Related Experiment Video
Updated: Aug 6, 2026

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Ejection Fraction in the Fast Lane
Peter L M Kerkhof1, Rienzi A Diaz-Navarro2,3, Neal Handly4
1Department Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
A new Kerkhof-Diaz-Handly (KDH) metric offers a more powerful evaluation of ventricular performance than traditional ejection fraction (EF) by incorporating physical units. This advancement provides a more complete assessment of cardiac function beyond simple dimensionless ratios.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Cardiac Mechanics
Background:
- Ventricular performance is commonly assessed using pressure, volume, and flow measurements.
- Traditional metrics like ejection fraction (EF) are dimensionless ratios and may be incomplete.
- Existing EF variations, such as first-third EF (⅓EF) and first-phase EF1, have limitations.
Purpose of the Study:
- To introduce a novel, more powerful metric for evaluating ventricular performance.
- To address the limitations of existing dimensionless metrics like EF.
- To propose a metric with physical units for a more complete assessment.
Main Methods:
- Utilized representative recordings from a chronically instrumented conscious dog model.
- Analyzed early events during ejection time (ET).
- Developed the Kerkhof-Diaz-Handly (KDH) metric based on these analyses.
Main Results:
- The KDH metric was proposed as a more powerful alternative to traditional EF.
- The KDH metric possesses physical units, unlike dimensionless EF ratios.
- The study highlights the variability of the diastolic phase (TD) in the cardiac cycle.
Conclusions:
- The KDH metric offers a more complete and physically meaningful assessment of ventricular performance.
- This new metric overcomes the inherent limitations of dimensionless ratios.
- Further investigation into the KDH metric could enhance cardiovascular diagnostics.
Related Concept Videos
Free Jet
Heart Failure II: Pathophysiology
Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart rate...
Exercise and Cardiac Output
Sustained exercise increases the muscles' oxygen demand, which can be met...
Velocity and Acceleration in Steady and Unsteady Flow
The acceleration can be generalized to any point in the flow, and expressed as components along three perpendicular directions, representing changes in velocity over time.
Rapidly Varying Flow

