Continuous left ventricular ejection fraction monitoring by central aortic pressure waveform analysis

Continuous left ventricular ejection fraction monitoring by aortic pressure waveform analysis

We developed a technique to monitor left ventricular ejection fraction (EF) by model-based analysis of the aortic pressure waveform. First, the aortic pressure waveform is represented with a lumped parameter circulatory model. Then, the model is fitted to each beat of the waveform to estimate its lumped parameters to within a constant scale factor equal to the arterial compliance (C (a)). Finally, the proportional parameter estimates are utilized to compute beat-to-beat absolute EF by cancelation of the C (a) scale factor. In this way, in contrast to conventional imaging, EF may be continuously monitored without any ventricular geometry assumptions. Moreover, with the proportional parameter estimates, relative changes in beat-to-beat left ventricular end-diastolic volume (EDV), cardiac output (CO), and maximum left ventricular elastance (E (max)) may also be monitored. To evaluate the technique, we measured aortic pressure waveforms, reference EF and EDV via standard echocardiography, and other cardiovascular variables from six dogs during various pharmacological influences and total intravascular volume changes. Our results showed overall EF and calibrated EDV root-mean-squared-errors of 5.6% and 4.1 mL, and reliable estimation of relative E (max) and beat-to-beat CO changes. These results demonstrate, perhaps for the first time, the feasibility of estimating EF from only a blood pressure waveform.

Continuous ejection fraction estimation by model-based analysis of an aortic pressure waveform: comparison to echocardiography

Left ventricular ejection fraction (EF) is perhaps the most clinically significant index of global ventricular function. EF is measured in clinical practice using imaging methods such as non-invasive echocardiography. However, imaging methods generally require a skilled operator and expensive equipment. Thus, EF is not sufficiently monitored. To this end, we have recently developed a novel technique to continuously (i.e., automatically) estimate EF by model-based analysis of an aortic pressure waveform. Here, we review the technique and present its evaluation with respect to reference echocardiography measurements from three dogs during diverse interventions. We report an overall EF error of only 8.3%. With further successful testing, the technique may ultimately be utilized for continuous EF monitoring in research and clinical settings in which an aortic catheter is employed.