Cardiac Triangle Mapping: A New Systems Approach for Noninvasive Evaluation of Left Ventricular End Diastolic Pressure

Abstract

Noninvasive and practical assessment of hemodynamics is a critical unmet need in the treatment of both chronic and acute cardiovascular diseases. Particularly, the ability to monitor left ventricular end-diastolic pressure (LVEDP) noninvasively offers enormous benefit for managing patients with chronic congestive heart failure. Recently, we provided proof of concept that a new cardiac metric, intrinsic frequency (IF), derived from mathematical analysis of non-invasively captured arterial waveforms, can be used to accurately compute cardiovascular hemodynamic measures, such as left ventricle ejection fraction (LVEF), by using a smartphone. In this manuscript, we propose a new systems-based method called cardiac triangle mapping (CTM) for hemodynamics evaluation of the left ventricle. This method is based on intrinsic frequency (IF) and systolic time interval (STI) methods that allows computation of LVEDP from noninvasive measurements. Since the CTM method only requires arterial waveform and electrocardiogram (ECG), it can eventually be adopted as a simple smartphone-based device, an inexpensive hand-held device, or perhaps (with future design modifications) a wearable sensor. Such devices, combined with this method, would allow for remote monitoring of heart failure patients.

Feasibility of Noninvasive Assessment of Cardiac Output during Exercise in Healthy Adults by a Novel Elaboration on Systolic Time Intervals

“…Systolic time interval (STI) has been used in clinical studies to determine left ventricular function performance [1, 2]. In addition, echocardiographic and electrocardiographic measures based on STIs have been applied to quantify CO and left ventricular function in clinical settings [3, 4].…”

Identifying Novel Phenotypes of Elevated Left Ventricular End Diastolic Pressure Using Hierarchical Clustering of Features Derived From Electromechanical Waveform Data

“…Patients with diminished ventricular function are the cohort most frequently encountered with elevated LVEDP, but an increased filling pressure may be the manifestation of multiple myocardial disease states including cardiomyopathies of ischemic, constrictive, restrictive, or valvular origin (5). Thus, higher filling pressures typically precede clinical deterioration in heart failure with reduced ejection fraction (HFrEF) as well as heart failure with preserved ejection fractions (HFpEF) (6). An elevated LVEDP does not indicate a specific diagnosis but provides important information that serves as a guide regarding the need for further evaluations or testing and affords data necessary for the development of an appropriate patient care plan.…”