Dolmer, Mathias Hagerup

Hansen, John

Kjærgaard, Benedict

Schmidt, Samuel Emil

Struijk, Johannes Jan

Søgaard, Peter

English

Background: Pulmonary Artery Pressure (PAP) is influenced by a range of pathological conditions, including heart failure, COPD, and pulmonary embolism. Gold standard assessment of PAP is invasive right heart catheterization. Noninvasive methods such as echocardiography, impedance cardiography and analyses of the second heart sound have been suggested for estimation of PAP. The aim of the current study is to develop an animal model for validation of a heart sound based method for noninvasive estimation of PAP.Methods: Anaesthetized and mechanically ventilated Danish Landrace pigs underwent arterial catheterization with a 6 Fr catheter in the femoral artery ( Avanti, Cordis Corporation, Tipperary, Ireland) and right ventricle catheterization with a Swan-Ganz catheter /Edwards Lifesciences) through a 10 Fr venous catheter (Avanti, Cordis Corporation, Tipperary, Ireland) inserted in a jugular vein. To avoid any effect of the catheter on the second heart sound, the pressure tip was placed in the right ventricle and right ventricular systolic pressure was used as a surrogate of PAP. Two approaches were used to increase PAP through pulmonary vasoconstriction. In one method hypoxic pulmonary vasoconstriction was caused by replacing inhalation oxygen with nitrogen and in the second approach, hypercapnic pulmonary vasoconstriction was caused by adding carbon dioxide to the inhalation air.Results: Nitrogen and carbon dioxide administration were repeated 2-3 times in three pigs. Right ventricular systolic pressure increased from a baseline pressure at 28.7±3.4 mmHg to 48.1±7.5 mmHg after nitrogen inhalation and to 60.0±23.0 mmHg after carbon dioxide administration. Between administrations, the right ventricular systolic pressure returned to 31.2±4.3 mmHg.Conclusion: This porcine model alters the pulmonary arteries pressure reversibly, which makes it a valuable model for validation of noninvasive PAP estimation methods

    Aalborg UniversitetPorcine model for validation of noninvasive estimation of pulmonary artery pressureSchmidt, Samuel Emil; Dolmer, Mathias Hagerup; Hansen, John; Struijk, Johannes Jan;Søgaard, Peter; Kjærgaard, BenedictCreative Commons LicenseUnspecifiedPublication date:2022Document VersionOther versionLink to publication from Aalborg UniversityCitation for published version (APA):Schmidt, S. E., Dolmer, M. H., Hansen, J., Struijk, J. J., Søgaard, P., & Kjærgaard, B. (2022). Porcine model forvalidation of noninvasive estimation of pulmonary artery pressure. Abstract from Computing in Cardiology, CinC,Tampere, Finland. https://cinc.org/2022/Program/accepted/42.htmlGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            - Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            - You may not further distribute the material or use it for any profit-making activity or commercial gain            - You may freely distribute the URL identifying the publication in the public portal -Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: November 19, 2022Porcine model for val idat ion of  noninvasive est imation of  pulmonary artery pressureS a m u e l  E m i l  S c h m i d t 1 , M a t h i a s  D o l m e r 1 , J o h n  H a n s e n 1 , J o h a n n e s  S t r u i j k 1 , P e t e r  S ø g a a r d 2 , B e n e d i c t  K j æ r g a a r d 21A a l b o r g  u n i v e r s i t y , 2A a l b o r g  U n i v e r s i t y  H o s p i t a lThanks to Noemi Giordano, Politecnico di Torino/Aalborg universityPresented at Computing in Cardiology 20222Study aimDevelop a model for validation of pulmonary artery pressure (PAP) estimation methodsProsed methods for noninvasive estimation of PAPEchocardiographyImpedance cardiography Analyses of the second heart sound (S2)1974Why measure PAP noninvasively?Detecting pulmonary hypertension (PH)PH has high mortalityPH has unspecify symptoms and multiple originswww.escardio.org/guidelines©ESC/ERS2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension(European Heart Journal; 2022 – doi: 10.1093/eurheartj/ehac237 and European Respiratory Journal; 2022 – doi: 10.1183/13993003.00879-2022)Figure 1Central illustrationP A G E4Why measure PAP noninvasively?Detect ion of  hear t  fa i lure  decompensat ion a t  the  ear ly  s tage  C a r d i o T e c h Mattia Arrigo, Petra Nijst, Alain Rudiger. Optimising Heart Failure Therapies in the Acute Setting, Cardiac Failure Review 2018;4(1)CardioMEMSP A G E5Protocol: Set-upDanish Landrace pigs  (Danish bacon )Anaesthetized and mechanically ventilatedArterial catheterization Right ventricle catheterization with a Swan-Ganz catheter. To avoid any effect of the catheter on the second heart sound, the pressure tip was placed in the right ventricleRight ventricular systolic pressure (RVBP) was used as a surrogate of PAP.ECG and heart sounds from two 3-axis accelerometers was recorded using an iWorxdata acquisition systemSwan-Ganz catheter Arterial catheterization P A G E6Provocation of pulmonary hypertension (Hypoxemia)Aim: Tricker pulmonary hypertension by pulmonary vasoconstriction*Method: Nitrogen asphyxiationThe ventilators oxygen supply was replaced with nitrogenStopping criteria: saturation in PAP or arrhythmiaPhysiology: Low O2 concentration in the inspiration air leads to alveolar hypoxia that leads to pulmonary vasoconstriction C a r d i o T e c h*D Tarry, M Powell, Hypoxic pulmonary vasoconstriction, BJA Education, Volume 17, Issue 6, June 2017P A G E7Provocation of pulmonary hypertension (Hypercapnia)Aim: Tricker pulmonary hypertension by pulmonary vasoconstriction*Method: Carbon dioxide asphyxiationCO2 was connected to the ventilator circuit and the CO2absorber was removed from the circuit to increase the CO2 concentrationStopping criteria was saturation in PAP or arrhythmiaPhysiology: High CO2 concentration in the inspiration air leads to alveolar hypercapnia, which leads to pulmonary vasoconstriction C a r d i o T e c h*D.A. Kregenow, E.R. Swenson. The lung and carbon dioxide: implications for permissive and therapeutic hypercapnia. European Respiratory Journal Jul 2002P A G E8Results: Hypercapnia(CO 2 inha la t ion)7 pigs &  19 sessions Duration of CO2 inhalation:  7.1±2.4 minutes C a r d i o T e c hBaseline Peak↑ HR* 76.58±22 bpm 149.80±50 bpm↑ SBP* 120.2±21 mmHg 223.7±52 mmHg↑ RVBP* 27.21±11 mmHg 54.38±24 mmHg* p<0.0001HRSBPRVBPP A G E90 2 4 6 8 10 12 14Time (m)-1000100delta HR (bpm)Heart Rate0 2 4 6 8 10 12 14Time (m)-1000100delta p (mmHg)Systolic pressure in the Aorta0 2 4 6 8 10 12 14Time (m)-20020406080delta p (mmHg)Systolic pressure in the Right Ventricle0 2 4 6 8 10 12 14Time (m)050100%SpO2HypoxemiaResults (Hypoxemia)(N i t rogen inha la t ion)7 pigs & 20 sessionsDuration of Nitrogen inhalation: 7.5 ±2.0 minutes C a r d i o T e c hBaseline Peak/Nadir (60 seconds)↑ HR* 77.55±16 bpm 111.2±28 bpm↓ SBP* 122.1±19 mmHg 82.2±21 mmHg↑ RVBP* 30.7±11 mmHg 44.3±14 mmHg* p<0.0001HRSBPRVBPP A G E1 0Results: Hypercapnia vs Hypoxemia0 2 4 6 8 10 12 14 16 18 20Time (m)-100-50050100150delta HR (bpm)Heart Rate0 2 4 6 8 10 12 14 16 18 20Time (m)-100-50050100150delta p (mmHg)Systolic pressure in the Aorta0 2 4 6 8 10 12 14 16 18 20Time (m)-20020406080delta p (mmHg)Systolic pressure in the Right Ventricle0 2 4 6 8 10 12 14 16 18 20Time (m)020406080100%SpO2Hypoxemia0 2 4 6 8 10 12 14 16 18 20Time (m)-100-50050100150delta HR (bpm)Heart Rate0 2 4 6 8 10 12 14 16 18 20Time (m)-100-50050100150delta p (mmHg)Systolic pressure in the Aorta0 2 4 6 8 10 12 14 16 18 20Time (m)-20020406080delta p (mmHg)Systolic pressure in the Right Ventricle0 2 4 6 8 10 12 14 16 18 20Time (m)020406080100%SpO2HypercapniaHRSBPRVSPHigh heart rate responseHigh SBP responseHigh RVSP responseMedian heart rate responseNegative SBP responseMedian RVSP responseP A G E1 1Results: Baseline valuesNo trends in baseline values between repetitions A reversible modelTrend in HR (p=0.75)1 2 3 4 5 6Experiment number50100150200HR (bpm)Trend in SBP (p=0.11)1 2 3 4 5 6Experiment number50100150200SBP (mmHg)Trend in RVBP (p=0.99)1 2 3 4 5 6Experiment number050RVBP (mmHg)P A G E1 2Preliminary results on second heart sound (S2)The time split between the aorta and the pulmonary value is used as predictor of changes in PAPC a r d i o T e c h0 100 200 300 400 500 600 700Time (s)80100120HR (bpm)Heart Rate0 100 200 300 400 500 600 700Time (s)80100120p (mmHg)Systolic pressure in the Aorta0 100 200 300 400 500 600 700Time (s)203040p (mmHg)Systolic pressure in the Right Ventricle0 100 200 300 400 500 600 700Time (s)50100%SpO20 100 200 300 400 500 600 700Time (s)30354045split (ms)S2 splitG5 hypoxemiaP A G E1 3Discussion:In the current porcine model, we was able to reversely increase the right ventricular systolic blood pressure as a proxy for pulmonary artery pressure Hypercapnia leads to: ↑ PAP and ↑SBPHypoxemia leads to:  ↑PAP and  ↓SBPThe opposing directions in systemic blood pressure allows separating the effect of PAP and SBP on the heart sounds or other estimation methodsC a r d i o T e c hThank youThank you

Porcine model for validation of noninvasive estimation of pulmonary artery pressure

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Porcine model for validation of noninvasive estimation of pulmonary artery pressure

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