Cardiovasc Eng Technol. 2021 Jun 22; doi: 10.1007/s13239-021-00556-5. Epub 2021 Jun 22.
Sensitivity Analysis of Single Beat Left Ventricular Elastance Estimation by Chen Method.
Cardiovascular engineering and technology
A Di Molfetta, G Ferrari, V Cusimano, G Di Ruzza, P Mollo, D Boncompagni, M Cesario, C Volponi, M Massetti, M Menichelli
Affiliations
Affiliations
- Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Roma, Italy. [email protected].
- Nalecz Institute of Technology, IBBE-PAS, Warsaw, Poland.
- IASI-Italian National Reserch Council, Rome, Italy.
- Department of Cardiology, Ospedale Spaziani, Via Armando Fabi, snc, 03100, Frosinone, Italy.
- Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Roma, Italy.
- Department of Cardiology, Ospedale Spaziani, Via Armando Fabi, snc, 03100, Frosinone, Italy. [email protected].
PMID: 34159533
DOI: 10.1007/s13239-021-00556-5
Abstract
INTRODUCTION: Left ventricular (LV) end-systolic elastance (Ees) can be estimated using single-beat (Ees(sb)) Chen method, employing systolic and diastolic arm-cuff pressures, stroke volume (SV), ejection fraction and estimated normalized ventricular elastance at arterial end-diastole. This work aims to conduct a sensitivity analysis of Chen formula to verify its reliability and applicability in clinical scenario.
METHODS: Starting from a baseline condition, we evaluated the sensitivity of Ees(sb) to the parameters contained in the formula. Moreover, a mathematical model of the cardiovascular system was used to evaluate the sensitivity of Ees(sb) to end-diastolic LV elastance (Eed), Ees, arterial systemic resistance (Ras) and heart rate (HR).
RESULTS: In accordance with Ees definition, Ees(sb) increases by increasing aortic pressure and pre-ejection time, reaching the highest value for a pre-ejection time = 40 ms, and then decreases. In contrast with Ees definition, Ees(sb) increases (from 3.21 mmHg/mL to 12.15 mmHg/mL) by increasing the LV end-systolic volume and decreases by increasing the SV. In the majority of the analysis with the mathematical model, Ees was underestimated using the Chen method: by increasing Ees (from 0.5 to 2.5 mmHg/mL), Ees(sb) passes only from 0.56 to 1.54 mmHg/mL. Ees(sb) increases for higher Eed (from 1.03 to 2.33 mmHg/mL). Finally, Ees(sb) decreases (increases) for HR < 50 bpm (< 50 bpm), and for Ras < 1100 mmHg/gcm
CONCLUSION: Unexpectedly Ees(sb) increases for higher LV end-systolic volume and decreases for higher SV. These results contrast with Ees definition, which is the ratio between the LV end-systolic pressure and the LV end-systolic volume. Moreover, Ees(sb) is influenced by cardiocirculatory parameters such as LV Eed, HR, Ras, ejection time, and pre-ejection time. Finally, Ees(sb) computed with the model output often underestimates model Ees.
Keywords: Chen; Echocardiography; Elastance; Pressure-volume loop; Single beat method
References
- Chen, C. H., B. Fetics, E. Nevo, C. E. Rochitte, K. R. Chiou, P. Y. A. Ding, M. Kawaguchi, and D. A. Kass. Non invasive single-beat determination of left ventricular end-systolic elastance in humans. J. Am. Coll. Cardiol. 38:2028–2034, 2001. - PubMed
- Di Molfetta, A., G. Ferrari, R. Iacobelli, L. Fresiello, M. Pilati, A. Toscano, S. Filippelli, S. Morelli, and A. Amodeo. Acute biventricular interaction in pediatric patients implanted with continuous flow and pulsatile flow LVAD: a simulation study. ASAIO J. 62(5):591–599, 2016. - PubMed
- Di Molfetta, A., L. Santini, G. B. Forleo, M. Cesario, C. Tota, M. Sgueglia, D. Sergi, G. Ferrari, and F. Romeo. Use of a comprehensive numerical model to improve biventricular pacemaker temporization in patients affected by heart failure undergoing to CRT-D therapy. Med. Biol. Eng. Comput. 48(8):755–764, 2010. - PubMed
- Di Molfetta, A., L. Santini, G. B. Forleo, V. Minni, K. Mafhouz, D. G. Della Rocca, L. Fresiello, F. Romeo, and G. Ferrari. Towards a personalized and dynamic CRT-D. A computational cardiovascular model dedicated to therapy optimization. Methods Inf. Med. 51(6):495–506, 2012. - PubMed
- Hayashi, K., K. Shigemi, T. Shishido, M. Sugimachr, and K. Sunagawa. Single-beat estimation of ventricular end-systolic elastance-effective arterial elastance as an index of ventricular mechanoenergetic performance. Anestesiology 92:1769–1776, 2000. - PubMed
- Kjørstad, K. E., C. Korvald, and T. Myrmel. Pressure-volume-based single-beat estimations cannot predict left ventricular contractility in vivo. Am. J. Physiol. Heart Circ. Physiol. 282(5):H1739–H1750, 2002. - PubMed
- Mihaileanu, S., and E. L. Antohi. Revisiting the relationship between left ventricular ejection fraction and ventricular-arterial coupling ESC. Heart Fail. 7(5):2214–2222, 2020. - PubMed
- Mirsky, I., T. Tajimi, and K. L. Peterson. The development of the entire end-systolic pressure-volume and ejection fraction–afterload relations: a new concept of systolic myocardial stiffness. Circulation 76:343–356, 1987. - PubMed
- Senzaki, H., C. H. Chen, and D. A. Kass. Single-beat estimation of end systolic pressure-volume relation in humans: a new method with the potential for non invasive application. Circulation 94:2497–2506, 1996. - PubMed
- Shih, H., Z. Hillel, C. Declerck, C. Anagnostopoulos, M. Kuroda, and D. Thys. An algorithm for real-time, continuous evaluation of left ventricular mechanics by single-beat estimation of arterial and ventricular elastance. J. Clin. Monit. 13(3):157–170, 1997. - PubMed
- Shishido, T., K. Hayashi, K. Shigemi, T. Sato, M. Sugimachi, and K. Sunagawa. Single-beat estimation of end-systolic elastance using bilinearly approximated time-varying elastance curve. Circulation 102:1983–1989, 2000. - PubMed
- Suga, H., and K. Sagawa. Instantaneous pressure-volume relationships and their ratio in the exercised, supported canine left ventricle. Circ. Res. 35:117–126, 1974. - PubMed
- Takeuchi, M., Y. Igarashi, S. Tomimoto, M. Odake, T. Hayashi, T. Tsukamoto, K. Hata, H. Takaoka, and H. Fukuzaki. Single-beat estimation of the slope of the end-systolic pressure-volume relation in the human left ventricle. Circulation 83:202–212, 1991. - PubMed
Publication Types