Faes Theo Jc, Kerkhof Peter Lm
Department of Physics and Medical Technology, VU-University Medical Center, Amsterdam, The Netherlands.
Clin Med Insights Cardiol. 2015 May 21;9(Suppl 1):73-91. doi: 10.4137/CMC.S18748. eCollection 2015.
In left ventricular heart failure, often a distinction is made between patients with a reduced and a preserved ejection fraction (EF). As EF is a composite metric of both the end-diastolic volume (EDV) and the end-systolic ventricular volume (ESV), the lucidity of the EF is sometimes questioned. As an alternative, the ESV-EDV graph is advocated. This study identifies the dependence of the EF and the EDV-ESV graph on the major determinants of ventricular performance. Numerical simulations were made using a model of the systemic circulation, consisting of an atrium-ventricle valves combination; a simple constant pressure as venous filling system; and a three-element Windkessel extended with a venous system. ESV-EDV graphs and EFs were calculated using this model while varying one by one the filling pressure, diastolic and systolic ventricular elastances, and diastolic pressure in the aorta. In conclusion, the ESV-EDV graph separates between diastolic and systolic dysfunction while the EF encompasses these two pathologies. Therefore, the ESV-EDV graph can provide an advantage over EF in heart failure studies.
在左心室心力衰竭中，通常会对射血分数（EF）降低和保留的患者进行区分。由于EF是舒张末期容积（EDV）和收缩末期心室容积（ESV）的综合指标，因此EF的清晰度有时会受到质疑。作为替代方案，有人提倡使用ESV-EDV图。本研究确定了EF和EDV-ESV图对心室功能主要决定因素的依赖性。使用体循环模型进行了数值模拟，该模型由心房-心室瓣膜组合、简单的恒压静脉充盈系统以及扩展了静脉系统的三元风箱模型组成。在逐一改变充盈压、舒张期和收缩期心室弹性以及主动脉舒张压的同时，使用该模型计算ESV-EDV图和EF。总之，ESV-EDV图可区分舒张功能障碍和收缩功能障碍，而EF则涵盖这两种病理情况。因此，在心力衰竭研究中，ESV-EDV图可能比EF具有优势。
