Validation of a Non-invasive Inverse Problem-Solving Method for Stroke Volume.

Vasiliki Bikia,Stamatia Pagoulatou,Carmel M Mceniery,Nikolaos Stergiopulos,Ian B Wilkinson,Emma Marie Roussel,Georgios Rovas

doi:10.3389/fphys.2021.798510

Vasiliki Bikia, Stamatia Pagoulatou + Show 5 more

Open Access

https://doi.org/10.3389/fphys.2021.798510

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Abstract

Stroke volume (SV) is a major biomarker of cardiac function, reflecting ventricular-vascular coupling. Despite this, hemodynamic monitoring and management seldomly includes assessments of SV and remains predominantly guided by brachial cuff blood pressure (BP). Recently, we proposed a mathematical inverse-problem solving method for acquiring non-invasive estimates of mean aortic flow and SV using age, weight, height and measurements of brachial BP and carotid-femoral pulse wave velocity (cfPWV). This approach relies on the adjustment of a validated one-dimensional model of the systemic circulation and applies an optimization process for deriving a quasi-personalized profile of an individual’s arterial hemodynamics. Following the promising results of our initial validation, our first aim was to validate our method against measurements of SV derived from magnetic resonance imaging (MRI) in healthy individuals covering a wide range of ages (n = 144; age range 18–85 years). Our second aim was to investigate whether the performance of the inverse problem-solving method for estimating SV is superior to traditional statistical approaches using multilinear regression models. We showed that the inverse method yielded higher agreement between estimated and reference data (r = 0.83, P < 0.001) in comparison to the agreement achieved using a traditional regression model (r = 0.74, P < 0.001) across a wide range of age decades. Our findings further verify the utility of the inverse method in the clinical setting and highlight the importance of physics-based mathematical modeling in improving predictive tools for hemodynamic monitoring.

Highlights

Over the last decade, hemodynamic monitoring has risen to the forefront of efficient and sustainable healthcare
The two key findings of this study are that the inverse problem-solving method yields accurate estimates of Stroke volume (SV) across a wide range of ages and SV values, in a simple and cost-efficient manner in comparison to PC-magnetic resonance imaging (MRI); and that a traditional statistical approach such as multilinear regression analysis is inferior to the more sophisticated inverse problem-solving technique, for a given set of clinical data
We have demonstrated that SV can be estimated accurately from non-invasive, obtained clinical measurements of brachial cuff blood pressure (BP) and carotid-femoral pulse wave velocity (cfPWV) using an inverse problemsolving method

Summary

Introduction

Hemodynamic monitoring has risen to the forefront of efficient and sustainable healthcare. Several less invasive methods for assessing CO and SV have been developed Such methods include either minimally invasive techniques such as pulse contour analysis or oesophageal doppler, which are still relatively invasive and are excluded from the routine clinical examination, or non-invasive techniques such as inert gas rebreathing, doppler ultrasound or magnetic resonance imaging (MRI). The latter, while completely non-invasive and reasonably accurate, is expensive and requires costly equipment and expert technical staff (Porter et al, 2015). None of these methods are practical for routine, continuous bedside monitoring of SV

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