Closing the Loop: Modelling of Heart Failure Progression from Health to End-Stage Using a Meta-Analysis of Left Ventricular Pressure-Volume Loops

Introduction The American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for the classification of heart failure (HF) are descriptive but lack precise and objective measures which would assist in categorising such patients. Our aim was two fold, firstly to demonstrate quantitatively the progression of HF through each stage using a meta-analysis of existing left ventricular (LV) pressure-volume (PV) loop data and secondly use the LV PV loop data to create stage specific HF models. Methods and Results A literature search yielded 31 papers with PV data, representing over 200 patients in different stages of HF. The raw pressure and volume data were extracted from the papers using a digitising software package and the means were calculated. The data demonstrated that, as HF progressed, stroke volume (SV), ejection fraction (EF%) decreased while LV volumes increased. A 2-element lumped parameter model was employed to model the mean loops and the error was calculated between the loops, demonstrating close fit between the loops. The only parameter that was consistently and statistically different across all the stages was the elastance (Emax). Conclusions For the first time, the authors have created a visual and quantitative representation of the AHA/ACC stages of LVSD-HF, from normal to end-stage. The study demonstrates that robust, load-independent and reproducible parameters, such as elastance, can be used to categorise and model HF, complementing the existing classification. The modelled PV loops establish previously unknown physiological parameters for each AHA/ACC stage of LVSD-HF, such as LV elastance and highlight that it this parameter alone, in lumped parameter models, that determines the severity of HF. Such information will enable cardiovascular modellers with an interest in HF, to create more accurate models of the heart as it fails

Ischaemic conditioning and targeting reperfusion injury: a 30 year voyage of discovery

To commemorate the auspicious occasion of the 30th anniversary of IPC, leading pioneers in the field of cardioprotection gathered in Barcelona in May 2016 to review and discuss the history of IPC, its evolution to IPost and RIC, myocardial reperfusion injury as a therapeutic target, and future targets and strategies for cardioprotection. This article provides an overview of the major topics discussed at this special meeting and underscores the huge importance and impact, the discovery of IPC has made in the field of cardiovascular research

Management of grown up congenital heart disease

s a result of the success of paediatric cardiology and cardiac surgery over the last three decades, there will shortly be more adults than children with congenital heart disease. Prior to the advent of surgery, less than 20% of children born with congenital heart malformations survived to adult life.1 Now, most deaths from congenital heart disease occur in adults. The ‘new population’ of patients with congenital heart disease no longer fits within traditional divisions of training and practice, which have separated adult and paediatric cardiology. Adult cardiologists are not equipped to deal with the range and complexity of grown-up patients with congenital heart disease, whereas paediatric cardiologists cannot be expected to manage the many acquired adult diseases in a paediatric medical environment. This report is intended to promote collaboration between the various professional groups involved in the care of adolescents and adults with congenital heart disease, administrators and those who provide resources for health care. Sustained effort to implement the recommendations of this Task Force will be required in order to bring to full fruition the huge successes achieved in the treatment of congenital heart disease in children over the last three decades