Abstract
The end-systolic elastance (\(E_{\text {es}}\)) – the slope of the end-systolic pressure-volume relationship (ESPVR) at the end of ejection phase – has become a reliable indicator of myocardial functional state. The estimation of \(E_{\text {es}}\) by the original multiple-beat method is invasive, which limits its routine usage. By contrast, non-invasive single-beat estimation methods, based on the assumption of the linearity of ESPVR and the uniqueness of the normalised time-varying elastance curve \(E^N(t)\) across subjects and physiology states, have been applied in a number of clinical studies. It is however known that these two assumptions have a limited validity, as ESPVR can be approximated by a linear function only locally, and \(E^N(t)\) obtained from a multi-subject experiment includes a confidence interval around the mean function. Using datasets of 3 patients undergoing general anaesthesia (each containing aortic flow and pressure measurements at baseline and after introducing a vasopressor noradrenaline), we first study the sensitivity of two single-beat methods—by Sensaki et al. and by Chen et al.—to the uncertainty of \(E^N(t)\). Then, we propose a minimally-invasive method based on a patient-specific biophysical modelling to estimate the whole time-varying elastance curve \(E^{\text {model}}(t)\). We compare \(E^{\text {model}}_{\text {es}}\) with the two single-beat estimation methods, and the normalised varying elastance curve \(E^{N,\text {model}}(t)\) with \(E^{N}(t)\) from published physiological experiments.
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Acknowledgment
We acknowledge Prof. Alexandre Mebazaa, and Prof. Etienne Gayat (Anaesthesiology and Intensive Care department, Lariboisière hospital, Paris, France) for their support in conducting the study. In addition, we would like to acknowledge Dr. Philippe Moireau, Inria research team M\(\mathsf {\** }\)DISIM, for the development of the cardiac simulation software CardiacLab used in this work.
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Le Gall, A., Vallée, F., Chapelle, D., Chabiniok, R. (2019). Minimally-Invasive Estimation of Patient-Specific End-Systolic Elastance Using a Biomechanical Heart Model. In: Coudière, Y., Ozenne, V., Vigmond, E., Zemzemi, N. (eds) Functional Imaging and Modeling of the Heart. FIMH 2019. Lecture Notes in Computer Science(), vol 11504. Springer, Cham. https://doi.org/10.1007/978-3-030-21949-9_29
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DOI: https://doi.org/10.1007/978-3-030-21949-9_29
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