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Beat-by-Beat Estimation of the Left Ventricular Pressure–Volume Loop Under Clinical Conditions

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Abstract

This paper develops a method for the minimally invasive, beat-by-beat estimation of the left ventricular pressure–volume loop. This method estimates the left ventricular pressure and volume waveforms that make up the pressure–volume loop using clinically available inputs supported by a short, baseline echocardiography reading. Validation was performed across 142,169 heartbeats of data from 11 Piétrain pigs subject to two distinct protocols encompassing sepsis, dobutamine administration and clinical interventions. The method effectively located pressure–volume loops, with low overall median errors in end-diastolic volume of 8.6%, end-systolic volume of 17.3%, systolic pressure of 19.4% and diastolic pressure of 6.5%. The method further demonstrated a low overall mean error of 23.2% predicting resulting stroke work, and high correlation coefficients along with a high percentage of trend compass ‘in band’ performance tracking changes in stroke work as patient condition varied. This set of results forms a body of evidence for the potential clinical utility of the method. While further validation in humans is required, the method has the potential to aid in clinical decision making across a range of clinical interventions and disease state disturbances by providing real-time, beat-to-beat, patient specific information at the intensive care unit bedside without requiring additional invasive instrumentation.

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Authors and Affiliations

  1. Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand

    Shaun Davidson, Chris Pretty, Shun Kamoi & J. Geoffrey Chase

  2. GIGA-Cardiovascular Sciences, University of Liège, Liège, Belgium

    Thomas Desaive

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  1. Shaun Davidson
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Correspondence to Shaun Davidson.

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Associate Editor Elena S. Di Martino oversaw the review of this article.

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Davidson, S., Pretty, C., Kamoi, S. et al. Beat-by-Beat Estimation of the Left Ventricular Pressure–Volume Loop Under Clinical Conditions. Ann Biomed Eng 46, 171–185 (2018). https://doi.org/10.1007/s10439-017-1947-9

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