Bilgi Coskun, Pahlevan Niema M
Department of Aerospace and Mechanical Engineering, University of Southern California, Los Angeles, CA, United States of America.
Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America.
Physiol Meas. 2025 Aug 13;46(8). doi: 10.1088/1361-6579/adf6fd.
The left ventricle (LV) pressure-volume (PV) loop provides comprehensive characteristic information into ventricular mechanics, aiding in the assessment of systolic and diastolic function. However, its routine clinical application is limited due to the invasiveness of conventional LV catheterization procedures. This study introduces a novel analytical framework for estimating LV pressure (LVP) waveforms noninvasively, using carotid pressure waveforms and routine cardiac imaging.The proposed method consists of a five-step analytical approach that integrates physical and physiological LV-aortic coupling relationships with a novel ventricular filling model. To assess the sensitivity and effectiveness of our method, we applied it on a clinical sample of 77 people (42% female), comprising healthy volunteers and heart failure (HF) patients, and analyzed the reconstructed PV-loops for key hemodynamic metrics.The proposed method robustly captured key hemodynamic changes associated with HF patients, including elevated LV end-diastolic pressure (< 0.01), loss of inotropy (< 0.001), and impaired ventricular efficiency (< 0.001). Additionally, HF patients exhibited significantly smaller stroke work (< 0.001), mean external power (< 0.01), and contractility (< 0.001) compared to the control group. These results align well with established clinical observations for HF, demonstrating the method's ability to detect pathological ventricular modifications.The proposed noninvasive LVP estimation method provides physiologically and clinically relevant PV-loop metrics without requiring invasive catheterization. By reliably capturing ventricular dysfunction in HF patients, this approach offers a promising alternative for noninvasive cardiac assessment. Its ability to enable routine evaluation of LV mechanics has the potential to improve HF diagnosis and therapeutic management, facilitating earlier intervention and more personalized treatment strategies.
左心室（LV）压力-容积（PV）环提供了关于心室力学的全面特征信息，有助于评估收缩和舒张功能。然而，由于传统左心室导管插入术具有侵入性，其在临床中的常规应用受到限制。本研究引入了一种新颖的分析框架，用于无创估计左心室压力（LVP）波形，该方法利用颈动脉压力波形和常规心脏成像。所提出的方法包括一个五步分析方法，该方法将物理和生理上的左心室-主动脉耦合关系与一个新颖的心室充盈模型相结合。为了评估我们方法的敏感性和有效性，我们将其应用于77人的临床样本（42%为女性），其中包括健康志愿者和心力衰竭（HF）患者，并分析重建的PV环以获取关键血流动力学指标。所提出的方法稳健地捕捉到了与HF患者相关的关键血流动力学变化，包括左心室舒张末期压力升高（<0.01）、心肌收缩力丧失（<0.001）和心室效率受损（<0.001）。此外，与对照组相比，HF患者的每搏功（<0.001）、平均外部功率（<0.01）和收缩性（<0.001）明显更小。这些结果与已确立的HF临床观察结果高度一致，证明了该方法检测病理性心室改变的能力。所提出的无创LVP估计方法无需侵入性导管插入即可提供生理和临床相关的PV环指标。通过可靠地捕捉HF患者的心室功能障碍，这种方法为无创心脏评估提供了一个有前景的替代方案。其能够对左心室力学进行常规评估，有可能改善HF的诊断和治疗管理，促进早期干预和更个性化的治疗策略。
