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Ciliberti P, Chinali M, Capelli C. Editorial: Ventricular mechanics in congenital heart disease and pediatric cardiology. Front Pediatr 2024; 12:1433819. [PMID: 38895194 PMCID: PMC11184132 DOI: 10.3389/fped.2024.1433819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Paolo Ciliberti
- Cardiology Unit, Bambino Gesù Children’s Hospital IRCSS, Rome, Italy
| | - Marcello Chinali
- Cardiology Unit, Bambino Gesù Children’s Hospital IRCSS, Rome, Italy
| | - Claudio Capelli
- Institute of Cardiovascular Science, UCL, London, United Kingdom
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2
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Quennelle S, Bonnet D. Pediatric heart failure with preserved ejection fraction, a review. Front Pediatr 2023; 11:1137853. [PMID: 37601131 PMCID: PMC10433757 DOI: 10.3389/fped.2023.1137853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Diastolic dysfunction refers to a structural or functional abnormality of the left ventricle, resulting in impaired filling of the heart. Severe diastolic dysfunction can lead to congestive heart failure even when the left ventricle systolic function is normal. Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of the hospitalizations for acute heart failure in the adult population but the clinical recognition and understanding of HFpEF in children is poor. The condition is certainly much less frequent than in the adult population but the confirmatory diagnosis of diastolic dysfunction in children is also challenging. The underlying causes of HFpEF in children are diverse and differ from the main cause in adults. This review addresses the underlying causes and prognostic factors of HFpEF in children. We describe the pulmonary hypertension profiles associated with this cardiac condition. We discuss diagnosis difficulties in clinical practice, and we provide a simplified diagnostic algorithm for HFpEF in children.
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Affiliation(s)
- Sophie Quennelle
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Equipe Projet HeKA, Paris, France
- Université Paris Cité, Paris, France
| | - Damien Bonnet
- Pediatric Cardiology Department, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, Paris, France
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3
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Sophocleous F, Delchev K, De Garate E, Hamilton MCK, Caputo M, Bucciarelli-Ducci C, Biglino G. Feasibility of Wave Intensity Analysis from 4D Cardiovascular Magnetic Resonance Imaging Data. Bioengineering (Basel) 2023; 10:662. [PMID: 37370593 DOI: 10.3390/bioengineering10060662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023] Open
Abstract
Congenital heart defects (CHD) introduce haemodynamic changes; e.g., bicuspid aortic valve (BAV) presents a turbulent helical flow, which activates aortic pathological processes. Flow quantification is crucial for diagnostics and to plan corrective strategies. Multiple imaging modalities exist, with phase contrast magnetic resonance imaging (PC-MRI) being the current gold standard; however, multiple predetermined site measurements may be required, while 4D MRI allows for measurements of area (A) and velocity (U) in all spatial dimensions, acquiring a single volume and enabling a retrospective analysis at multiple locations. We assessed the feasibility of gathering hemodynamic insight into aortic hemodynamics by means of wave intensity analysis (WIA) derived from 4D MRI. Data were collected in n = 12 BAV patients and n = 7 healthy controls. Following data acquisition, WIA was successfully derived at three planes (ascending, thoracic and descending aorta) in all cases. The values of wave speed were physiological and, while the small sample limited any clinical interpretation of the results, the study shows the possibility of studying wave travel and wave reflection based on 4D MRI. Below, we demonstrate for the first time the feasibility of deriving wave intensity analysis from 4D flow data and open the door to research applications in different cardiovascular scenarios.
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Affiliation(s)
- Froso Sophocleous
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - Kiril Delchev
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Estefania De Garate
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Mark C K Hamilton
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- Royal Brompton and Harefield Hospitals, Guys and St Thomas NHS Trust, London UB9 6JH, UK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London WC2R 2LS, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
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4
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Hofmann A, Tran V, Eng N, Valdovinos J. Graphical User Interface for Calculating Wave Intensity from Cardiac Catheterization Measurements. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5663-5667. [PMID: 34892407 DOI: 10.1109/embc46164.2021.9629931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Wave intensity analysis (WIA) as a framework to assess cardiovascular hemodynamics has been successfully used in many clinical applications. Typically, wave intensity calculations require the simultaneous acquisition of blood velocity and blood pressure at the same vascular site. Unfortunately, many hemodynamic parameters that are used to monitor pre-operative patient hemodynamic state use both invasively acquired blood pressure measurements in catheterization laboratory and non-invasively acquired blood velocity measurements. To utilize wave intensity analysis to assess patients undergoing cardiac interventional procedures, we have developed a graphical user interface (GUI) that uses standard clinical measurements which include invasive blood pressure waveforms and Doppler echocardiography images to calculate wave intensity parameters. The GUI consists of three main subroutines that allow clinicians to import raw data and extract and analyze the blood pressure and blood velocity signals separately. Using the electrocardiogram signals as an alignment marker, the re-formatted signals are aligned, and wave intensity is calculated. Wave intensity features such as forward compression wave (FCW), forward expansion wave (FEW) and wave speed are calculated and output in a table for statistical analysis. The GUI represents the first attempt to create a program that encourages clinicians to use WIA for hemodynamic assessment in patients undergoing cardiac catheterization procedures with the data they have already procured.
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Bhuva AN, D'Silva A, Torlasco C, Nadarajan N, Jones S, Boubertakh R, Van Zalen J, Scully P, Knott K, Benedetti G, Augusto JB, Bastiaenen R, Lloyd G, Sharma S, Moon JC, Parker KH, Manisty CH, Hughes AD. Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2021; 21:805-813. [PMID: 31501858 DOI: 10.1093/ehjci/jez227] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/01/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms. METHODS AND RESULTS Two hundred and six healthy volunteers (age range 21-73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, -6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (-8.6 and -20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001). CONCLUSION This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.
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Affiliation(s)
- Anish N Bhuva
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - A D'Silva
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - C Torlasco
- IRCCS, Istituto Auxologico Italiano, Via Ludovico Ariosto 13, 20145 Milan, Italy, Italy
| | - N Nadarajan
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - S Jones
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK
| | - R Boubertakh
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J Van Zalen
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - P Scully
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K Knott
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - G Benedetti
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - J B Augusto
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Rachel Bastiaenen
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - G Lloyd
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - S Sharma
- Cardiovascular Sciences Research Centre, St. George's University of London, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - J C Moon
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - K H Parker
- Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - C H Manisty
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, 69 Chenies Mews, London WC1E6HX, UK.,MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK
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Valdovinos J, Eng N, Russell M, Zahn S, Levi DS. Assessing Single Ventricle Function in the Fontan Circulation using Wave Intensity Analysis. Pediatr Cardiol 2021; 42:804-813. [PMID: 33515090 DOI: 10.1007/s00246-021-02544-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/05/2021] [Indexed: 01/09/2023]
Abstract
Single ventricle hearts palliated with the Fontan operation present complications later in life as a result of increased venous pressures and abnormal ventricle function. Wave intensity analysis uses measurements of blood velocity and pressure to represent arterial hemodynamics as summations of energy waves. This methodology could potentially be a useful tool in assessment of Fontan patients. The clinical value of wave intensity parameters was utilized to evaluate the functional performance of the single ventricle in Fontan patients. A retrospective analysis of invasive hemodynamic data was retrospectively obtained from routine cardiac catheterization of patients with Fontan circulation (n = 20) and comparison to those with biventricular circulation (n = 10) who presented to the catheterization laboratory for closure of small patent ductus arteriosus (PDAs). Wave intensity analysis and wave energy flux was calculated using aortic pressure waveforms and echocardiography aortic Doppler measurements as previously described. Significant differences were seen in the peak forward compression wave (p = 0.013), early systolic energy flux (p = 0.005) and the systolic and diastolic ratio (p = 0.006) in Fontan patients versus controls. Within the Fontan group, there was a positive correlation (0.54, p = 0.02) between the wave speed and pulmonary vascular resistance. Early systolic energy flux was a potential individual indicator of a Fontan patients heart failure classification (AUC = 0.71). Wave intensity analysis could be a useful tool in screening Fontan patients and predicting clinical outcomes and Fontan failure. Future prospective analyses of Fontan hemodynamics and WIA are needed.
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Affiliation(s)
- John Valdovinos
- Electrical and Computer Engineering Department, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA.
| | - Nicolas Eng
- Electrical and Computer Engineering Department, California State University Northridge, 18111 Nordhoff St., Northridge, CA, 91330, USA
| | - Matthew Russell
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, 200 UCLA Medical Plaza STE 330, Los Angeles, CA, 90095, USA
| | - Samuel Zahn
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, 200 UCLA Medical Plaza STE 330, Los Angeles, CA, 90095, USA
| | - Daniel S Levi
- Division of Pediatric Cardiology, UCLA Mattel Children's Hospital, 200 UCLA Medical Plaza STE 330, Los Angeles, CA, 90095, USA
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Schäfer M, Frank BS, Humphries SM, Hunter KS, Carmody KL, Jacobsen R, Mitchell MB, Jaggers J, Stone ML, Morgan GJ, Barker AJ, Browne LP, Ivy DD, Younoszai A, Di Maria MV. Flow profile characteristics in Fontan circulation are associated with the single ventricle dilation and function: principal component analysis study. Am J Physiol Heart Circ Physiol 2020; 318:H1032-H1040. [PMID: 32167782 DOI: 10.1152/ajpheart.00686.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Fontan circulation is characterized as a nonpulsatile flow propagation without a pressure-generating ventricle. However, flow through the Fontan circulation still exhibits oscillatory waves as a result of pressure changes generated by the systemic single ventricle. Identification of discrete flow patterns through the Fontan circuit may be important to understand single ventricle performance. Ninety-seven patients with Fontan circulation underwent phase-contrast MRI of the right pulmonary artery, yielding subject-specific flow waveforms. Principal component (PC) analysis was performed on preprocessed flow waveforms. Principal components were then correlated with standard MRI indices of function, volume, and aortopulmonary collateral flow. The first principal component (PC) described systolic versus diastolic-dominant flow through the Fontan circulation, accounting for 31.3% of the variance in all waveforms. The first PC correlated with end-diastolic volume (R = 0.34, P = 0.001), and end-systolic volume (R = 0.30, P = 0.003), cardiac index (R = 0.51, P < 0.001), and the amount of aortopulmonary collateral flow (R = 0.25, P = 0.027)-lower ventricular volumes and a smaller volume of collateral flow-were associated with diastolic-dominant cavopulmonary flow. The second PC accounted for 19.5% of variance and described late diastolic acceleration versus deceleration and correlated with ejection fraction-diastolic deceleration was associated with higher ejection fraction. Principal components describing the diastolic flow variations in pulmonary arteries are related to the single ventricle function and volumes. Particularly, diastolic-dominant flow without late acceleration appears to be related to preserved ventricular volume and function, respectively.NEW & NOTEWORTHY The exact physiological significance of flow oscillations of phasic and temporal flow variations in Fontan circulation is unknown. With the use of principal component analysis, we discovered that flow variations in the right pulmonary artery of Fontan patients are related to the single ventricle function and volumes. Particularly, diastolic-dominant flow without late acceleration appears to be related to more ideal ventricular volume and systolic function, respectively.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Benjamin S Frank
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | | | - Kendall S Hunter
- Department of Bioengineering, College of Engineering and Applied Sciences, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Katherine L Carmody
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Roni Jacobsen
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Max B Mitchell
- Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - James Jaggers
- Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Matthew L Stone
- Section of Congenital Heart Surgery, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Gareth J Morgan
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Alex J Barker
- Department of Bioengineering, College of Engineering and Applied Sciences, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado.,Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Lorna P Browne
- Department of Radiology, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - D Dunbar Ivy
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Adel Younoszai
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
| | - Michael V Di Maria
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Denver, Colorado
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Hametner B, Bauer A, Wassertheurer S. Unveiling the Vascular Mechanisms Behind Long-Term Effects of Coarctation Treatment Using Pulse Wave Dynamics. J Am Heart Assoc 2020; 8:e012278. [PMID: 30929552 PMCID: PMC6509706 DOI: 10.1161/jaha.119.012278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
See Article by Martins et al and Kowalski et al
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Affiliation(s)
- Bernhard Hametner
- 1 Center for Health & Bioresources AIT Austrian Institute of Technology Vienna Austria
| | - Andreas Bauer
- 1 Center for Health & Bioresources AIT Austrian Institute of Technology Vienna Austria.,2 Institute for Analysis and Scientific Computing Vienna University of Technology Vienna Austria
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Abstract
Background Systolic left ventricular function strongly influences the blood pressure waveform. Therefore, pressure-derived parameters might potentially be used as non-invasive, diagnostic markers of left ventricular impairment. The aim of this study was to investigate the performance of pressure-based parameters in combination with electrocardiography (ECG) for the detection of left ventricular systolic dysfunction defined as severely reduced ejection fraction (EF). Methods and results Two populations, each comprising patients with reduced EF and pressure-matched controls, were included for the main analysis (51/102 patients) and model testing (44/88 patients). Central pressure was derived from radial readings and used to compute blood flow. Subsequently, pulse wave analysis and wave intensity analysis were performed and the ratio of the two peaks of forward intensity (SDR) was calculated as a novel index of ventricular function. SDR was significantly decreased in the reduced EF group (2.5 vs. 4.4, P<0.001), as was central pulse pressure, augmentation index and ejection duration (ED), while the QRS-duration was prolonged. SDR and ED were independent predictors of ventricular impairment and when combined with QRS in a simple decision tree, a reduced EF could be detected with a sensitivity of 92% and a specificity of 80%. The independent power of ED, SDR and QRS to predict reduced EF was furthermore confirmed in the test population. Conclusion The detection or indication of reduced ejection fraction from pressure-derived parameters seems feasible. These parameters could help to improve the quality of cardiovascular risk stratification or might be used in screening strategies in the general population.
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