Predictive Modeling of Secondary Pulmonary Hypertension in Left Ventricular Diastolic Dysfunction.
Predictive Modeling of Secondary Pulmonary Hypertension in Left Ventricular Diastolic Dysfunction.
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DOI：
10.3389/fphys.2021.666915
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发表时间：
2021
影响因子：
4
通讯作者：
Schiavazzi DE
中科院分区：
文献类型：
--
作者：
Harrod KK;Rogers JL;Feinstein JA;Marsden AL;Schiavazzi DE
舒张功能障碍是大约三分之一心力衰竭患者发生的常见病理。这种情况可能与心输出量或全身压力的显着下降无关，因此比收缩压情况更难以诊断。左心室舒张受损或僵硬度增加会导致上游肺动脉压力增加，被归类为继发性或 II 类肺动脉高压（2018 年尼斯分类）。这可能导致右心室后负荷增加，导致右心室衰竭。因此，肺动脉压力升高是舒张性心力衰竭（有时称为射血分数保留的心力衰竭，HFpEF）的重要临床指标，与相关死亡率显着相关。然而，该量的准确测量通常是通过侵入性导管插入术并在症状出现后获得的。在这项研究中，我们使用微分代数循环模型的血流动力学一致性，根据其他可能非侵入性的临床数据来预测成年患者的肺压。我们研究了该问题的几个方面，包括模型输出代表足够宽的病理谱的能力、模型参数的可识别性以及预测肺压的准确性。我们还发现，使用同化模型参数作为特征的分类器不存在丢失数据的问题，并且能够以足够高的准确度检测肺动脉高压。对于 82 名患有不同程度的心力衰竭严重程度的患者的队列，我们发现收缩压、舒张压和楔形肺动脉压的平均估计值分别在 8、6 和 6 mmHg 以内。我们还表明，一般来说，数据可用性的增加可以改善预测。
Diastolic dysfunction is a common pathology occurring in about one third of patients affected by heart failure. This condition may not be associated with a marked decrease in cardiac output or systemic pressure and therefore is more difficult to diagnose than its systolic counterpart. Compromised relaxation or increased stiffness of the left ventricle induces an increase in the upstream pulmonary pressures, and is classified as secondary or group II pulmonary hypertension (2018 Nice classification). This may result in an increase in the right ventricular afterload leading to right ventricular failure. Elevated pulmonary pressures are therefore an important clinical indicator of diastolic heart failure (sometimes referred to as heart failure with preserved ejection fraction, HFpEF), showing significant correlation with associated mortality. However, accurate measurements of this quantity are typically obtained through invasive catheterization and after the onset of symptoms. In this study, we use the hemodynamic consistency of a differential-algebraic circulation model to predict pulmonary pressures in adult patients from other, possibly non-invasive, clinical data. We investigate several aspects of the problem, including the ability of model outputs to represent a sufficiently wide pathologic spectrum, the identifiability of the model's parameters, and the accuracy of the predicted pulmonary pressures. We also find that a classifier using the assimilated model parameters as features is free from the problem of missing data and is able to detect pulmonary hypertension with sufficiently high accuracy. For a cohort of 82 patients suffering from various degrees of heart failure severity, we show that systolic, diastolic, and wedge pulmonary pressures can be estimated on average within 8, 6, and 6 mmHg, respectively. We also show that, in general, increased data availability leads to improved predictions.
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DOI：
10.1016/s0735-1097(83)80278-2
发表时间：
1983-01-01
影响因子：
24
作者：
GORDON, EP;SCHNITTGER, I;POPP, RL
通讯作者：
POPP, RL
影响因子：
4.6
作者：
AVANZOLINI, G;BARBINI, P;CEVESE, A
通讯作者：
CEVESE, A
DOI：
10.1109/pgec.1965.264137
发表时间：
1965-01-01
期刊：
IEEE TRANSACTIONS ON ELECTRONIC COMPUTERS
影响因子：
--
作者：
COVER, TM
通讯作者：
COVER, TM
影响因子：
--
作者：
KULLBACK, S;LEIBLER, RA
通讯作者：
LEIBLER, RA
影响因子：
24
作者：
Lam, Carolyn S. P.;Roger, Veronique L.;Rodeheffer, Richard J.;Borlaug, Barry A.;Enders, Felicity T.;Redfield, Margaret M.
通讯作者：
Redfield, Margaret M.