Ventricular Ejection Fraction and Global Strains in Connection with the Volume Regulation Graph

Peter L.M. Kerkhof, Jacqueline Y. Bell-Beringer, Rienzi A. Diaz-Navarro, John K.J. Li, Neal Handly

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Ejection fraction (EF) is traditionally considered useful to infer ventricular function. Newer metrics such as global function index (GFI) and various strains add supplemental diagnostic or prognostic value. All these candidates refer to dimensionless ratios, rather than to the characteristics of the underlying components. Therefore, we introduced the volume regulation graph (VRG), relating end-systolic volume (ESV) to end-diastolic volume (EDV). An individual patient is then uniquely defined by the prevailing working point in the volume domain. Alternatively, the combination of EF=(1-ESV/EDV) and any suitable companion (denoted as C) metric (e.g. the Pythagorean mean) specifies this working point.An expression relates EF to global longitudinal (GLS) and circumferential strain (GCS): ESV/EDV = (GLS+1) (GCS+1)2, resembling the empirical regression equation for the VRG. However, the latter has a non-zero intercept (mL). The discrepancy can be solved by the introduction of one or more pertinent companion metrics.We studied 96 patients by cardiac magnetic resonance imaging and calculated EF, EFC, GFI, GLS and GCS. The GFI is inversely related to GLS (R2=0.26). For regression we found: ESV=0.74 EDV-27.0 with R2=0.81 for N=96. Similar results were obtained for echocardiography data (N=25). Graphs relating EF to GLS and GCS indicate that EFC can distinguish patients with nearly identical values for these 3 metrics.Thus, the VRG offers a unifying framework that visualizes the association between ESV and EDV, while documenting iso-EF and iso-EFC trajectories. Newer metrics including GFI, GLS and GCS require consideration of a companion variable such as EFC to permit a comprehensive analysis.Clinical Relevance - The VRG allows insight into ventricular functioning and illustrates the working point concept. Companion metrics (having a physical dimension) should be considered in conjunction with any traditional ratio-based index.

Original languageEnglish (US)
Title of host publication2023 45th Annual International Conference of the IEEE Engineering in Medicine and Biology Conference, EMBC 2023 - Proceedings
PublisherInstitute of Electrical and Electronics Engineers Inc.
ISBN (Electronic)9798350324471
DOIs
StatePublished - 2023
Externally publishedYes
Event45th Annual International Conference of the IEEE Engineering in Medicine and Biology Conference, EMBC 2023 - Sydney, Australia
Duration: Jul 24 2023Jul 27 2023

Publication series

NameProceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS

Conference

Conference45th Annual International Conference of the IEEE Engineering in Medicine and Biology Conference, EMBC 2023
Country/TerritoryAustralia
CitySydney
Period7/24/237/27/23

ASJC Scopus subject areas

  • Signal Processing
  • Biomedical Engineering
  • Computer Vision and Pattern Recognition
  • Health Informatics

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