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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

  1. Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Roma, Italy. [email protected].
  2. Nalecz Institute of Technology, IBBE-PAS, Warsaw, Poland.
  3. IASI-Italian National Reserch Council, Rome, Italy.
  4. Department of Cardiology, Ospedale Spaziani, Via Armando Fabi, snc, 03100, Frosinone, Italy.
  5. Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Roma, Italy.
  6. 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

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