SPC365

VALID-PS: Non-Invasive Validation of Echocardiographic Pressure-Strain Loops as Highly Reproducible Surrogates for Ventriculo-Arterial Coupling

Session: Sessão de Posters 47 - Dos dados às decisões: a revolução da IA em cardiologia
Speaker: Lígia Mendes

Congress: CPC 2026
Topic: O. Basic Science
Theme: 36. Basic Science
Subtheme: 36.2 Basic Science - Cardiac Biology and Physiology
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Lígia Lopes Mendes; João Colaço; José Ferreira Santos; João Pereira; Ana Teresa Timóteo

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">Introduction:</span></span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">The assessment of Ventriculo-Arterial (VA) coupling provides essential insights into cardiovascular performance but traditionally requires invasive pressure-volume (PV) loops. Non-invasive Pressure-Strain Loops (PSL) combine speckle-tracking echocardiography with estimated left ventricular pressure to quantify Myocardial Work (MW). However, PSL validation against distinct physiological hemodynamic perturbations remains limited. The VALID-PS study aimed to validate PSL-derived indices as physiological surrogates for PV relationships during standardised manoeuvres in healthy volunteers.</span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">Methods:</span></span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">In this prospective, observational, within-subject repeated-measures study, healthy volunteers underwent three standardised manoeuvres: Semi-supine Exercise (contractility/preload challenge, n=31), Isometric Handgrip (afterload challenge, n=30), and Passive Leg Raising (PLR) (preload/afterload challenge, n=30). Six co-primary PSL endpoints were analysed: Arterial Elastance (Ea), End-Systolic Pressure (ESP), Systolic Strain Rate (SSR), Strain Range, Peak Systolic Strain, and Global Work Index (GWI). Intra- and inter-observer reproducibility were assessed in a sub-cohort (n=15). Multiplicity was controlled using Holm-Bonferroni correction.</span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">Results:</span></span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="color:#000000; font-family:Google Sans Text"><span style="font-size:11pt">PSL analysis successfully tracked predictable physiological shifts across all interventions. Exercise elicited a contractility-dominant response, where Global Work Index (GWI) increased significantly (Effect Size [ES] d=1.03, p&lt;0.001), along with Systolic Strain Rate (d=1.29) and Peak Systolic Strain (d=0.88), while Arterial Elastance (Ea) remained stable. Conversely, Isometric Handgrip and Passive Leg Raising (PLR) produced afterload-dominant patterns characterised by significant increases in End-Systolic Pressure (Handgrip d=1.11; PLR d=1.21) and Ea (Handgrip d=0.79; PLR d=0.77, p&le;0.001), with minimal changes in strain-based performance. Regarding reliability, PSL parameters demonstrated </span><span style="font-size:14.666667px">good to excellent</span><span style="font-size:11pt">&nbsp;reproducibility, with intra-observer Intraclass Correlation Coefficients (ICC) ranging from 0.86 to 0.90 and inter-observer ICCs ranging from 0.72 to 0.87.</span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">Conclusion:</span></span></span></strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Google Sans Text&quot;"><span style="color:black">Non-invasive Pressure-Strain Loops are highly reproducible and physiologically sensitive surrogates for assessing VA coupling. The method accurately discriminated between contractility-driven (exercise) and load-driven (handgrip/PLR) hemodynamic states, validating its use as a robust tool for non-invasive serial monitoring in clinical physiology.</span></span></span></span></span></span><br />
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