Abstract
We introduce a novel approach to estimate cardiac output (CO) and central systolic blood pressure (cSBP) from noninvasive measurements of peripheral cuff-pressure and carotid-to-femoral pulse wave velocity (cf-PWV). The adjustment of a previously validated one-dimensional arterial tree model is achieved via an optimization process. In the optimization loop, compliance and resistance of the generic arterial tree model as well as aortic flow are adjusted so that simulated brachial systolic and diastolic pressures and cf-PWV converge towards the measured brachial systolic and diastolic pressures and cf-PWV. The process is repeated until full convergence in terms of both brachial pressures and cf-PWV is reached. To assess the accuracy of the proposed framework, we implemented the algorithm on in vivo anonymizeddata from 20 subjects and compared the method-derived estimates of CO and cSBP to patient-specific measurements obtained with Mobil-O-Graph apparatus (central pressure) and two-dimensional transthoracic echocardiography (aortic blood flow). Both CO and cSBP estimates were found to be in good agreement with the reference values achieving an RMSE of 0.36 L/min and 2.46 mmHg, respectively. Low biases were reported, namely -0.04 ± 0.36 L/min for CO predictions and -0.27 ± 2.51 mmHg for cSBP predictions. Our one-dimensional model can be successfully "tuned" to partially patient-specific standards by using noninvasive, easily obtained peripheral measurement data. The in vivo evaluation demonstrated that this method can potentially be used to obtain central aortic hemodynamic parameters in a noninvasive and accurate way.
Highlights
C ENTRAL hemodynamic quantities, such as cardiac output (CO) and central aortic pressure, have been generally shown to be more powerful predictors of clinical outcomes than corresponding measurements obtained in the peripheral arteries such as the radial, femoral or brachial arteries [1], [2]
Ill or intensive care unit patients often require continuous assessment of cardiac output for diagnostic purposes or for guiding therapeutic interventions [3]–[5], whereas several studies have shown the pathophysiological importance of central systolic blood pressure as the critical index for diagnosis and preventing cardiovascular diseases [6]–[8]
Local arterial compliance is calculated after approximating pulse wave velocity (PWV) as an inverse power function of arterial lumen diameter, following the physiological values reported in the literature
Summary
C ENTRAL hemodynamic quantities, such as cardiac output (CO) and central aortic pressure, have been generally shown to be more powerful predictors of clinical outcomes than corresponding measurements obtained in the peripheral arteries such as the radial, femoral or brachial arteries [1], [2]. Despite the diagnostic importance of central measurements, their clinical use is severely hampered by their invasive nature (in case of central pressure) or cost and need of special equipment and training (in case of aortic blood flow). Peripheral measurements such as systolic and diastolic brachial pressure, on the other hand, are noninvasive and can be monitored by any clinician on a regular basis [9]. Data assimilation has significantly promoted patient-specific modeling and has become an area of increasing interest [23], [24]
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