scholarly journals A Case of Noncompaction at All Segments of Both Right and Left Ventricles

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Ali Pourmoghaddas ◽  
Reihaneh Zavar ◽  
Mohaddeseh Behjati
Keyword(s):  
Mental Retardation ◽  
Left Ventricle ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Normal Limits ◽  
Great Vessels ◽  
Situs Solitus ◽  
Sternal Border ◽  
D Loop

Background. Noncompaction/hypertrabeculation left ventricle (NCM/HVM) is most commonly reported in one or more segments of left ventricle and sometimes both ventricles. In this case, we present noncompaction of all segments of right and left ventricle, in a young man with mental retardation.Case Presentation. A 19-year-old male was referred to us with sudden dyspnea at rest and chest discomfort. He was a known case of mental retardation. He was born full term with birth weight = 1250 grams. On physical examination. A systolic murmur (II/VI) at left sternal border was heard. ECG showed increased voltage in precordial lead and deep ST segment depression. Chest X-ray (CXR) was within normal limits. Transthoracic echocardiography showed situs solitus, D loop, normal connection of great vessels, noncompaction LV at all segments (noncompaction/compaction = 2.5/0.5) with moderate systolic dysfunction (LVEF = 40%), diastolic dysfunction grade II, normal RV size with mild systolic dysfunction and hypertrabeculation, mild tricuspid regurgitation (TR), and normal pulmonary artery systolic pressure. After injection of agitated saline some bubbles were passed from right to left through patent foramen oval (PFO).Conclusions. Extensive sinusoid formation and trabeculation of RV and nearby all LV segments and its association with mental retardation suggest presence of strong genetic background.

scholarly journals Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study—RES-PH Study

2021 ◽  
Vol 11 (6) ◽  
pp. 489
Author(s):  
Egidio Imbalzano ◽  
Marco Vatrano ◽  
Alberto Lo Gullo ◽  
Luana Orlando ◽  
Alberto Mazza ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Equal Distribution ◽  
Ventricular Ejection Fraction

Introduction. The actual prevalence of pulmonary hypertension (PH) in Italy is unknown. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) from the regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation. Objectives. We aimed to evaluate the frequency of suspected PH among unselected patients. Methods. We conducted a retrospective cross-sectional database search of 7005 patients, who underwent echocardiography, to estimate the prevalence of PH, between January 2013 and December 2014. Medical and echocardiographic data were collected from a stratified etiological group of PH, using criteria of the European Society of Cardiology classifications. Results. The mean age of the study population was 57.1 ± 20.5 years, of which 55.3% were male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs. 48.7%; p = 0.873). The prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs. 56.8%; p = 0.671). PH is predominant in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction and related with age. PASP was significantly linked with left atrial increase and left ventricular ejection fraction. In addition, an increased PASP was related to an enlargement of the right heart chamber. Conclusions. PH has a frequency of 4.3% in our unselected population, but the prevalence may be more relevant in specific subgroups. A larger epidemiological registry could be an adequate strategy to increase quality control and identify weak points in the evaluation and treatment of these patients.

Abstract 307: Poor Right Ventricular Systolic Function (lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and all Cause Mortality in Elderly Patients with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Gunjan Choudhary ◽  
Umashankar Lakshmanadoss ◽  
Hari Prasad ◽  
Zaruhi Babayan ◽  
Dwight Stapleton
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Elderly Patients ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
All Cause Mortality ◽  
Early Readmission ◽  
Rv Function

Background: Heart failure(HF) related early readmission (<30days) and mortality is higher in elderly patients. Right ventricular (RV) dysfunction is associated with worse prognosis in patients with HF with reduced ejection fraction (HFrEF). We evaluated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolic excursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission and mortality in elderly HF patients. Methods: This is single center observational study of elderly (≥65 years )patients with HFrEF. Patients with principal discharge diagnosis of HFrEF are included (n = 278, age 77 ± 9 years, 38% female, LVEF 29% ± 9%). Demographic and echocardiographic data are collected. TAPSE (as a marker of RV systolic dysfunction) and PASP are measured as per ASE guidelines. Prediction models are performed. Results: Among 278 patients, 62 patients ( 22.3%) had HF related early readmission and 123 patients (44%) died at the end of 5 year. On univariate analysis, older age, Hypertension, Diabetes, higher PASP , RV systolic dysfunction (TAPSE <16mm) and BMI< 25 are predictors of early readmission and mortality (P value <0.05). On multivariate logistic regression analysis, early HF readmission was predicted by TAPSE <16 mm (OR=23.6; p < 0.001; CI 10.23-54.60) and PASP >50 mmHg ( OR = 34; p < 0.001; 95 CI 14.08-82.81); five year all cause mortality was predicted by TAPSE < 16mm (OR = 1.85; p 0.023; 95 CI 1.08-3.16) and PASP >50 mmHg (OR = 2.11; p 0.009; 95 CI 1.19-3.72). Conclusion: TAPSE <16 mm and PASP >50 mmHg are strong predictors of early readmission and five year all cause mortality in elderly HF patients. The assessment of RV function through TAPSE and PASP, helps to risk-stratify elderly patients with HFrEF.

P6 Characterisation of right heart dysfunction in left ventricular systolic failure

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H H L Chen ◽  
C H Gan ◽  
D Makarious ◽  
C H Ng ◽  
A Bhat ◽  
...  
Keyword(s):  
Systolic Function ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Disease Process ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
P Value ◽  
Basal Diameter ◽  
Lv Dysfunction ◽  
Rv Function

Abstract Funding Acknowledgements Nil Background Left and right ventricular (RV) function is proposed to be intimately linked. Reduced systolic ventricular interaction in patients with reduced global left ventricular (LV) performance is hypothesised to result in a reduction in RV contractile performance, even if the RV is not directly involved in the disease process. Concurrent RV and LV dysfunction is known to carry a poorer prognosis. However, the incidence of RV structural change and systolic dysfunction in patients with LV dysfunction in patients in a clinical setting is not well characterised. Purpose To determine the prevalence of RV systolic impairment in patients with LV systolic impairment from non-ischaemic cardiomyopathy (NICM); and to characterise the relationship between LV and RV systolic function using echocardiographic parameters. Methods 86 consecutive patients with stable heart failure with reduced ejection fraction secondary to NICM without valvular, congenital, and pulmonary disease were recruited. All patients underwent a comprehensive transthoracic echocardiogram and were stratified into tertiles based on LVEF (mild: 40-49%, moderate: 30-39%, severe: &lt;30%). RV function was characterised using standard and novel measures. 2D RV free wall peak systolic strain (RV FWS) was measured using vendor independent software (TomTec Image Arena, Germany v4.6).  Results Of the mild, moderate and severe groups (mean age 58 ± 34, 36% men): mean LVEF (%) was 46 ± 6, 35 ± 6, 22 ± 10 ; mean pulmonary artery systolic pressure (mmHg) was 28 ± 24, 34 ± 31, 38 ± 24; 26%, 79%, 74% had mild or moderate pulmonary hypertension respectively. 33% had RV impairment based on TAPSE of &lt;1.6cm; 48% had RV impairment based on RVS’ of &lt;10cm/s; and 65% had RV impairment based on a FAC of &lt;35%.  Conclusion Whilst there is a concurrent increase in the prevalence of RV impairment with severity of LV systolic impairment, interestingly not all patients with LV dysfunction had RV dysfunction. The presence of RV dysfunction is greatest when measured using FAC and RV FWS. Routine screening of RV dysfunction in patients with HFrEF secondary to NICM may help identify patients with poorer prognosis, who could benefit with more intensive follow up and treatment. LVEF 40-49% (n = 31) LVEF 30-39% (n = 28) LVEF &lt; 30% (n = 27) ONE WAY ANOVA Significance (P value) Mean RV Basal Diameter (cm) 4.1 ± 1.3 3.7 ± 1.6 3.6 ± 1.5 0.51 Mean TAPSE (cm) 2.1 ± 0.8 1.9 ± 1.0 1.7 ± 1.1 0.49 Mean RVS" (cm/s) 11 ± 5 11 ± 6 9 ± 6 0.24 Mean FAC (%) 44 ± 20 29 ± 21 17 ± 13 0.000 Mean RV FWS (%) -27.4 ± 14.4 -17.2 ± 11.6 -7.9 ± 6 0.000

scholarly journals Simultaneous Pulmonary Artery Pressure and Left Ventricle Stroke Volume Assessment Predicts Adverse Events in Patients With Pulmonary Embolism

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Hayaan Kamran ◽  
Essa H. Hariri ◽  
Jean‐Pierre Iskandar ◽  
Aditya Sahai ◽  
Ihab Haddadin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Left Ventricle ◽  
Adverse Events ◽  
Pulmonary Artery ◽  
Stroke Volume ◽  
Acute Pulmonary Embolism ◽  
Systolic Pressure ◽  
Severity Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Advanced Therapies

Background Certain echocardiographic parameters may serve as early predictors of adverse events in patients with hemodynamically compromising pulmonary embolism (PE). Methods and Results An observational analysis was conducted for patients with acute pulmonary embolism evaluated by a Pulmonary Embolism Response Team (PERT) between 2014 and 2020. The performance of clinical prediction algorithms including the Pulmonary Embolism Severity Index and Carl Bova score were compared using a ratio of right ventricle and left ventricle hemodynamics by dividing the pulmonary artery systolic pressure by the left ventricle stroke volume. The primary outcome of in‐hospital mortality, cardiac arrest, and the need for advanced therapies was evaluated by univariate and multivariable analyses. Of the 343 patients meeting the inclusion criteria, 215 had complete data. Pulmonary artery systolic pressure/left ventricle stroke volume was a clear predictor of the primary end point (odds ratio [OR], 2.31; P =0.005), performing as well or better than the Pulmonary Embolism Severity Index (OR, 1.43; P =0.06) or the Bova score (OR, 1.28; P =0.01). Conclusions This study is the first study to demonstrate the utility of early pulmonary artery systolic pressure/left ventricle stroke volume in predicting adverse clinical events in patients with acute pulmonary embolism. Pulmonary artery systolic pressure/left ventricle stroke volume may be a surrogate marker of ventricular asynchrony in high‐risk pulmonary embolism and should be prognostically evaluated.

scholarly journals Heart reHeart remodeling in patients with severe systolic dysfunction due tocancer chemotherapymodeling in patients with severe systolic dysfunction due tocancer chemotherapy.

Kardiologiia ◽  
2020 ◽  
Vol 60 (3) ◽  
pp. 51-58
Author(s):  
E. I. Emelina ◽  
A. A. Ibragimova ◽  
I. I. Ganieva ◽  
G. E. Gendlin ◽  
I. G. Nikitin ◽  
...  
Keyword(s):  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Pulmonary Artery Systolic Pressure ◽  
Ventricular Ejection Fraction ◽  
Men And Women

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.

scholarly journals AB0307 IS THERE ANY INFLUENCE OF THE ANTIRHEUMATIC THERAPY ON ECHOCARDIOGRAPHIC FINDINGS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1179.2-1179
Author(s):  
T. Panafidina ◽  
T. Popkova ◽  
L. Kondrateva ◽  
A. Volkov ◽  
E. Nasonov ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Therapy Group ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Lower Percentage ◽  
Pulmonary Artery Systolic Pressure ◽  
Antirheumatic Therapy ◽  
Cross Sectional ◽  
Valve Insufficiency

Background:Cardiovascular diseases are becoming the leading cause of death among SLE patients due to increasing life-spans. Transthoracic echocardiography (TTE) is a routine and widely available modality in everyday clinical practice useful to identify specific pathological cardiac changes and predictors of heart failure.Objectives:The goal was to identify potential abnormalities in the TTE findings in SLE patients, with and without antirheumatic therapy.Methods:This is a prospective cross-sectional study including 91pts (91% females, aged 32[28-41]years (median [interquartile range 25%-75%]) with SLE (SLICC 2012 criteria). All patients were divided into 2 groups: the 1st group was composed of “untreated” patients and the 2nd – of patients receiving antirheumatic therapy. The 1st group included 43pts (93% females) aged 31[27–40]years who were not receiving steroids, immunosuppressants and biological agents at the time of enrollment, 5(12%) of them were on hydroxychloroquine (HCQ) therapy 200 mg/day. The 2nd group is represented by 48pts (89% females) with median age 34[28-45]years. Out of them 47(98%) patients were on prednisone therapy at 10[8-15]mg/day, 10(21%)- on cyclophosphamide, 6(13%)-azathioprine, 4(8%)-mycophenolate mofetil, 4(8%)-methotrexate, 37(71%)–HCQ, and 9(19%)–on biologic (rituximab, belimumab). Both groups were matched by age and gender. Patients receiving antirheumatic therapy (group 2) had longer disease duration (96 vs 18 months, p<0,00001), lower disease activity (SLEDAI-2K 4 vs 11 scores, p<0,001), higher SLICC/DI (1 vs 0 score, p<0,001); lower percentage of them had skin lesions (11 vs 57%, p<0,0001), arthritis (22 vs 52%, p<0,05) and hematological disorders (24 vs 74%, p<0,0001) than “untreated” patients from the 1st group.Results:Valve insufficiency with varying degree of clinically insignificant regurgitation and pericarditis were the commonest pathology found in “untreated” and “treated” SLE patients based on TTE data. No differences in rates of valve insufficiency (95% and 83%), pericarditis (43% and 47%) (both exudative and adhesive), endocarditis (26% and 33%), median left ventricular (LV) ejection fraction (64[59-68]% and 64[61-69]%), LV end-systolic dimension (30[27-32]mm and 29[25-31]mm), LV end-diastolic dimension (48[45-50]mm and 45[42-49]mm), pulmonary artery systolic pressure (25[22-31]mm Hg and 23[22-30]mm Hg), LV diastolic disfunction (26% and 21%) and LV systolic dysfunction (9% and 6%), LV myocardial hypertrophy (14% and 21%) and left atrium dilatation (9% and 21%) were found between the “untreated” SLE patients and patients receiving antirheumatic therapy (p>0,05 for all cases). Higher rates of mitral and tricuspid valves prolapse was seen more often in “treatment-naїv” SLE patients: 16(47%) vs 10(21%), p<0,01.Conclusion:Valvular dysfunction (insufficiency with clinically insignificant regurgitation), pericarditis, endocarditis and LVDD were the most common cardiac TTE abnormalities in SLE patients. Antirheumatic therapy seems not to worsen structural and functional cardiac abnormalities based on TTE findings in SLE patients. Only mitral and tricuspid valves prolapse was seen more often in “treatment-naїv” SLE patients.Disclosure of Interests:None declared

scholarly journals Post-COVID myocarditis diagnosed by endomyocardial biopsy and/or magnetic resonance imaging 2–9 months after acute COVID-19

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Blagova ◽  
D H Ainetdinova ◽  
Y U A Lutokhina ◽  
V M Novosadov ◽  
R S Rud' ◽  
...  
Keyword(s):  
Heart Failure ◽  
Endomyocardial Biopsy ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
Funding Sources ◽  
Cardiac Symptoms ◽  
Recurrent Atrial Fibrillation ◽  
Chronic Myocarditis

Abstract Purpose To study clinical features of myocarditis and its possible mechanisms (including persistence of SARS-Cov-2 in the myocardium) in the long-term period after acute COVID-19. Methods Fifteen patients (8 male and 7 female, mean age 47.8±13.4, 24–65 years) diagnosed with postcovid myocarditis were included in the study. The diagnosis of COVID-19 was confirmed by positive PCR results in 40%, and seroconversion in all patients. The average time of admission after COVID-19 was 4 [3; 7] months, from 2 to 9 months. The diagnosis of myocarditis was confirmed by cardiac MRI in 10 patients and by right ventricular endomyocardial biopsy (EMB) in 6 patients. The PCR for cardiotropic viruses and PCR with immunohistochemical study for SARS-Cov2 detection were used. All patients had study for anti-heart antibodies (AHA), EchoCG, and Holter ECG. Coronary atherosclerosis was excluded in all patients over 40 years (7 coronary angiography, 4 cardiac CT). Results A clear association of the cardiac symptoms with a previous new coronavirus infection was noted in all patients. The symptoms started 1–5 months following COVID-19. MRI showed subepicardial and intramyocardial LGE, signs of hyperemia, increased T1 relaxation time, edema. AHA levels were increased 3–4-fold in 73%. Two variants of postcovid myocarditis were observed. 1. Arrhythmic variant (n=6) – newly developed frequent supraventricular or ventricular extrasystole, recurrent atrial fibrillation in the absence of systolic dysfunction. 2. Decompensated variant with biventricular heart failure (n=9): the mean LV EF was 34.1±7.8% (23 to 46%), LV EDD 5.8±0.7 cm, EDV 153.8±46.1 ml, pulmonary artery systolic pressure 40.7±11.2 mmHg. In one case, myocarditis was accompanied by IgG4- and ANCA-negative aortitis. SARS-Cov-2 RNA was detected in 4 of 5 myocardial biopsies (in one case the material in the study). The longest period of virus persistence after COVID-19 was 9 months. By using spike and nucleocapsid antibodies, coronavirus was detected in cardiomycytes and macrophages. Data of patients with morphologically proved myocarditis are presented in Table 1. Lymphocytic myocarditis was diagnosed and confirmed immunohistochemically (n=5); giant cell myocarditis with atrial standstill was detected in one more case (Fig. 1). Three patients had also signs of endocarditis, in two cases with parietal thrombosis. Conclusions COVID-19 can lead to the subacute and chronic myocarditis of varying severity. Post-COVID myocarditis manifests itself in two main clinical forms - isolated arrhythmias and systolic dysfunction with heart failure. Post-COVID myocarditis is characterized by prolonged persistence of coronavirus (up to 9 months in this study, in most patients with decompensated variant) in combination with high immune activity (high titers of AHA), which should be considered as the main mechanisms of its long-term course. Treatment approaches for such myocarditis require investigation. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Patients with EMB proved myocarditis Figure 1. The EMB in postcovide myocarditis

Life-threatening Takotsubo Cardiomyopathy

2011 ◽  
Vol 9 (2) ◽  
pp. 119 ◽  
Author(s):  
Karen Mrejen-Shakin ◽  
Ricardo Lopez ◽  
Mohandas M Shenoy ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Acute Heart Failure ◽  
Takotsubo Cardiomyopathy ◽  
Stress Test ◽  
Systolic Dysfunction ◽  
Apical Ballooning ◽  
Assisted Ventilation ◽  
Two Dimensional ◽  
Life Threatening

Objective:To report a case of seizure-induced takotsubo cardiomyopathy with rare etiology and rarer complications.Methods:A 50-year-old woman had multiple epileptic seizures and later developed acute heart failure complicated by ventricular fibrillation and shock. A two-dimensional echocardiogram revealed apical ballooning of the left ventricle resembling a takotsubo (a Japanese fisherman's pot used to trap octopi). The apex was also hypokinetic.Results:The hemodynamic abnormalities normalized with defibrillation, assisted ventilation, inotropic support, and pressor agents. More importantly, the apical ballooning deformity and systolic dysfunction reversed. The echocardiogram normalized three months later. A nuclear treadmill stress test was negative for ischemia.Conclusions:Apical ballooning of the left ventricle and hypokinesis are typical echocardiographic features in takotsubo cardiomyopathy, a stress-induced heart disease. It may follow severe emotional, physical, and neurologic stressors, in our rare case, grand mal seizures (0.2 % of all takotsubo disease patients). Also rare are life-threatening complications. Based on these observations, in a case with severe stress followed by acute heart failure, takotsubo cardiomyopathy should be a major diagnostic consideration. The dramatic initial triggering event, in our case an epileptic seizure, should not mask the possibility of coexisting takotsubo cardiomyopathy. Awareness of this disease, anticipation of complications, and two-dimensional echocardiography will help channel the management in the right direction.

Linear O2 Use-Pressure-Volume Area Relation from Curved End-Systolic Pressure-Volume Relation of the Blood-Perfused Rat Left Ventricle.

1998 ◽  
Vol 48 (3) ◽  
pp. 197-204 ◽  
Author(s):  
Yoshiki HATA ◽  
Taisuke SAKAMOTO ◽  
Shingo HOSOGI ◽  
Tohru OHE ◽  
Hiroyuki SUGA ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Systolic Pressure ◽  
Volume Relation
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