A Study on Ejection Fraction in Patients with Mitral and Aortic Regurgitation Based on Cardiovascular Models
DOI:
https://doi.org/10.59958/hsf.7697Keywords:
ejection fraction, net ejection fraction, stroke volume, net stroke volume, cardiovascular modelAbstract
Background: Whether it is healthy or patients with mitral and aortic regurgitation, clinicians cannot measure the regurgitation of the valve when using two-dimensional echocardiography to measure ejection fraction. Whether the mitral valve and aortic valve are in a healthy state or in a reflux state, there is a reflux volume. The actual stroke output will be less than the stroke output measured by echocardiography, making the calculated ejection fraction higher. Methods: This article proposes for the first time the concept of net ejection fraction (NEF) as the percentage of net stroke output to left ventricular end diastolic volume. The net stroke output is the integral of aortic valve flow during one cardiac cycle at the same time. Using a systemic arterial circulation model, investigate the relationship between ejection fraction and net ejection fraction through numerical simulation methods. Results: The final results showed a strong linear correlation between mitral regurgitation volume (VRmi), aortic regurgitation volume (VRao), and the difference between ejection fraction and net ejection fraction (DEF). The net ejection fraction of the moderate mitral regurgitation group decreased by an average of 26.3% ± 9.95% compared to the ejection fraction measured by echocardiography. The severe mitral regurgitation group showed a decrease of 31.9% ± 9.3%. Moderate descent of aortic valve by 25.8% ± 11.1%. Severe aortic valve descent of 30.9% ± 10.3%. Conclusions: Clinical doctors can evaluate the left ventricular systolic function of patients based on the ejection fraction measured by echocardiography combined with valve regurgitation. The net ejection fraction avoids overestimation of left ventricular systolic function and has high reliability. It can accurately reflect the left ventricular systolic function of patients with mitral and aortic regurgitation, and has certain guiding significance for clinical doctors to grasp the patient's condition.
References
Greaves SC. Assessment of left ventricular systolic function in research and in clinical practice. Heart (British Cardiac Society). 2000; 83: 493–494.
Fan Y, Pui-Wai Lee A. Valvular Disease and Heart Failure with Preserved Ejection Fraction. Heart Failure Clinics. 2021; 17: 387–395.
Suri RM, Schaff HV, Dearani JA, Sundt TM, Daly RC, Mullany CJ, et al. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. The Journal of Thoracic and Cardiovascular Surgery. 2009; 137: 1071–1076.
Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2019; 32: 1–64.
Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999; 100: 2153–2160.
Xu Z, Liu Q, Su XJ. Reliability analysis of ultrasonic measurement of left ventricular ejection fraction in patients with moderate to severe mitral regurgitation. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine. 2011; 21: 46–48. (In Chinese)
Li DL, Fang XX. The reliability of LVEF measured by ultrasound in patients with moderate or severe mitral regurgitation. Chinese and Foreign Medical Research. 2013; 11: 64–65. (In Chinese)
Salame G, Northcutt N, Soni NJ. Focused Cardiac Ultrasonography for Left Ventricular Systolic Function. The New England Journal of Medicine. 2020; 382: 976–977.
Dandel M. It is time to think about further optimization of the echocardiographic assessment of left ventricular responses to mitral regurgitation. International Journal of Cardiology. 2024; 401: 131841.
Kataria R, Khalil A, Coglianese E, Crowley J, Silverman MG, Shelton K, et al. Effect of Impella 5.5 on Preexisting Functional Mitral Regurgitation in Patients with Heart Failure-Related Cardiogenic Shock. Structural Heart: the Journal of the Heart Team. 2022; 6: 100072.
Bartko PE, Hülsmann M, Hung J, Pavo N, Levine RA, Pibarot P, et al. Secondary valve regurgitation in patients with heart failure with preserved ejection fraction, heart failure with mid-range ejection fraction, and heart failure with reduced ejection fraction. European Heart Journal. 2020; 41: 2799–2810.
Corporan D, Onohara D, Amedi A, Saadeh M, Guyton RA, Kumar S, et al. Hemodynamic and transcriptomic studies suggest early left ventricular dysfunction in a preclinical model of severe mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery. 2021; 161: 961–976.e22.
He ZM, Liu YF, Jing T, Zhang GJ, Liu HY, Wang H. Heart valve model with controllable closing volume. Journal of Drainage and Irrigation Machinery Engineering. 2019; 37: 1–6,37. (In Chinese)
Shim EB, Sah JY, Youn CH. Mathematical modeling of cardiovascular system dynamics using a lumped parameter method. The Japanese Journal of Physiology. 2004; 54: 545–553.
Frolov SV, Sindeev SV, Lischouk VA, Gazizova DS, Liepsch D, Balasso A. A Lumped Parameter Model of Cardiovascular System with Pulsating Heart for Diagnostic Studies. Journal of Mechanics in Medicine and Biology. 2017; 17: 21.
Shimizu S, Une D, Kawada T, Hayama Y, Kamiya A, Shishido T, et al. Lumped parameter model for hemodynamic simulation of congenital heart diseases. The Journal of Physiological Sciences: JPS. 2018; 68: 103–111.
Suga H, Sagawa K, Shoukas AA. Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circulation Research. 1973; 32: 314–322.
Korakianitis T, Shi Y. Numerical simulation of cardiovascular dynamics with healthy and diseased heart valves. Journal of Biomechanics. 2006; 39: 1964–1982.
Yoganathan AP, He Z, Casey Jones S. Fluid mechanics of heart valves. Annual Review of Biomedical Engineering. 2004; 6: 331–362.
Wang H, Cui Z, Zhou Z, He Z. A Single-opening&closing Valve Tester for Direct Measurement of Closing Volume of the Heart Valve. Cardiovascular Engineering and Technology. 2022; 13: 80–89.
Otemuyiwa BT, Lee EM, Sella E, Madamanchi C, Balasubramanian S, Ma T, et al. Effects of Mitral Valve Prolapse on Quantification of Mitral Regurgitation and Ejection Fraction Using Cardiac MRI. Radiology. Cardiothoracic Imaging. 2023; 5: e220069.
