their potential utility in centers lacking specialized C-Cath equipment. |
| Yuriditsky E, Zhang RS, Zhang P, Postelnicu R, Greco AA, Horowitz JM, Bernard S, Leiva O, Mukherjee V, Hena K, Elbaum L, Alviar CL, Keller NM, Bangalore S. Right Ventricular-Pulmonary Arterial Uncoupling as a Predictor of Invasive Hemodynamics and Normotensive Shock in Acute Pulmonary Embolism. Am J Cardiol. 2025 Feb 1;236:1-7. doi: 10.1016/j.amjcard.2024.10.036. Epub 2024 Nov 4. PMID: 39505227. | This study demonstrates that the echocardiographic TAPSE/PASP ratio strongly predicts reduced cardiac index and normotensive shock in patients with acute pulmonary embolism undergoing mechanical thrombectomy. These findings suggest that noninvasive assessment of right ventricular-pulmonary arterial coupling may enhance risk stratification and hemodynamic evaluation in PE management. |
| da Rocha BRB, Yogeswaran A, Lakatos BK, Fábián A, Gall H, Ghofrani HA, Kremer NC, Schäfer S, Seeger W, Zedler D, Yildiz S, Rako ZA, Kovács A, Tello K. Loss of right ventricular outflow function in pulmonary hypertension. J Heart Lung Transplant. 2025 Feb;44(2):273-277. doi: 10.1016/j.healun.2024.09.026. Epub 2024 Oct 10. PMID: 39393615. | Three-dimensional (3D) echocardiographic assessment of right ventricular outflow tract (RVOT) function using ReVISION software revealed that patients with pulmonary hypertension (PH) had significantly lower RVOT ejection fractions (EF) than healthy controls (30.4% vs. 44.2%, p < 0.001), with lower RVOT-EF correlating with greater disease severity and clinical worsening. Notably, even patients with preserved overall right ventricular function (RV-EF ≥35%) but reduced RVOT-EF had worse outcomes, highlighting the potential of segmental RVOT analysis for identifying high-risk PH patients. |
| Araos, Joaquin D.V.M., Ph.D.; Glocker, Felix M.Sc.; Owyang, Clark G. M.D.; Teran, Felipe M.D.; Kim, Jiwon M.D.; Nieman, Gary B.S.; Heerdt, Paul M. M.D., Ph.D. Biventricular Response to Positive End-expiratory Pressure in Swine: Assessment Based on Beat-to-beat Pressure Waveform Analysis. Anesthesiology, February 13, 2025. | DOI: 10.1097/ALN.0000000000005363 | Increasing positive end-expiratory pressure (PEEP) impairs right ventricular function by increasing afterload while preserving left ventricular function, with effects more pronounced at higher PEEP levels. This study suggests that continuous, beat-to-beat pressure-based analysis could provide a practical bedside alternative for monitoring PEEP-related hemodynamic changes. |
| Lyhne, M. D., Yuriditsky, E., Zochios, V., Dragsbaek, S. J., Hansen, J. V., Andersen, M. J., Mellemkjær, S., Kabrhel, C., & Andersen, A. (2025). Pulmonary Artery Pulsatility Index in Acute and Chronic Pulmonary Embolism. Medicina, 61(2), 363. https://doi.org/10.3390/medicina61020363 | The pulmonary artery pulsatility index (PAPi) was evaluated as a marker of right ventricular (RV) injury in acute pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH), but it did not effectively distinguish PE from sham conditions or consistently detect therapeutic effects in humans. While PAPi changed with certain pharmacological interventions in experimental PE, it did not correlate well with cardiac output or RV-PA coupling, highlighting the need for further research to determine its clinical utility. |
| Sivakumar N, Zhang C, Chang-Chien C, et al. An Unsupervised Approach to Derive Right Ventricular Pressure-Volume Loop Phenotypes in Pulmonary Hypertension. Pulm Circ. 2025;15(1):e70057. Published 2025 Feb 20. doi:10.1002/pul2.70057 | Right ventricle (RV) dysfunction is a key driver of clinical worsening in pulmonary hypertension (PH), but routine clinical assessments lack direct integration of RV function metrics. This study applied data-driven modeling to identify three distinct PV loop-derived RV phenotypes, demonstrating that clinically accessible hemodynamic and imaging measurements—particularly exercise mean pulmonary arterial pressure (mPAP)—can predict these phenotypes with high accuracy (AUC = 0.93), potentially improving risk stratification and clinical decision-making. |
| Siuba, M. T., et al. (2025, March). ARDS subphenotypes exhibit different right ventricular-pulmonary arterial coupling profiles. CHEST Critical Care, 3(1), 100119. | This study analyzed RV-PA coupling in ARDS subphenotypes, finding that the more severe, inflammatory subphenotype B had worse coupling metrics. These differences persisted even after adjusting for higher PEEP in subphenotype B. |
| Sousa, M.L.A., Menga, L.S., Schreiber, A. et al. Individualized PEEP can improve both pulmonary hemodynamics and lung function in acute lung injury. Crit Care 29, 107 (2025). https://doi.org/10.1186/s13054-025-05325-7 | This study compared three PEEP titration strategies in porcine lung injury models, showing that individualized PEEP optimizes ventilation and pulmonary hemodynamics, while minimizing pulmonary vascular resistance and optimizing cardiopulmonary interactions. Excessively low or high PEEP can impair pulmonary circulation. |
| Ripollés-Melchor J, Tomé-Roca JL, Zorrilla-Vaca A, et al. Hemodynamic Management Guided by the Hypotension Prediction Index in Abdominal Surgery: A Multicenter Randomized Clinical Trial. Anesthesiology. 2025;142(4):639-654. doi:10.1097/ALN.0000000000005355 | In this multicenter randomized trial involving 917 patients undergoing moderate- to high-risk elective abdominal surgery, HPI-guided intraoperative hemodynamic management was compared to standard care. The results showed no significant reduction in moderate-to-severe postoperative acute kidney injury, overall complications, or other secondary outcomes with HPI-guided therapy. |
| Oğuz M, Uzun M, Yılmaz İ, Erdem A, Demirci M, Duran NE. Pulmonary arterial stiffness and vascular tone in pulmonary hypertension: Insights from waveform-derived reflection index and hemodynamic correlations. Heart Lung. 2025;70:50-56. doi:10.1016/j.hrtlng.2024.11.007 | This study evaluated the Reflection Index (RI) as a marker of pulmonary vascular changes in patients undergoing right heart catheterization for suspected pulmonary hypertension (PH). RI showed significant correlations with key hemodynamic and echocardiographic parameters and demonstrated moderate predictive power for PH, supporting its potential as an independent indicator of pulmonary arterial stiffness and vascular tone. |
| Machado, P., Cohen, I. S., Osler, B., McDonald, M. E., Esposito, C., Davis, M., Fischman, D., Savage, M. P., Mehrotra, P., Forsberg, F., & Dave, J. K. (2025). Left ventricular and aortic pressures measured with fluid-filled and solid-state pressure catheters: Similarities and differences. Journal of Interventional Cardiology. https://doi.org/10.1155/joic/9359365 | The study compared left ventricular and aortic pressures measured simultaneously using fluid-filled and solid-state pressure catheters in patients undergoing left heart catheterization. Results indicated that fluid-filled catheters significantly overestimated left ventricular systolic pressure, minimum-diastolic pressure, and aortic systolic pressure compared to solid-state catheters, though contraction and relaxation rates did not differ significantly between catheter types. |
| Barrientos, L., et al. (Year). Deep learning-based measurement of isovolumic relaxation time from cardiovascular magnetic resonance long-axis cines: Validation with pressure-derived IVRT. Journal of Cardiovascular Magnetic Resonance, 27, 101286. | The study developed and validated a deep learning-based method to automatically measure isovolumic relaxation time (IVRT) from cardiovascular magnetic resonance (CMR) long-axis cine images by tracking mitral and tricuspid valve plane motions. The automated IVRT measurements showed strong correlations with manual measurements and invasive pressure-derived IVRT, suggesting potential clinical utility in evaluating diastolic dysfunction. |
| Kalra PR, Gogorishvili I, Khabeishvili G, et al. First-in-Human Implantable Inferior Vena Cava Sensor for Remote Care in Heart Failure: FUTURE-HF. JACC Heart Fail. Published online March 27, 2025. doi:10.1016/j.jchf.2025.01.019 | This first-in-human study evaluated the safety and feasibility of a novel implantable inferior vena cava (IVC) sensor for remote heart failure (HF) management, demonstrating successful implantation in 50 patients with high adherence and no device-related complications at 3 months. Sensor-derived IVC measurements showed strong correlation with CT values, and exploratory outcomes indicated potential clinical benefits, including reduced HF events and improved patient status. |
| Hemodynamix related publications | Summary |
| Gaertner M, Glocker R, Glocker F, Hopf HB. Continuous long-term wireless measurement of right ventricular pressures and estimated diastolic pulmonary artery pressure in patients with severe COVID-19 acute respiratory distress syndrome. ESC Heart Fail. 2021 Dec;8(6):5213-5221. doi: 10.1002/ehf2.13600. Epub 2021 Sep 6. PMID: 34490736; PMCID: PMC8652894. | Analysis of continuous right ventricular pressure waveforms up to 30 days. |
| Kremer N, Rako Z, Glocker F, Tello K. Monitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography. Circ Heart Fail. 2023 Jan;16(1):e010097. doi: 10.1161/CIRCHEARTFAILURE.122.010097. Epub 2022 Nov 14. PMID: 36373554. | Combination of right ventricular pressure waveforms and volume curves from 3D-Echocardiography. |
| Gaertner M, Glocker R, Glocker F, Hopf HB. Pressure-based beat-to-beat right ventricular ejection fraction and Tau from continuous measured ventricular pressures in COVID-19 ARDS patients. Pulm Circ. 2023 Jan 6;13(1):e12179. doi: 10.1002/pul2.12179. PMID: 36718290; PMCID: PMC9817071. | Analysis of continuous right ventricular pressure waveforms up to 30 days and calculation of pressure-based ejection fraction and relaxation constant Tau. |
| Kremer N, Glocker F, Schäfer S, Rako Z, Yogeswaran A, Seeger W, Hopf HB, Tello K. Precision cardiac monitoring: algorithmic real-time assessment of right ventricular function in pulmonary hypertension. ESC Heart Fail. 2024 Aug;11(4):2469-2472. doi: 10.1002/ehf2.14833. Epub 2024 Apr 30. PMID: 38689380; PMCID: PMC11287341. | Validation of method to estimate hydromotive source pressure for continuous calculation of pressure-based ejection fraction. |
| Araos, Joaquin D.V.M., Ph.D.; Glocker, Felix M.Sc.; Owyang, Clark G. M.D.; Teran, Felipe M.D.; Kim, Jiwon M.D.; Nieman, Gary B.S.; Heerdt, Paul M. M.D., Ph.D. Biventricular Response to Positive End-expiratory Pressure in Swine: Assessment Based on Beat-to-beat Pressure Waveform Analysis. Anesthesiology, February 13, 2025. | DOI: 10.1097/ALN.0000000000005363 | Increasing positive end-expiratory pressure (PEEP) impairs right ventricular function by increasing afterload while preserving left ventricular function, with effects more pronounced at higher PEEP levels. This study suggests that continuous, beat-to-beat pressure-based analysis could provide a practical bedside alternative for monitoring PEEP-related hemodynamic changes. |
| Other Ressources | Link |
| Hemodynamic calculator | REV00 |
| EF and coupling cheat sheet | REV00 |
| This table is continuously updated and extended – last update 11.04.2025 |
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