International Journal of Cardiology

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International Journal of Cardiology Pressure–volume loop-derived cardiac indices during dobutamine stress: a step towards understanding limitations in cardiac output in children with hypoplastic left heart syndrome James Wong, Kuberan Pushparajah, Adelaide de Vecchi, Bram Ruijsink, Gerald F. Greil, Tarique Hussain, Reza Razavi International Journal of Cardiology Volume 230, Pages 439-446 (March 2017) DOI: 10.1016/j.ijcard.2016.12.087 Copyright © 2016 Terms and Conditions

Fig. 1 Workflow for composing pressure–volume loops using cine CMR and invasive ventricular pressure measurements. MR-compatible catheters are positioned within the RV and the Fontan circuit. Ventricular pressure traces are synchronised to CMR volumetrics to generate a pressure–volume loop. International Journal of Cardiology 2017 230, 439-446DOI: (10.1016/j.ijcard.2016.12.087) Copyright © 2016 Terms and Conditions

Fig. 2 Mean effect of dobutamine stress on contractility (top left), afterload (top right), and ventriculo-arterial coupling ratio (lower). International Journal of Cardiology 2017 230, 439-446DOI: (10.1016/j.ijcard.2016.12.087) Copyright © 2016 Terms and Conditions

Fig. 3 (a) Pressure–volume loops for all of the studies: at rest (left); with dobutamine at 10mcg/kg/min (middle); and with dobutamine at 20mcg/kg/min (right). Volumes are indexed to body surface area to allow comparison of loops. (b) Response of power (left) and stroke work (right) to dobutamine. International Journal of Cardiology 2017 230, 439-446DOI: (10.1016/j.ijcard.2016.12.087) Copyright © 2016 Terms and Conditions

Fig. 4 Relationship of mean preload to mean indexed SV. Standard deviation bars are shown. The fall in stroke volume with increasing dobutamine stress is matched by a fall in preload. International Journal of Cardiology 2017 230, 439-446DOI: (10.1016/j.ijcard.2016.12.087) Copyright © 2016 Terms and Conditions