[en] ABSTRACT: INTRODUCTION: : Functional time-varying cardiac elastances (FTVE) contain a rich amount of information about the specific cardiac state of a patient. However, a FTVE waveform is very invasive to directly measure, and is thus currently not used in clinical practice. This paper presents a method for the estimation of a patient specific FTVE, using only metrics that are currently available in a clinical setting. METHOD: : Correlations are defined between invasively measured FTVE waveforms and the aortic and pulmonary artery pressures from 2 cohorts of porcine subjects, 1 induced with pulmonary embolism, the other with septic shock. These correlations are then used to estimate the FTVE waveform based on the individual aortic and pulmonary artery pressure waveforms, using the "other" dysfunction's correlations as a cross validation. RESULTS: : The cross validation resulted in 1.26% and 2.51% median errors for the left and right FTVE respectively on pulmonary embolism, while the septic shock cohort had 2.54% and 2.90% median errors. CONCLUSIONS: : The presented method accurately and reliably estimated a patient specific FTVE, with no added risk to the patient. The cross validation shows that the method is not dependent on dysfunction and thus has the potential for generalisation beyond pulmonary embolism and septic shock.
Disciplines :
Engineering, computing & technology: Multidisciplinary, general & others General & internal medicine
Author, co-author :
Stevenson, David
Revie, James
Chase, J. Geoffrey
Hann, Christopher E.
Shaw, Geoffrey M.
LAMBERMONT, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Frais communs médecine
GHUYSEN, Alexandre ; Centre Hospitalier Universitaire de Liège - CHU > Urgences
Kolh, Philippe ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Biochimie et physiologie générales, humaines et path.
Desaive, Thomas ; Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
Language :
English
Title :
Beat-to-beat estimation of the continuous left and right cardiac elastance from metrics commonly available in clinical settings.
Guyton A, Hall J. Textbook of Medical Physiology 2000, Philadelphia: W B Saunders Company.
Grenvik A, Ayres SM, Holbrook PR. Textbook of Critical Care 1989, Philadelphia: W B Saunders Company.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29(7):1303-10. 10.1097/00003246-200107000-00002, 11445675.
Kearon C. Diagnosis of pulmonary embolism. CMAJ 2003, 168(2):183-94. 140429, 12538548.
Pineda LA, HV S, Grant BJB. Clinical suspicion of fatal pulmonary embolism. Chest 2001, 120(3):791-5. 10.1378/chest.120.3.791, 11555511.
Frazier S, Skinner GJ. Pulmonary artery catheters: state of the controversy. J Cardiovasc Nursing 2008, 23:113-21.
Chatterjee K. The Swan-Ganz Catheters: Past, Present, and Future. Circulation 2009, 119:147-152. 10.1161/CIRCULATIONAHA.108.811141, 19124674.
Cooper A, Doig WJ, Sibbald GS. Pulmonary artery catheters in the critically ill. Crit Care Med 1996, 12:777-94.
Weber KT, Janicki JS. The heart as a muscle-pump system and the concept of heart-failure. Am Heart J 1979, 98(3):371-84. 10.1016/0002-8703(79)90051-6, 382811.
Ross JJ. Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis 1976, 18:255-64. 10.1016/0033-0620(76)90021-9, 128034.
Smith BW, Chase JG, Nokes RI, Shaw GM, Wake G. Minimal haemodynamic system model including ventricular interaction and valve dynamics. Med Eng Phys 2004, 26(2):131-9. 10.1016/j.medengphy.2003.10.001, 15036180.
Starfinger C, Chase JG, Hann CE, Shaw GM, Lambermont B, Ghuysen A, Kolh P, Dauby PC, Desaive T. Model-based identification and diagnosis of a porcine model of induced endotoxic shock with hemofiltration. Math Biosci 2008, 216(2):132-9. 10.1016/j.mbs.2008.08.014, 18817788.
Chung DC, Niranjan SC, Clark J, Bidani A, Johnston WE, Zwischenberger JB, Traber DL. A dynamic model of ventricular interaction and pericardial influence. Am J Physiol 1997, 272(6 Pt 2):H2942-62.
Revie J, Stevenson D, Chase G, Hann CE, Lambermont B, Ghuysen A, Kolh P, Morimont P, Shaw GM, Desaive T. Clinical detection and monitoring of acute pulmonary embolism: proof of concept of a computer-based method. Ann of Intensive Care 2011, 1(33).
Revie J, Stevenson D, Chase JG, Hann CE, Lambermont B, Ghuysen A, Kolh P, Shaw GM, Heldmann S, Desaive T. Validation of subject-specific cardiovascular system models from porcine measurements. Comput Methods Programs Biomed 2011, in-press.
Suga H, Sagawa K. Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 1974, 35:117-26. 10.1161/01.RES.35.1.117, 4841253.
Sagawa K. The end-systolic pressure-volume relation of the ventricle: definition, modifications and clinical use. Circulation 1981, 63(6):1223-7. 10.1161/01.CIR.63.6.1223, 7014027.
Suga H, Sagawa K, Shoukas AA. Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 1973, 32(3):314-22. 10.1161/01.RES.32.3.314, 4691336.
Burkhoff D, Sugiura S, Yue DT, Sagawa K. Contractility-dependent curvilinearity of end-systolic pressure-volume relations. Am J Physiol 1987, 252(6 Pt 2):H1218-27.
Senzaki H, Chen CH, Kass DA. Single-beat estimation of end-systolic pressure-volume relation in humans. A new method with the potential for noninvasive application. Circulation 1996, 94(10):2497-506. 10.1161/01.CIR.94.10.2497, 8921794.
Sunagawa K, Sagawa K, Maughan WL. Ventricular interaction with the loading system. Ann Biomed Eng 1984, 12(2):163-89. 10.1007/BF02584229, 6507965.
Guarini M, Urzúa J, Cipriano A, González W. Estimation of caridac function from computer analysis of the arterial pressure waveform. IEEE Trans on Biomed Eng 1998, 45(12):1420-8.
Swamy G, Kuiper J, Gudur MSR, Bari ON, Mukkamala R. Continuous left ventricular ejection fraction monitoring by aortic pressure waveform analysis. Ann Biomed Eng 2009, 37(6):1055-68. 10.1007/s10439-009-9675-4, 19308732.
Shishido T, Hayashi K, Shigemi K, Sato T, Sugimachi M, Sunagawa K. Single-beat estimation of end-systolic elastance using bilinearly approximated time-varying elastance curve. Circulation 2000, 102(16):1983-9. 10.1161/01.CIR.102.16.1983, 11034949.
ten Brinke EA, Klautz RJ, Verwey HF, van der Wall EE, Dion RA, Steendijk P. Single-beat estimation of the left ventricular end-systolic pressure-volume relationship in patients with heart failure. Acta Physiol (Oxf) 2010, 198:37-46.
Burkhoff D. Chasing the elusive pressure-volume relationship. J Am Coll Cardiol Img 2009, 2:1282-4.
Starfinger C, Hann CE, Chase JG, Desaive T, Ghuysen A, Shaw GM. Model-based cardiac diagnosis of pulmonary embolism. Comput Methods Programs Biomed 2007, 87:46-60. 10.1016/j.cmpb.2007.03.010, 17478006.
Sagawa K. The ventricular pressure-volume diagram revisited. Circ Res 1978, 43(5):677-87. 10.1161/01.RES.43.5.677, 361275.
Suga H. Ventricular energetics. Physiol Rev 1990, 70(2):247-77.
Burkhoff D, Sagawa K. Ventricular efficiency predicted by an analytical model. Regu Physiol 1986, 250(6):R1021-7.
Broscheit JA, Weidemann F, Strotmann J, Steendijk P, Karle H, Roewer N, Greim CA. Time-varying elastance concept applied to the relation of carotid arterial flow velocity and ventricular area. J Cardiothorac Vasc Anesth 2006, 20(3):340-6. 10.1053/j.jvca.2006.01.014, 16750733.
Suga H. Total mechanical energy of a ventricle model and cardiac oxygen consumption. Heart 1979, 236(3):H498-5.
Desaive T, Dutron S, Lambermont B, Kolh P, Hann CE, Chase JG, Dauby PC, Ghuysen A. Close-loop model of the cardiovascular system including ventricular interaction and valve dynamics: application to pulmonary embolism. IFMBE Proceedings, 12th Intl Conference on Biomedical Engineering (ICBME): Dec 7-10; 2005:4, Singapore, ISSN 1727-1983.
Ghuysen A, Lambermont B, Kolh P, Tchana-Sato V, Magis D, Gerard P, Mommens V, Janssen N, Desaive T, D'Orio V. Alteration of right ventricular-pulmonary vascular coupling in a porcine model of progressive pressure overloading. Shock 2008, 29(2):197-204.
Lambermont B, Ghuysen A, Kolh P, Tchana-Sato V, Segers P, Gerard P, Morimont P, Magis D, Dogne JM, Masereel B, D'Orio V. Effects of endotoxic shock on right ventricular systolic function and mechanical efficiency. Cardiovasc Res 2003, 59(2):412-8. 10.1016/S0008-6363(03)00368-7, 12909324.
Hann CE, Chase JG, Shaw GM. Efficient implementation of non-linear valve law and ventricular interaction dynamics in the minimal cardiac model. Comput Methods Programs Biomed 2005, 80:65-74. 10.1016/j.cmpb.2005.06.003, 16039750.