Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females

Peter L. M. Kerkhof, Tatiana Kuznetsova, J. Yasha Kresh, Neal Handly

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

Abstract

Recent advances in cardiac imaging techniques have substantially contributed to a growing interest in the analysis of global cardiac chamber dimensions and regional myocardial deformation. During the cardiac cycle, ventricular luminal volume varies due to the contraction process, which also confers a shape change including substantial alteration of long axis length, as well as rotation of the base compared to the apex. Local deformation can be assessed by strain (rate) analysis. Reviewing the present literature, it must be concluded that there is no single metric available to comprehensively characterize ventricular function. Every candidate advanced thus far has been found to incompletely reflect ventricular performance. This observation is not surprising in view of the complexity of the cardiac pump system. Additionally, sex-specific modifiers may play a role. More than three decades ago, it was shown that on average the ventricular volume is smaller in healthy women compared to matched males. Therefore, the present contribution concerns the interpretation of data derived from the healthy heart in both men and women. Starting from the classical Starling concept, we apply a simple mathematical transformation which permits an insightful representation of ventricular mechanics. Relating end-systolic volume (ESV) to end-diastolic volume creates the ventricular volume regulation graph which features the pertinent working point of an individual heart. This fundamental approach illustrates why certain proposed performance indexes cannot individually reveal the essence of ventricular systolic function. We demonstrate that particular metrics are highly interconnected and just tell us the same story in a different disguise. It is imperative to understand which associations exist and if they expectedly are (nearly) linear or frankly nonlinear. Notably, ejection fraction (EF) is primarily determined by ESV, while in turn EF is not much different from ventriculo-arterial coupling (VAC). Insight into cardiac function is promoted by identification of the paramount/essential components involved. The smaller ESV (p < 0.0001) implies that EF is higher in women and may also have consequences for VAC.
Original languageEnglish
Title of host publicationAdvances in Experimental Medicine and Biology
PublisherSpringer New York LLC
Pages123-138
Number of pages16
Volume1065
ISBN (Print)978-3-319-77931-7
DOIs
Publication statusPublished - 2018

Publication series

NameAdvances in Experimental Medicine and Biology
ISSN (Print)0065-2598
ISSN (Electronic)2214-8019

Cite this

Kerkhof, P. L. M., Kuznetsova, T., Yasha Kresh, J., & Handly, N. (2018). Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females. In Advances in Experimental Medicine and Biology (Vol. 1065, pp. 123-138). (Advances in Experimental Medicine and Biology). Springer New York LLC. https://doi.org/10.1007/978-3-319-77932-4_8
Kerkhof, Peter L. M. ; Kuznetsova, Tatiana ; Yasha Kresh, J. ; Handly, Neal. / Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females. Advances in Experimental Medicine and Biology. Vol. 1065 Springer New York LLC, 2018. pp. 123-138 (Advances in Experimental Medicine and Biology).
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Kerkhof, PLM, Kuznetsova, T, Yasha Kresh, J & Handly, N 2018, Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females. in Advances in Experimental Medicine and Biology. vol. 1065, Advances in Experimental Medicine and Biology, Springer New York LLC, pp. 123-138. https://doi.org/10.1007/978-3-319-77932-4_8

Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females. / Kerkhof, Peter L. M.; Kuznetsova, Tatiana; Yasha Kresh, J.; Handly, Neal.

Advances in Experimental Medicine and Biology. Vol. 1065 Springer New York LLC, 2018. p. 123-138 (Advances in Experimental Medicine and Biology).

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

TY - CHAP

T1 - Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females

AU - Kerkhof, Peter L. M.

AU - Kuznetsova, Tatiana

AU - Yasha Kresh, J.

AU - Handly, Neal

PY - 2018

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N2 - Recent advances in cardiac imaging techniques have substantially contributed to a growing interest in the analysis of global cardiac chamber dimensions and regional myocardial deformation. During the cardiac cycle, ventricular luminal volume varies due to the contraction process, which also confers a shape change including substantial alteration of long axis length, as well as rotation of the base compared to the apex. Local deformation can be assessed by strain (rate) analysis. Reviewing the present literature, it must be concluded that there is no single metric available to comprehensively characterize ventricular function. Every candidate advanced thus far has been found to incompletely reflect ventricular performance. This observation is not surprising in view of the complexity of the cardiac pump system. Additionally, sex-specific modifiers may play a role. More than three decades ago, it was shown that on average the ventricular volume is smaller in healthy women compared to matched males. Therefore, the present contribution concerns the interpretation of data derived from the healthy heart in both men and women. Starting from the classical Starling concept, we apply a simple mathematical transformation which permits an insightful representation of ventricular mechanics. Relating end-systolic volume (ESV) to end-diastolic volume creates the ventricular volume regulation graph which features the pertinent working point of an individual heart. This fundamental approach illustrates why certain proposed performance indexes cannot individually reveal the essence of ventricular systolic function. We demonstrate that particular metrics are highly interconnected and just tell us the same story in a different disguise. It is imperative to understand which associations exist and if they expectedly are (nearly) linear or frankly nonlinear. Notably, ejection fraction (EF) is primarily determined by ESV, while in turn EF is not much different from ventriculo-arterial coupling (VAC). Insight into cardiac function is promoted by identification of the paramount/essential components involved. The smaller ESV (p < 0.0001) implies that EF is higher in women and may also have consequences for VAC.

AB - Recent advances in cardiac imaging techniques have substantially contributed to a growing interest in the analysis of global cardiac chamber dimensions and regional myocardial deformation. During the cardiac cycle, ventricular luminal volume varies due to the contraction process, which also confers a shape change including substantial alteration of long axis length, as well as rotation of the base compared to the apex. Local deformation can be assessed by strain (rate) analysis. Reviewing the present literature, it must be concluded that there is no single metric available to comprehensively characterize ventricular function. Every candidate advanced thus far has been found to incompletely reflect ventricular performance. This observation is not surprising in view of the complexity of the cardiac pump system. Additionally, sex-specific modifiers may play a role. More than three decades ago, it was shown that on average the ventricular volume is smaller in healthy women compared to matched males. Therefore, the present contribution concerns the interpretation of data derived from the healthy heart in both men and women. Starting from the classical Starling concept, we apply a simple mathematical transformation which permits an insightful representation of ventricular mechanics. Relating end-systolic volume (ESV) to end-diastolic volume creates the ventricular volume regulation graph which features the pertinent working point of an individual heart. This fundamental approach illustrates why certain proposed performance indexes cannot individually reveal the essence of ventricular systolic function. We demonstrate that particular metrics are highly interconnected and just tell us the same story in a different disguise. It is imperative to understand which associations exist and if they expectedly are (nearly) linear or frankly nonlinear. Notably, ejection fraction (EF) is primarily determined by ESV, while in turn EF is not much different from ventriculo-arterial coupling (VAC). Insight into cardiac function is promoted by identification of the paramount/essential components involved. The smaller ESV (p < 0.0001) implies that EF is higher in women and may also have consequences for VAC.

KW - Ventricular volume

KW - Sex-specific analysis

KW - Starling concept

KW - Ejection fraction

KW - Cardiac output

KW - Heart rate

KW - End-systolic volume

KW - Systolic elastance

KW - Ventriculo-arterial coupling

KW - Pressure-volume loop

KW - History of cardiology

KW - Titin isoforms

KW - Soltis-Saucerman model

KW - Cardiomyogenesis

KW - Review

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T3 - Advances in Experimental Medicine and Biology

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BT - Advances in Experimental Medicine and Biology

PB - Springer New York LLC

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Kerkhof PLM, Kuznetsova T, Yasha Kresh J, Handly N. Cardiophysiology illustrated by comparing ventricular volumes in healthy adult males and females. In Advances in Experimental Medicine and Biology. Vol. 1065. Springer New York LLC. 2018. p. 123-138. (Advances in Experimental Medicine and Biology). https://doi.org/10.1007/978-3-319-77932-4_8