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Sensitivity Analysis of Single Beat Left Ventricular Elastance Estimation by Chen Method.

A Di Molfetta1, G Ferrari2, V Cusimano3

  • 1Department of Cardiac Surgery, Policlinico Gemelli Hospital, Largo Agostino Gemelli, 8, 00100, Roma, Italy. Arianna.dimolfetta@gmail.com.

Cardiovascular Engineering and Technology
|June 23, 2021
PubMed
Summary
This summary is machine-generated.

The Chen method for estimating left ventricular end-systolic elastance (Ees) shows unreliable results, often underestimating actual Ees and yielding counterintuitive outcomes with varying stroke volume and end-systolic volume. Clinical application requires careful consideration of its limitations.

Keywords:
ChenEchocardiographyElastancePressure-volume loopSingle beat method

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Area of Science:

  • Cardiovascular Physiology
  • Biomedical Engineering
  • Clinical Diagnostics

Background:

  • Left ventricular end-systolic elastance (Ees) is a critical index of cardiac contractility.
  • The single-beat (Ees(sb)) Chen method offers a non-invasive approach to estimate Ees using arm-cuff pressures and stroke volume (SV).
  • Assessing the reliability of Ees(sb) is crucial for its accurate clinical application.

Purpose of the Study:

  • To perform a sensitivity analysis of the Chen method's formula for Ees(sb).
  • To evaluate the reliability and clinical applicability of the Ees(sb) estimation.
  • To investigate the influence of various cardiovascular parameters on Ees(sb) using a mathematical model.

Main Methods:

  • Sensitivity analysis of the Chen formula parameters under baseline conditions.
  • Utilized a mathematical model of the cardiovascular system.
  • Evaluated Ees(sb) sensitivity to end-diastolic LV elastance (Eed), Ees, arterial systemic resistance (Ras), and heart rate (HR).

Main Results:

  • Ees(sb) demonstrated counterintuitive behavior, increasing with LV end-systolic volume and decreasing with SV, contrary to Ees definition.
  • The Chen method often underestimated Ees when analyzed with a mathematical model.
  • Ees(sb) was significantly influenced by Eed, HR, Ras, ejection time, and pre-ejection time.

Conclusions:

  • The Ees(sb) estimation via the Chen method exhibits significant limitations and unreliability.
  • Observed discrepancies with Ees definition highlight potential issues in clinical interpretation.
  • The method's sensitivity to multiple cardiovascular parameters necessitates caution in its application.