Heart-Lung Interactions & Cardiovascular Insufficiency

心肺相互作用

• 批准号: 6418634
• 负责人: MICHAEL R PINSKY
• 金额: $ 10.72万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2007-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6418634
• 关键词: bioimaging /biomedical imaging; cardiopulmonary disease; cardiovascular imaging /visualization; echocardiography; heart contraction; heart function; hemodynamics; human subject; patient oriented research; positive pressure breathing; pulmonary respiration; pulse pressure wave; respiratory imaging /visualization; vasomotion

We shall use the clinical analysis of heart-lung interactions as the vehicle for training post-doctoral candidates. This is an excellent and proven productive pathway for mentoring because it is based in clinically relevant cardiopulmonary physiology and requires the trainee to learn to use state-of-the-art imaging techniques with broad applications to the operating room, ICU, general hospital ward and out- patient clinic. Ventilation and ventilatory maneuvers have profound and often poorly understood hemodynamic effects especially in the setting of cardio-respiratory failure. Although numerous investigators have studied heart-lung interactions, an accurate clinical application has been lacking. Our goal is to develop and validate clinically relevant and easily applicable bedside tools for the rapid and unambiguous diagnosis of the etiology of hemodynamic insufficiency and the impact of ventilatory and adjunct cardiovascular therapies upon it. We use as our research environment, the echocardiographic clinic and the cardiac surgery suite. To accomplish these goals we are testing three hypothesis: 1) Ventilation-induced changes in LV preload and afterload are non-linear between forceful and relaxed spontaneous and positive- pressure inspiration. 2) Low levels of positive end-expiratory pressure improve LV performance by minimizing ventricular interdependence and LV ejection asynchrony by increasing ITP. 3) LV contractile reserve and preload responsiveness (often opposite ends of the cardiac function spectrum) and arterial tone can be readily identified by analysis of the arterial pulse pressure responses to spontaneous and positive-pressure ventilation. We shall use state-of-the-art echocardiographic imaging techniques (acoustic quantification and tissue Doppler imaging) for complex analysis of LV performance and simple aortic-pulsed Doppler and arterial pressure waveform analysis to assess preload-responsiveness, contractile reserve and arterial tone to derive clinically useful information.

我们将使用心肺相互作用的临床分析作为训练博士后候选者的工具。这是一种出色且良好的富有成效的指导途径外诊所。通风和通风操作具有深刻的，通常对血液动力学作用的了解，尤其是在心脏呼吸衰竭的情况下。尽管许多研究人员研究了心肺相互作用，但缺乏准确的临床应用。我们的目标是开发和验证与临床相关且易于适用的床旁工具，以快速且明确的诊断血液动力学功能不全的病因以及通风和辅助心血管疗法对其的影响。我们用作研究环境，超声心动图诊所和心脏手术套件。为了实现这些目标，我们正在检验三个假设：1）通风诱导的LV预加载和后负载的变化在有力的和放松的自发性和正压灵感之间是非线性的。 2）低水平的正急血压通过通过增加ITP来最大程度地减少心室相互依赖性和LV弹性异步来改善LV性能。 3）通过分析动脉脉压压力响应对自发和正压通风的动脉压力响应，可以轻松地识别出LV收缩储备和预加载响应性（通常相反的心脏功能谱系的相对端）和动脉音调。我们将使用最先进的超声心动图成像技术（声学定量和组织多普勒成像）进行LV性能和简单主动脉脉冲的多普勒和动脉压力波形分析的复杂分析，以评估预努力反应性，收缩储备和动脉储备和动脉储备至得出临床上有用的信息。