Annals of Biomedical Engineering

, Volume 40, Issue 5, pp 987–995

Kinematic Modeling-based Left Ventricular Diastatic (Passive) Chamber Stiffness Determination with In-Vivo Validation

Article

Abstract

The slope of the diastatic pressure–volume relationship (D-PVR) defines passive left ventricular (LV) stiffness \( \mathcal{K}.\) Although \( \mathcal{K} \) is a relative measure, cardiac catheterization, which is an absolute measurement method, is used to obtain the former. Echocardiography, including transmitral flow velocity (Doppler E-wave) analysis, is the preferred quantitative diastolic function (DF) assessment method. However, E-wave analysis can provide only relative, rather than absolute pressure information. We hypothesized that physiologic mechanism-based modeling of E-waves allows derivation of the D-PVRE-wave whose slope, \( \mathcal{K}_{{\text{E-}}{\text{wave}}} \), provides E-wave-derived diastatic, passive chamber stiffness. Our kinematic model of filling and Bernoulli’s equation were used to derive expressions for diastatic pressure and volume on a beat-by-beat basis, thereby generating D-PVRE-wave, and \( \mathcal{K}_{{\text{E-}}{\text{wave}}} \). For validation, simultaneous (conductance catheter) PV and echocardiographic E-wave data from 30 subjects (444 total cardiac cycles) having normal LV ejection fraction (LVEF) were analyzed. For each subject (15 beats average) model-predicted \( \mathcal{K}_{{\text{E-}}{\text{wave}}} \) was compared to experimentally measured \( \mathcal{K}_{\text{CATH}} \) via linear regression yielding as follows: \( \mathcal{K}_{{\text{E-}}{\text{wave}}} = \alpha {\mathcal{K}}_{\text{CATH}} + b\;(R^{2} = 0.92), \) where, α = 0.995 and b = 0.02. We conclude that echocardiographically determined diastatic passive chamber stiffness, \( \mathcal{K}_{{\text{E-}}{\text{wave}}} \), provides an excellent estimate of simultaneous, gold standard (PV)-defined diastatic stiffness, \( \mathcal{K}_{\text{CATH}} \). Hence, in chambers at diastasis, passive LV stiffness can be accurately determined by means of suitable analysis of Doppler E-waves (transmitral flow).

Keywords

Diastolic function Kinematic modeling Left ventricle Diastatic stiffness Echocardiography Hemodynamics 

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Copyright information

© Biomedical Engineering Society 2011

Authors and Affiliations

  1. 1.Cardiovascular Biophysics Laboratory, Cardiovascular Division, Department of MedicineWashington University Medical CenterSt. LouisUSA
  2. 2.Department of Physics, College of Arts and SciencesWashington UniversitySt. LouisUSA

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