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Cardiophysiology Illustrated by Comparing Ventricular Volumes in Healthy Adult Males and Females

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Sex-Specific Analysis of Cardiovascular Function

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1065))

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.

Assessment of cardiac size. Art work by Piet Michiels, Leuven, Belgium.

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Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands

    Peter L. M. Kerkhof

  2. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    Tatiana Kuznetsova

  3. Departments of Cardiothoracic Surgery and Medicine (Cardiology), Drexel University College of Medicine, IME, University of Pennsylvania, Philadelphia, PA, USA

    J. Yasha Kresh

  4. Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA

    Neal Handly

Authors
  1. Peter L. M. Kerkhof
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  2. Tatiana Kuznetsova
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  3. J. Yasha Kresh
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  4. Neal Handly
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Corresponding author

Correspondence to Peter L. M. Kerkhof .

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Editors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands

    Peter L. M. Kerkhof

  2. Mayo Clinic, Rochester, Minnesota, USA

    Virginia M. Miller

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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: Kerkhof, P., Miller, V. (eds) Sex-Specific Analysis of Cardiovascular Function. Advances in Experimental Medicine and Biology, vol 1065. Springer, Cham. https://doi.org/10.1007/978-3-319-77932-4_8

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