Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;13(1):139-146.
doi: 10.1007/s13239-021-00556-5. Epub 2021 Jun 22.

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

A Di Molfetta  1 , G Ferrari  2 , V Cusimano  3 , G Di Ruzza  4 , P Mollo  4 , D Boncompagni  4 , M Cesario  4 , C Volponi  4 , M Massetti  5 , M Menichelli  6
Affiliations

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

A Di Molfetta et al. Cardiovasc Eng Technol. 2022 Feb.

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/gcm4 (> 1100 mmHg/gcm4).

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.

PubMed Disclaimer

References

    1. 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. - DOI
    1. 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. - DOI
    1. 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. - DOI
    1. 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. - DOI
    1. 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. - DOI

LinkOut - more resources