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The Volume Regulation Graph versus the Ejection Fraction as Metrics of Left Ventricular Performance in Heart Failure with and without a Preserved Ejection Fraction: A Mathematical Model Study.

Faes TJ, Kerkhof PL - Clin Med Insights Cardiol (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physics and Medical Technology, VU-University Medical Center, Amsterdam, The Netherlands.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

(A) The simulated pressures, volumes, and elastances for healthy control conditions. Left column: Pressures (top), volumes (middle), and elastances (bottom) as function of time with the colors as follows: atrium in blue, ventricle in black, and arterial in red. The colors of the abscissa refer to cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. Right column: Pressure–volume loop (top) and elastance–volume loop (bottom) with the colors referring to the cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. (B) Simulation for HFpEF conditions (see legend Fig. 2A). (C) Simulation for HFrEF conditions (see legend Fig. 2A).
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f2-cmc-suppl.1-2015-073: (A) The simulated pressures, volumes, and elastances for healthy control conditions. Left column: Pressures (top), volumes (middle), and elastances (bottom) as function of time with the colors as follows: atrium in blue, ventricle in black, and arterial in red. The colors of the abscissa refer to cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. Right column: Pressure–volume loop (top) and elastance–volume loop (bottom) with the colors referring to the cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. (B) Simulation for HFpEF conditions (see legend Fig. 2A). (C) Simulation for HFrEF conditions (see legend Fig. 2A).

Mentions: Figure 2 shows the simulation results of pressures, volumes, and elastances as a function of time and, additionally, the LV pressure–volume and elastance–volume loops for a control and the HFpEF and HFrEF groups.


The Volume Regulation Graph versus the Ejection Fraction as Metrics of Left Ventricular Performance in Heart Failure with and without a Preserved Ejection Fraction: A Mathematical Model Study.

Faes TJ, Kerkhof PL - Clin Med Insights Cardiol (2015)

(A) The simulated pressures, volumes, and elastances for healthy control conditions. Left column: Pressures (top), volumes (middle), and elastances (bottom) as function of time with the colors as follows: atrium in blue, ventricle in black, and arterial in red. The colors of the abscissa refer to cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. Right column: Pressure–volume loop (top) and elastance–volume loop (bottom) with the colors referring to the cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. (B) Simulation for HFpEF conditions (see legend Fig. 2A). (C) Simulation for HFrEF conditions (see legend Fig. 2A).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446890&req=5

f2-cmc-suppl.1-2015-073: (A) The simulated pressures, volumes, and elastances for healthy control conditions. Left column: Pressures (top), volumes (middle), and elastances (bottom) as function of time with the colors as follows: atrium in blue, ventricle in black, and arterial in red. The colors of the abscissa refer to cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. Right column: Pressure–volume loop (top) and elastance–volume loop (bottom) with the colors referring to the cardiac phases: filling in green, ejection in red, and both iso-volumetric phases in blue. (B) Simulation for HFpEF conditions (see legend Fig. 2A). (C) Simulation for HFrEF conditions (see legend Fig. 2A).
Mentions: Figure 2 shows the simulation results of pressures, volumes, and elastances as a function of time and, additionally, the LV pressure–volume and elastance–volume loops for a control and the HFpEF and HFrEF groups.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Physics and Medical Technology, VU-University Medical Center, Amsterdam, The Netherlands.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus