A novel analytical framework for noninvasive estimation of left ventricular pressure and pressure-volume loops

The left ventricle (LV) pressure-volume (PV) loop provides comprehensive characteristic information into ventricular mechanics, aiding in the assessment of systolic and diastolic function. However, its routine clinical application is limited due to the invasiveness of conventional LV catheterization procedures. This study introduces a novel analytical framework for estimating LV pressure (LVP) waveforms noninvasively, using carotid pressure waveforms and routine cardiac imaging. Approach: The proposed method consists of a five-step analytical approach that integrates physical and physiological LV-aortic coupling relationships with a novel ventricular filling model. To assess the sensitivity and effectiveness of our method, we applied it on a clinical sample of 77 people (42% female), comprising healthy volunteers and heart failure (HF) patients, and analyzed the reconstructed PV-loops for key hemodynamic metrics. Main Results: The proposed method robustly captured key hemodynamic changes associated with HF patients, including elevated LV end-diastolic pressure (p<0.01), loss of inotropy (p<0.001), and impaired ventricular efficiency (p<0.001). Additionally, HF patients exhibited significantly smaller stroke work (p<0.001), mean external power (p<0.01), and contractility (p<0.001) compared to the control group. These results align well with established clinical observations for HF, demonstrating the method's ability to detect pathological ventricular modifications. Significance: The proposed noninvasive LVP estimation method provides physiologically and clinically relevant PV-loop metrics without requiring invasive catheterization. By reliably capturing ventricular dysfunction in HF patients, this approach offers a promising alternative for noninvasive cardiac assessment. Its ability to enable routine evaluation of LV mechanics has the potential to improve heart failure diagnosis and therapeutic management, facilitating earlier intervention and more personalized treatment strategies. .