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This does not independently restore historical checkpoints, authenticate arbitrary JSON, or certify production release." }, "observations": [ { "dtSec": 0.002, "rest": { "operating": [ { "metricId": "systemic-net-flow.cardiac-index", "lower": 2.5, "upper": 4, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, CI", "basis": "source-informed-operating-target", "actual": 2.951852453078972, "status": "passed" }, { "metricId": "central-venous-pressure.mean", "lower": 2, "upper": 6, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean RAP", "basis": "source-informed-operating-target", "actual": 3.0795269250090356, "status": "passed" }, { "metricId": "pulmonary-artery-pressure.mean", "lower": 8, "upper": 20, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean PAP", "basis": "source-informed-operating-target", "actual": 17.89193948419189, "status": "passed" }, { "metricId": "aortic-pressure.maximum", "lower": 90, "upper": 140, "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, invasive versus cuff-calibrated pressure distinction", "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range", "actual": 111.29648919100829, "status": "passed" }, { "metricId": "aortic-pressure.minimum", "lower": 60, "upper": 90, "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, DBP calibration; no central-DBP reference interval", "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range", "actual": 77.52496257161738, "status": "passed" }, { "metricId": "left-ventricle.native-end-filling-pressure", "lower": null, "upper": 16, "sourceId": "nagueh-2025-lv-diastolic-function", "locator": "Section2, Table1 p539 (>16), Figure1 p540", "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range", "actual": 10.92333041639932, "status": "passed" } ], "comparison": { "profileId": "main-wire-resting-reference-profile-v1", "scope": "Settled resting unassisted, nonshunting sinus baseline; source comparisons are not patient-fit targets or a replacement for numerical/construction checks.", "subject": { "bodySurfaceAreaM2": 1.9, "allowedHeartRatesBpm": [ 60, 70 ], "sex": "unspecified", "age": "unspecified", "ethnicity": "unspecified" }, "startTimeSec": 45.29657142857139, "endTimeSec": 46.153714285714244, "heartRateBpm": 70.00000000000026, "selectionRule": "Report every declared comparison, never select a stratum because it passes. This comparison profile alone provides no sex-union, sex-intersection or summed-score admission rule; any consuming design decision must be explicit and separately versioned.", "entries": [ { "metricId": "aortic-valve.ejection-time", "unit": "s", "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals", "locator": "Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval", "role": "method-context", "mapping": "Native accumulated positive AoV-flow duration, not mitral-leaflet color-TDI timing. Opening-to-closure interpretation requires the separate morphology/timing observer to establish one forward episode; this comparison does not enforce that condition. No HR correction or method equivalence inferred.", "comparisons": [ { "stratum": "Copenhagen pooled healthy adults; HR 63 +/- 10", "range": { "lower": 0.248, "upper": 0.336 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.25800000000000267, "observationStatus": "observed" }, { "metricId": "pulmonary-valve.ejection-time", "unit": "s", "sourceId": "van-oort-1988-pulmonary-doppler", "locator": "Abstract: population and recording stations; no numeric adult ET interval verified", "role": "method-context", "mapping": "Native accumulated positive PV-flow duration; the separate morphology/timing observer must establish one forward episode. Doppler PA versus RVOT station, respiration and HR differ. No adult ET bounds inferred from acceleration time, tissue S-wave duration or LVET.", "comparisons": [], "actual": 0.25800000000000267, "observationStatus": "observed" }, { "metricId": "aortic-pressure.maximum", "unit": "mmHg", "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, Standardizing methodologies; Table 2, Normal population, all adult age rows", "role": "method-context", "mapping": "Model Ao root pressure is invasive-like. Source cSBP is cuff-calibrated noninvasive estimation; authors explicitly distinguish it from higher invasive intra-aortic SBP. 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No catheter transfer function or peripheral waveform is simulated.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 8, "upper": 20 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 17.89193948419189, "observationStatus": "observed" }, { "metricId": "pcwp-surrogate.mean", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, PAWP; section 5.1.12.1", "role": "method-context", "mapping": "Observed quantity remains LA mean, not a wedge measurement or LVEDP. PAWP <=15 is the guideline clinical reference upper limit, not a healthy-cohort distribution or a verified model LA-to-PAWP transfer. No lower bound is invented.", "comparisons": [ { "stratum": "adult RHC PAWP clinical reference", "range": { "lower": null, "upper": 15 }, "statistic": "clinical-upper-limit", "status": "not-above-source-upper-limit" } ], "actual": 8.402828017409725, "observationStatus": "observed" }, { "metricId": "left-ventricle.edv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 46, "upper": 104 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 46, "upper": 91 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 75.63750481438039, "observationStatus": "observed" }, { "metricId": "left-ventricle.esv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 11, "upper": 41 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 11, "upper": 34 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 33.46818399406834, "observationStatus": "observed" }, { "metricId": "left-ventricle.ejection-fraction", "unit": "fraction", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 0.53, "upper": 0.79 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 0.55, "upper": 0.8 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.5575186664842852, "observationStatus": "observed" }, { "metricId": "right-ventricle.edv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 49, "upper": 117 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 47, "upper": 99 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 74.08611607131662, "observationStatus": "observed" }, { "metricId": "right-ventricle.esv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 12, "upper": 56 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 11, "upper": 43 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 31.917135989589642, "observationStatus": "observed" }, { "metricId": "right-ventricle.ejection-fraction", "unit": "fraction", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 0.44, "upper": 0.77 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 0.49, "upper": 0.77 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.5691886998251382, "observationStatus": "observed" }, { "metricId": "systemic-net-flow.cardiac-index", "historicalCheckId": "systemic-forward-flow.cardiac-index", "unit": "L/min/m2", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, CI; section 5.1.12.1, direct Fick/thermodilution", "role": "operating-comparison", "mapping": "Use signed native AoV NET output/BSA under a distinct metric ID. Interpretation as whole-circulation CO requires a settled unassisted nonshunting state; no positive-only flow substitution or distal-CMR-plane equivalence.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 2.5, "upper": 4 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 2.951852453078972, "observationStatus": "observed" }, { "metricId": "systemic-net-flow.stroke-volume-index", "historicalCheckId": "systemic-forward-flow.stroke-volume-index", "unit": "mL/m2", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, SVI; section 5.1.12.1", "role": "coupled-flow-context", "mapping": "Signed native AoV NET volume/BSA. CI = HR * SVI / 1000, so this is a coupled comparison, not a second independent fitting objective. The CI-conditional interval is reported separately; it is not this published SVI interval.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 33, "upper": 47 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 42.16932075827087, "observationStatus": "observed" } ], "flowCoupling": { "basis": "signed-native-AoV-net-flow", "ciMinusHrTimesSviOver1000": 0, "ciConditionalSviIntervalMlPerM2": { "lower": 35.71428571428558, "upper": 57.14285714285693 }, "conditionalIntervalIsPublishedSviReference": false, "forwardMinusNetCi": 0, "pulmonaryMinusAorticNetFlowLPerMin": -0.0000453108243894107 }, "nativeLvEndDiastolicPressure": { "timeSec": 45.40342857142857, "absolutePressureMmHg": 10.92333041639932, "transmuralPressureMmHg": 10.92333041639932, "externalPressureMmHg": 0, "differenceFromMeanLaMmHg": 2.5205023989895956 }, "observationApplicabilityEstablished": false, "applicabilityReview": "Caller must separately establish settlement, no support/shunt and correct pressure reference. This readback does not infer those conditions from a plausible scalar or small flow mismatch.", "admissionDecision": "not-performed", "physiologicalNormalityClaimed": false }, "invalidOrFailedRetained": [], "unavailable": [], "anatomyReviewRequired": false, "historicalWarnings": [ { "checkId": "left-ventricle.maximum-dpdt", "status": "failed", "actual": 2564.254456175632, "minimum": 1200, "maximum": 2500, "unit": "mmHg/s" }, { "checkId": "left-ventricle.minimum-dpdt", "status": "failed", "actual": -1538.8738086540834, "minimum": -1400, "maximum": -700, "unit": "mmHg/s" }, { "checkId": "timing.ict", "status": "failed", "actual": 0.08914285714285342, "minimum": 0.02, "maximum": 0.07, "unit": "s" }, { "checkId": "timing.tei-index", "status": "failed", "actual": 0.7021040974529081, "minimum": 0.29, "maximum": 0.65, "unit": "ratio" } ], "status": "passed" }, "native": { "methodId": "main-wire-baseline-observation-v2", "timingBasis": 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0.011891591439983515, "maximumRecentNormalizedOutputDelta": 0.013824126215219718, "maximumRecentNormalizedLandmarkDelta": 0.5000536197508154, "measurementDurationSec": 4.2799999999991485 }, "hypovolemic": { "policyId": "main-wire-fixed-tone-reservoir-closure-v2", "completedBeatCount": 27, "maximumRecentRedistributedVolumeMl": 0.04698897551998096, "maximumRecentNormalizedOutputDelta": 0.0158988576751824, "maximumRecentNormalizedLandmarkDelta": 0.989731792725645, "measurementDurationSec": 24.000000000006914 }, "hypervolemic": { "policyId": "main-wire-fixed-tone-reservoir-closure-v2", "completedBeatCount": 23, "maximumRecentRedistributedVolumeMl": 0.04465837825095818, "maximumRecentNormalizedOutputDelta": 0.016843278498754444, "maximumRecentNormalizedLandmarkDelta": 0.5487979024458838, "measurementDurationSec": 20.57000000000516 } }, "endDiastolicDefinition": "inlet-valve-closure", "protocolId": "main-wire-integrated-model-fixed-tone-reservoir-settled-preload-reserve-v2" } }, { "dtSec": 0.001, "rest": { "operating": [ { "metricId": "systemic-net-flow.cardiac-index", "lower": 2.5, "upper": 4, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, CI", "basis": "source-informed-operating-target", "actual": 2.953486980340189, "status": "passed" }, { "metricId": "central-venous-pressure.mean", "lower": 2, "upper": 6, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean RAP", "basis": "source-informed-operating-target", "actual": 3.0758312292703462, "status": "passed" }, { "metricId": "pulmonary-artery-pressure.mean", "lower": 8, "upper": 20, "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean PAP", "basis": "source-informed-operating-target", "actual": 17.871712825373265, "status": "passed" }, { "metricId": "aortic-pressure.maximum", "lower": 90, "upper": 140, "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, invasive versus cuff-calibrated pressure distinction", "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range", "actual": 111.35437812029431, "status": "passed" }, { "metricId": "aortic-pressure.minimum", "lower": 60, "upper": 90, "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, DBP calibration; no central-DBP reference interval", "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range", "actual": 77.54846420758432, "status": "passed" }, { "metricId": "left-ventricle.native-end-filling-pressure", "lower": null, "upper": 16, "sourceId": "nagueh-2025-lv-diastolic-function", "locator": "Section2, Table1 p539 (>16), Figure1 p540", "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range", "actual": 10.940681495804986, "status": "passed" } ], "comparison": { "profileId": "main-wire-resting-reference-profile-v1", "scope": "Settled resting unassisted, nonshunting sinus baseline; source comparisons are not patient-fit targets or a replacement for numerical/construction checks.", "subject": { "bodySurfaceAreaM2": 1.9, "allowedHeartRatesBpm": [ 60, 70 ], "sex": "unspecified", "age": "unspecified", "ethnicity": "unspecified" }, "startTimeSec": 47.0108571428571, "endTimeSec": 47.86799999999995, "heartRateBpm": 70.00000000000026, "selectionRule": "Report every declared comparison, never select a stratum because it passes. This comparison profile alone provides no sex-union, sex-intersection or summed-score admission rule; any consuming design decision must be explicit and separately versioned.", "entries": [ { "metricId": "aortic-valve.ejection-time", "unit": "s", "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals", "locator": "Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval", "role": "method-context", "mapping": "Native accumulated positive AoV-flow duration, not mitral-leaflet color-TDI timing. Opening-to-closure interpretation requires the separate morphology/timing observer to establish one forward episode; this comparison does not enforce that condition. No HR correction or method equivalence inferred.", "comparisons": [ { "stratum": "Copenhagen pooled healthy adults; HR 63 +/- 10", "range": { "lower": 0.248, "upper": 0.336 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.25499999999999545, "observationStatus": "observed" }, { "metricId": "pulmonary-valve.ejection-time", "unit": "s", "sourceId": "van-oort-1988-pulmonary-doppler", "locator": "Abstract: population and recording stations; no numeric adult ET interval verified", "role": "method-context", "mapping": "Native accumulated positive PV-flow duration; the separate morphology/timing observer must establish one forward episode. Doppler PA versus RVOT station, respiration and HR differ. No adult ET bounds inferred from acceleration time, tissue S-wave duration or LVET.", "comparisons": [], "actual": 0.25800000000000267, "observationStatus": "observed" }, { "metricId": "aortic-pressure.maximum", "unit": "mmHg", "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, Standardizing methodologies; Table 2, Normal population, all adult age rows", "role": "method-context", "mapping": "Model Ao root pressure is invasive-like. Source cSBP is cuff-calibrated noninvasive estimation; authors explicitly distinguish it from higher invasive intra-aortic SBP. Published P10/P90 are context, not 95% normal cutoffs or a model calibration target.", "comparisons": [ { "stratum": "women 20-29", "range": { "lower": 80, "upper": 110 }, "statistic": "published-10th-90th-percentiles", "status": "outside-source-range" }, { "stratum": "men 20-29", "range": { "lower": 92, "upper": 115 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "women 30-39", "range": { "lower": 84, "upper": 119 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "men 30-39", "range": { "lower": 88, "upper": 120 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "women 40-49", "range": { "lower": 87, "upper": 123 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "men 40-49", "range": { "lower": 90, "upper": 123 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "women 50-59", "range": { "lower": 93, "upper": 127 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "men 50-59", "range": { "lower": 96, "upper": 126 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "women 60-69", "range": { "lower": 97, "upper": 129 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "men 60-69", "range": { "lower": 97, "upper": 128 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "women 70+", "range": { "lower": 100, "upper": 131 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" }, { "stratum": "men 70+", "range": { "lower": 99, "upper": 130 }, "statistic": "published-10th-90th-percentiles", "status": "inside-source-range" } ], "actual": 111.35437812029431, "observationStatus": "observed" }, { "metricId": "aortic-pressure.minimum", "unit": "mmHg", "sourceId": "herbert-2014-central-pressure-reference", "locator": "Methods, Standardizing methodologies; Table 1, brachial DBP summary", "role": "method-context", "mapping": "Source assumes DBP consistency for calibration, but does not publish a central-DBP normal interval. Do not turn the brachial mean +/- SD into a verified Ao-node cutoff.", "comparisons": [], "actual": 77.54846420758432, "observationStatus": "observed" }, { "metricId": "central-venous-pressure.mean", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean RAP; section 5.1.12.1", "role": "operating-comparison", "mapping": "Absolute lumped pressure, no respiratory cycle; compare with supine end-expiratory catheter values at the specified zero. No catheter transfer function or peripheral waveform is simulated.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 2, "upper": 6 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 3.0758312292703462, "observationStatus": "observed" }, { "metricId": "pulmonary-artery-pressure.maximum", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, systolic PAP; section 5.1.12.1", "role": "operating-comparison", "mapping": "Absolute lumped pressure, no respiratory cycle; compare with supine end-expiratory catheter values at the specified zero. No catheter transfer function or peripheral waveform is simulated.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 15, "upper": 30 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 26.166946644089006, "observationStatus": "observed" }, { "metricId": "pulmonary-artery-pressure.minimum", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, diastolic PAP; section 5.1.12.1", "role": "operating-comparison", "mapping": "Absolute lumped pressure, no respiratory cycle; compare with supine end-expiratory catheter values at the specified zero. No catheter transfer function or peripheral waveform is simulated.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 4, "upper": 12 }, "statistic": "published-reference-interval", "status": "outside-source-range" } ], "actual": 12.033879931571496, "observationStatus": "observed" }, { "metricId": "pulmonary-artery-pressure.mean", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, mean PAP; section 5.1.12.1", "role": "operating-comparison", "mapping": "Absolute lumped pressure, no respiratory cycle; compare with supine end-expiratory catheter values at the specified zero. No catheter transfer function or peripheral waveform is simulated.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 8, "upper": 20 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 17.871712825373265, "observationStatus": "observed" }, { "metricId": "pcwp-surrogate.mean", "unit": "mmHg", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, PAWP; section 5.1.12.1", "role": "method-context", "mapping": "Observed quantity remains LA mean, not a wedge measurement or LVEDP. PAWP <=15 is the guideline clinical reference upper limit, not a healthy-cohort distribution or a verified model LA-to-PAWP transfer. No lower bound is invented.", "comparisons": [ { "stratum": "adult RHC PAWP clinical reference", "range": { "lower": null, "upper": 15 }, "statistic": "clinical-upper-limit", "status": "not-above-source-upper-limit" } ], "actual": 8.377448604361563, "observationStatus": "observed" }, { "metricId": "left-ventricle.edv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 46, "upper": 104 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 46, "upper": 91 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 75.64295372966694, "observationStatus": "observed" }, { "metricId": "left-ventricle.esv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 11, "upper": 41 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 11, "upper": 34 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 33.45028227043039, "observationStatus": "observed" }, { "metricId": "left-ventricle.ejection-fraction", "unit": "fraction", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 0.53, "upper": 0.79 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 0.55, "upper": 0.8 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.557787201303969, "observationStatus": "observed" }, { "metricId": "right-ventricle.edv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 49, "upper": 117 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 47, "upper": 99 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 74.05801462802198, "observationStatus": "observed" }, { "metricId": "right-ventricle.esv-index", "unit": "mL/m2", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 12, "upper": 56 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 11, "upper": 43 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 31.865701345460426, "observationStatus": "observed" }, { "metricId": "right-ventricle.ejection-fraction", "unit": "fraction", "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows", "role": "demographic-comparison", "mapping": "Native valve-closure cavity blood volumes, BSA indexed; compared with anatomical bSSFP CMR excluding papillary/trabecular myocardium from the blood pool. No validated image segmentation or age/sex assignment; separate marginal ranges are not a joint distribution. EF is derived from EDV and ESV.", "comparisons": [ { "stratum": "men, pooled adult ages", "range": { "lower": 0.44, "upper": 0.77 }, "statistic": "published-reference-interval", "status": "inside-source-range" }, { "stratum": "women, pooled adult ages", "range": { "lower": 0.49, "upper": 0.77 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 0.5697197459921762, "observationStatus": "observed" }, { "metricId": "systemic-net-flow.cardiac-index", "historicalCheckId": "systemic-forward-flow.cardiac-index", "unit": "L/min/m2", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, CI; section 5.1.12.1, direct Fick/thermodilution", "role": "operating-comparison", "mapping": "Use signed native AoV NET output/BSA under a distinct metric ID. Interpretation as whole-circulation CO requires a settled unassisted nonshunting state; no positive-only flow substitution or distal-CMR-plane equivalence.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 2.5, "upper": 4 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 2.953486980340189, "observationStatus": "observed" }, { "metricId": "systemic-net-flow.stroke-volume-index", "historicalCheckId": "systemic-forward-flow.stroke-volume-index", "unit": "mL/m2", "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11, SVI; section 5.1.12.1", "role": "coupled-flow-context", "mapping": "Signed native AoV NET volume/BSA. CI = HR * SVI / 1000, so this is a coupled comparison, not a second independent fitting objective. The CI-conditional interval is reported separately; it is not this published SVI interval.", "comparisons": [ { "stratum": "resting adult RHC reference", "range": { "lower": 33, "upper": 47 }, "statistic": "published-reference-interval", "status": "inside-source-range" } ], "actual": 42.19267114771683, "observationStatus": "observed" } ], "flowCoupling": { "basis": "signed-native-AoV-net-flow", "ciMinusHrTimesSviOver1000": 0, "ciConditionalSviIntervalMlPerM2": { "lower": 35.71428571428558, "upper": 57.14285714285693 }, "conditionalIntervalIsPublishedSviReference": false, "forwardMinusNetCi": 0, "pulmonaryMinusAorticNetFlowLPerMin": -0.00004759741231552539 }, "nativeLvEndDiastolicPressure": { "timeSec": 47.11571428571428, "absolutePressureMmHg": 10.940681495804986, "transmuralPressureMmHg": 10.940681495804986, "externalPressureMmHg": 0, "differenceFromMeanLaMmHg": 2.5632328914434233 }, "observationApplicabilityEstablished": false, "applicabilityReview": "Caller must separately establish settlement, no support/shunt and correct pressure reference. This readback does not infer those conditions from a plausible scalar or small flow mismatch.", "admissionDecision": "not-performed", "physiologicalNormalityClaimed": false }, "invalidOrFailedRetained": [], "unavailable": [], "anatomyReviewRequired": false, "historicalWarnings": [ { "checkId": "left-ventricle.maximum-dpdt", "status": "failed", "actual": 2600.069420559839, "minimum": 1200, "maximum": 2500, "unit": "mmHg/s" }, { "checkId": "left-ventricle.minimum-dpdt", "status": "failed", "actual": -1556.3378585441976, "minimum": -1400, "maximum": -700, "unit": "mmHg/s" }, { "checkId": "timing.ict", "status": "failed", "actual": 0.0931428571428583, "minimum": 0.02, "maximum": 0.07, "unit": "s" }, { "checkId": "timing.tei-index", "status": "failed", "actual": 0.7338935574229916, "minimum": 0.29, "maximum": 0.65, "unit": "ratio" } ], "status": "passed" }, "native": { "methodId": "main-wire-baseline-observation-v2", "timingBasis": "completed-beat-closures-and-observed-flow-zero-crossings", "left": { "timing": { "ictSec": 0.0931428571428583, "ejectionTimeSec": 0.25499999999999545, "irtSec": 0.0940000000000012, "teiIndex": 0.7338935574229916 }, "inletFlow": { "basis": "atrial-capture-anchored-native-volumetric-flow", "peakEMlPerSec": 395.4783918497746, "peakAMlPerSec": 425.6736979598212, "peakEToA": 0.9290646656000421, "peakETimeSec": 47.61485714285714, "peakATimeSec": 47.91885714285714 }, "events": { "inletClosureTimeSec": 47.11571428571428, "outletOpeningTimeSec": 47.20885714285714, "outletClosureTimeSec": 47.46385714285714, "inletOpeningTimeSec": 47.55785714285714, "atrialCaptureTimeSec": 47.86799999999995, "atrialCaptureId": "rounded-ejection-v1-capture-owner:batch:111:atrial:capture:regular-atrial-source-v1:47:rounded-ejection-v1-regular-sinus-configuration39:rounded-ejection-v1-regular-sinus-owner2:55", "nextInletClosureTimeSec": 47.97285714285714 } }, "right": { "timing": { "ictSec": 0.027999999999998693, "ejectionTimeSec": 0.25800000000000267, "irtSec": 0.06400000000000006, "teiIndex": 0.3565891472868132 }, "inletFlow": { "basis": "atrial-capture-anchored-native-volumetric-flow", "peakEMlPerSec": 358.4730194390545, "peakAMlPerSec": 328.91486903521934, "peakEToA": 1.0898656557866655, "peakETimeSec": 47.564857142857136, "peakATimeSec": 47.927857142857135 }, "events": { "inletClosureTimeSec": 47.17285714285714, "outletOpeningTimeSec": 47.20085714285714, "outletClosureTimeSec": 47.45885714285714, "inletOpeningTimeSec": 47.52285714285714, "atrialCaptureTimeSec": 47.86799999999995, "atrialCaptureId": "rounded-ejection-v1-capture-owner:batch:111:atrial:capture:regular-atrial-source-v1:47:rounded-ejection-v1-regular-sinus-configuration39:rounded-ejection-v1-regular-sinus-owner2:55", "nextInletClosureTimeSec": 48.03 } } }, "tau": { "methodId": "main-wire-lv-relaxation-tau-v1", "status": "measured", "issue": null, "window": { "startTimeSec": 47.49535714285714, "endTimeSec": 47.54286897925166, "durationSec": 0.047511836394519946, "sampleCount": 50, "nextEdpMmHg": 10.940620277030689, "pressureDropMmHg": 54.19554309457547, "maximumStepSec": 0.0010000000000047748 }, "weiss": { "tauMs": 31.736099228551446, "asymptoteMmHg": 0, "rSquared": 0.9961308267181175, "pressureRmseMmHg": 1.2966033649700524, "normalizedPressureRmse": 0.02392453864162553 }, "glantz": { "tauMs": 52.75046189406872, "asymptoteMmHg": -21.35246739487585, "rSquared": 0.9522581954283542, "pressureRmseMmHg": 0.4780318727573256, "normalizedPressureRmse": 0.008820501566394906 }, "relaxationTrace": { "maximumDipAndRecoveryMmHg": 0, "maximumRiseFromRunningMinimumMmHg": 0, "excursions": [] }, "endpointSensitivity": { "shortenedWindowTauMs": 31.737728555117723, "relativeDifference": 0.00005133721411246761 }, "sensitivityStatus": "measured", "referenceStatus": "not-above-prolongation-reference" }, "checks": [ { "checkId": "settlement.period1", "status": "passed", "actual": 1, "minimum": 1, "maximum": 1, "unit": "bool", "historicalRole": "numerical-quality" }, { "checkId": 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0, "maximum": 10, "unit": "mmHg", "historicalRole": "construction-guard" }, { "checkId": "aortic-valve.ejection-time", "status": "passed", "actual": 0.25499999999999545, "minimum": 0.24, "maximum": 0.34, "unit": "s", "historicalRole": "physiological-target" }, { "checkId": "left-ventricle.maximum-dpdt", "status": "failed", "actual": 2600.069420559839, "minimum": 1200, "maximum": 2500, "unit": "mmHg/s", "historicalRole": "reference-warning" }, { "checkId": "left-ventricle.minimum-dpdt", "status": "failed", "actual": -1556.3378585441976, "minimum": -1400, "maximum": -700, "unit": "mmHg/s", "historicalRole": "reference-warning" }, { "checkId": "mitral-flow.peak-e-to-a", "status": "passed", "actual": 0.9290646656000421, "minimum": 0.8, "maximum": 2, "unit": "ratio", "historicalRole": "reference-warning" }, { "checkId": "timing.ict", "status": "failed", "actual": 0.0931428571428583, "minimum": 0.02, "maximum": 0.07, "unit": "s", "historicalRole": "reference-warning" }, { "checkId": 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"main-wire-standard70-baseline-evaluation-roles-v3", "observationMethodId": "main-wire-baseline-observation-v2", "sourceComparisonTiming": "retrospective-provenance-audit-not-original-cutoff-derivation", "operatingTargetInterpretation": "Retained ET, pressures, indexed size, EF, CI and SVI are predeclared resting-baseline design targets. Failure means the intended operating point was not met, not physiological impossibility. Their source-specific observation limitations remain binding; no cross-modality universal normality is claimed.", "referenceSubjectInterpretation": "BSA 1.9 m2 and sex-neutral synthetic anatomy do not identify age, sex or ethnicity. Conserved cavity blood volume is conceptually closer to anatomical segmentation excluding myocardial tissue from the blood pool than to smooth-contour volume that includes that tissue. This is an operator comparison, not a validated imaging-equivalence claim or permission to select the cohort that passes a candidate.", "supplementalChecks": [ { "checkId": "left-ventricle.relaxation-tau", "observationMethodId": "main-wire-lv-relaxation-tau-v1", "evaluationRole": "reference-warning", "measurementMeaning": "Intracavitary LV Weiss zero-asymptote time-weighted log-pressure fit, from minimum dP/dt interval midpoint after AVC to next EDP + 5 mmHg before MVO; Glantz derivative-pressure free-asymptote sensitivity fit reported separately.", "requiredObservation": "Prospective v3 baseline assessment must contain an interpretable tau observation; unavailable or poor fit is unresolved analysis, not normality and not a disease diagnosis.", "referenceSourceIds": [ "nagueh-2025-lv-diastolic-function", "hirota-1980-lv-relaxation" ], "referenceUpperMs": 48, "boundRationale": "ASE 2025 section 2/Table 1 calls >48 ms prolonged. Contextual warning only, no arbitrary normal lower bound and no transfer of that threshold to Glantz. Hirota reports 33 +/- 8 ms in 18 selected controls, using P0 / peak negative dP/dt, not this fitted observer; that cohort is not a normal interval.", "qualityRationale": "Minimum window support and regression/residual limits are explicit provisional numerical fit-usability settings, not empirically established physiological limits. Both fits and the extrapolated Glantz pressure asymptote remain visible; neither may be selected for being closer to a target." } ], "claimScope": { "currentBaselineEvidenceRole": "construction", "finalConfirmationStatus": "unavailable", "reason": "Standard68/69 gates, Standard69 preload-reserve floors, and candidate outputs were inspected during model construction; no lineage-disjoint final evidence set has been frozen." }, "sources": [ { "sourceId": "herbert-2014-central-pressure-reference", "title": "Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors", "year": 2014, "identifiers": { "doi": "10.1093/eurheartj/ehu293" }, "verification": "primary-full-text-methods-and-results-checked", "verificationScope": "Methods, Standardizing methodologies, and Tables 1-2 checked on 2026-09-07. Cuff-calibrated noninvasive cSBP differs from invasive intra-aortic pressure; Table 2 gives P10/P90, not 95% normal limits. Does not verify retained Ao-node bounds.", "url": "https://academic.oup.com/eurheartj/article/35/44/3122/2293191" }, { "sourceId": "van-oort-1988-pulmonary-doppler", "title": "Reference values for pulsed Doppler signals from the blood flow velocity on both sides of the pulmonary valve", "year": 1988, "identifiers": { "doi": "10.1093/oxfordjournals.eurheartj.a062515", "pmid": "3383877" }, "verification": "primary-abstract-population-and-method-checked-not-full-text", "verificationScope": "215 healthy subjects aged 1-65; pulmonary artery and RVOT Doppler measurements. Adult ejection-time limits not verified; acceleration time or LV timing is not substituted.", "url": "https://pubmed.ncbi.nlm.nih.gov/3383877/" }, { "sourceId": "murgo-1980-human-aortic-waveforms", "title": "Aortic input impedance in normal man: relationship to pressure wave forms", "year": 1980, "identifiers": { "doi": "10.1161/01.CIR.62.1.105", "pmid": "7379273" }, "verification": "author-institution-abstract-checked-not-full-text", "url": "https://scholars.uthscsa.edu/es/publications/aortic-input-impedance-in-normal-man-relationship-to-pressure-wav/" }, { "sourceId": "kohli-2017-normalized-human-pv-loops", "title": "The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop", "year": 2017, "identifiers": { "doi": "10.14814/phy2.13160", "pmid": "28351966" }, "verification": "primary-full-text-methods-and-figures-4-5-checked", "url": "https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.13160" }, { "sourceId": "lang-2015-chamber-quantification", "title": "Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", "year": 2015, "identifiers": { "doi": "10.1016/j.echo.2014.10.003", "pmid": "25559473" }, "verification": "primary-source-metadata-checked", "url": "https://www.asecho.org/wp-content/uploads/2016/02/2015_ChamberQuantificationREV.pdf" }, { "sourceId": "kou-2014-norre-chamber-reference", "title": "Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study", "year": 2014, "identifiers": { "doi": "10.1093/ehjci/jet284", "pmid": "24451180" }, "verification": "primary-source-metadata-checked", "url": "https://orbi.uliege.be/bitstream/2268/169431/1/Eur%20Heart%20J%20Cardiovasc%20Imaging-2014-Kou-680-90.pdf" }, { "sourceId": "kawel-boehm-2015-cmr-normal-values", "title": "Normal values for cardiovascular magnetic resonance in adults and children", "year": 2015, "identifiers": { "doi": "10.1186/s12968-015-0111-7", "pmid": "25928314" }, "verification": "primary-source-metadata-checked", "url": "https://link.springer.com/content/pdf/10.1186/s12968-015-0111-7.pdf" }, { "sourceId": "carlsson-2012-cmr-cardiac-output", "title": "Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure", "year": 2012, "identifiers": { "doi": "10.1186/1532-429X-14-51", "pmid": "22839436" }, "verification": "primary-full-text-methods-and-results-checked", "url": "https://link.springer.com/article/10.1186/1532-429X-14-51" }, { "sourceId": "kawel-boehm-2025-scmr-reference-values", "title": "Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update", "year": 2025, "identifiers": { "doi": "10.1016/j.jocmr.2025.101853", "pmcid": "PMC12159681" }, "verification": "primary-full-text-methods-and-results-checked", "verificationScope": "Sections 2-4 and Tables 2, 3, 8, 9; anatomical versus smooth segmentation and pooled adult sex-specific intervals. No current gate endpoints are verified by this source comparison.", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12159681/" }, { "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables", "title": "Cardiovascular Magnetic Resonance Reference Ranges From the Healthy Hearts Consortium: author-published anatomical segmentation tables", "year": 2024, "identifiers": { "doi": "10.1016/j.jcmg.2024.01.009", "pmid": "38613554" }, "verification": "author-published-tables-7-and-37-checked-not-full-article", "verificationScope": "Full one-page source PDFs visually checked, including headers, age columns, units and N ranges. White men and women aged 40-49 are parallel illustrative comparisons, not the declared model subject or a new gate.", "url": "https://healthy-hearts.org.uk/tables/" }, { "sourceId": "barratt-boyes-wood-1958-healthy-hemodynamics", "title": "Cardiac output and related measurements and pressure values in the right heart and associated vessels, together with an analysis of the hemo-dynamic response to the inhalation of high oxygen mixtures in healthy subjects", "year": 1958, "identifiers": { "pmid": "13514210" }, "verification": "primary-source-metadata-checked", "url": "https://pubmed.ncbi.nlm.nih.gov/13514210/" }, { "sourceId": "mukherjee-2025-right-heart-guideline", "title": "Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography", "year": 2025, "identifiers": { "doi": "10.1016/j.echo.2025.01.006", "pmid": "40044341" }, "verification": "primary-source-metadata-checked", "url": "https://www.asecho.org/wp-content/uploads/2025/03/PIIS0894731725000379.pdf" }, { "sourceId": "kovacs-2009-healthy-pap-review", "title": "Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review", "year": 2009, "identifiers": { "doi": "10.1183/09031936.00145608" }, "verification": "primary-source-metadata-checked", "url": "https://publications.ersnet.org/highwire_display/entity_view/node/476971/full" }, { "sourceId": "zeder-2024-healthy-pawp-meta-analysis", "title": "Pulmonary arterial wedge pressure in healthy subjects: a meta-analysis", "year": 2024, "identifiers": { "doi": "10.1183/13993003.00967-2024", "pmid": "38964777" }, "verification": "primary-source-metadata-checked", "url": "https://publications.ersnet.org/content/erj/64/2/2400967" }, { "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "title": "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension", "year": 2022, "identifiers": { "doi": "10.1183/13993003.00879-2022", "pmid": "36028254" }, "verification": "primary-table-11-and-rhc-methods-checked", "verificationScope": "Table 11 and section 5.1.12.1, European Heart Journal pp. 3646-3647. Passage verification does not establish the model operator mapping or support wider retained pressure bounds.", "url": "https://publications.ersnet.org/lookup/pmid/36028254" }, { "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals", "title": "Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study", "year": 2023, "identifiers": { "doi": "10.1007/s00392-023-02269-2" }, "verification": "primary-source-metadata-checked", "url": "https://link.springer.com/article/10.1007/s00392-023-02269-2" }, { "sourceId": "nagueh-2025-lv-diastolic-function", "title": "Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography", "year": 2025, "identifiers": { "doi": "10.1016/j.echo.2025.03.011" }, "verification": "primary-source-metadata-checked", "url": "https://www.asecho.org/wp-content/uploads/2025/07/Left-Ventricular-Diastolic-Function.pdf" }, { "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve", "title": "Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle", "year": 1977, "identifiers": { "pmid": "602351" }, "verification": "primary-source-metadata-checked", "url": "https://pubmed.ncbi.nlm.nih.gov/602351/" }, { "sourceId": "hirota-1980-lv-relaxation", "title": "A clinical study of left ventricular relaxation", "year": 1980, "identifiers": { "doi": "10.1161/01.cir.62.4.756", "pmid": "7190882" }, "verification": "primary-source-metadata-checked", "url": "https://pubmed.ncbi.nlm.nih.gov/7190882/" }, { "sourceId": "stein-1980-rv-pressure-fall", "title": "Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle", "year": 1980, "identifiers": { "doi": "10.1378/chest.78.1.10", "pmid": "7471826" }, "verification": "primary-source-metadata-checked", "url": "https://pubmed.ncbi.nlm.nih.gov/7471826/" } ], "evidenceBindings": [ { "evidenceId": "lang-ase-eacvi-2015", "canonicalSourceIds": [ "lang-2015-chamber-quantification" ], "useRole": "construction-context", "measurementMeaning": "Adult echocardiographic LV chamber volumes and systolic function.", "limitations": "Modality-, sex-, age-, and body-size-dependent reference context; it does not directly define this model's joint admissible interval." }, { "evidenceId": "kou-norre-2014", "canonicalSourceIds": [ "kou-2014-norre-chamber-reference" ], "useRole": "construction-context", "measurementMeaning": "Two-dimensional echocardiographic adult chamber-size reference ranges.", "limitations": "The cohort and measurement method do not identify a unique 0D-model parameter vector or a joint multivariate normal region." }, { "evidenceId": "cmr-consolidated-normal-reference-2016", "canonicalSourceIds": [ "kawel-boehm-2015-cmr-normal-values" ], "useRole": "construction-context", "measurementMeaning": "CMR chamber-volume and function reference context across published cohorts.", "limitations": "The retained legacy evidence ID has a 2016 label but resolves to the 2015 publication; CMR and echocardiographic volumes are not interchangeable without a measurement model." }, { "evidenceId": "lang-ase-eacvi-2015-3de-rv", "canonicalSourceIds": [ "lang-2015-chamber-quantification" ], "useRole": "construction-context", "measurementMeaning": "Adult three-dimensional echocardiographic RV volumes and ejection fraction.", "limitations": "A 0D chamber volume is compared only as broad construction context; acquisition and segmentation conventions remain different." }, { "evidenceId": "cardiac-index-clinical-reference", "canonicalSourceIds": [ "carlsson-2012-cmr-cardiac-output", "barratt-boyes-wood-1958-healthy-hemodynamics" ], "useRole": "construction-context", "measurementMeaning": "Resting forward cardiac output indexed to body surface area.", "limitations": "The model interval is an engineering synthesis across methods and cohorts, not a verbatim interval from either source." }, { "evidenceId": "resting-indexed-flow-reference", "canonicalSourceIds": [ "carlsson-2012-cmr-cardiac-output", "barratt-boyes-wood-1958-healthy-hemodynamics" ], "useRole": "construction-context", "measurementMeaning": "Resting systemic forward stroke volume indexed to body surface area.", "limitations": "Stroke-volume index depends on heart rate, body-size convention, cohort, and acquisition method; the gate is a broad engineering envelope." }, { "evidenceId": "mukherjee-ase-right-heart-2025", "canonicalSourceIds": [ "mukherjee-2025-right-heart-guideline", "kovacs-2009-healthy-pap-review" ], "useRole": "construction-context", "measurementMeaning": "Right-heart echocardiographic assessment and healthy pulmonary arterial pressure context.", "limitations": "This does not directly support the exact 10-35 mmHg model interval or validate the current pulmonary waveform shape." }, { "evidenceId": "kovacs-pawp-healthy-meta-2024", "canonicalSourceIds": [ "zeder-2024-healthy-pawp-meta-analysis" ], "useRole": "construction-context", "measurementMeaning": "Supine resting pulmonary arterial wedge pressure in healthy subjects.", "limitations": "The retained legacy evidence ID uses the last author's name; the model reports mean LA pressure, not a simulated wedged-catheter measurement." } ], "checkGroups": [ { "groupId": "settlement", "checkIds": [ "settlement.period1" ], "evidenceRole": "construction", "thresholdBasis": "exact-contract", "contextEvidenceIds": [], "measurementMeaning": "Whether the exact periodic classifier established the required period-one terminal state.", "changeReason": "Fail closed before interpreting any derived baseline measurement.", "analysisPartition": "objective", "evaluationRole": "numerical-quality", "observationLimitations": "Period-one settlement is numerical admissibility, not physiological normality or independent model validation.", "evidenceGap": "No clinical population interval applies to an exact periodic-classifier contract.", "sourceComparisons": [] }, { "groupId": "ventricular-pressure-morphology", "checkIds": [ "waveform.LVP.single-peak-no-ringing", "waveform.RVP.single-peak-no-ringing" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Algorithmic peak count, total variation and episode count of pressure during the associated semilunar-valve forward-flow episode.", "changeReason": "Retain the artifact guards motivated by Standard65-to-68 ringing, separately from unvalidated contour reference corridors. This is a current-model construction requirement, not a claim that every healthy human trace has one peak.", "analysisPartition": "objective", "evaluationRole": "construction-guard", "observationLimitations": "Prominence and variation depend on accepted sampling and the thresholded forward-flow episode. Real arterial reflection can produce a systolic shoulder or secondary rise; the current lumped model has no explicit propagation/reflection mechanism, so that observation does not explain its numerical or coupled-mode ringing.", "evidenceGap": "No primary healthy-cohort distribution supports the exact peak-count or variation cutoffs. They remain transparent construction guards; no clinical normality follows from passing.", "sourceComparisons": [] }, { "groupId": "ventricular-pressure-contour-reference", "checkIds": [ "waveform.LVP.rounded-not-plateau", "waveform.RVP.rounded-not-plateau" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Central accepted-sample-index pressure range divided by full ejection pressure range, jointly with the first maximum's normalized sample index. The check reports peak index when that alone fails; it is not PV-loop curvature or a time-weighted shape measurement.", "changeReason": "Demote the frozen central-range and peak-index corridors to descriptive warnings: no matched normal distribution supports the limits, and a single compound failure previously conflated late pressure peak with flatness. Numerical thresholds are not widened to admit a candidate.", "analysisPartition": "objective", "evaluationRole": "reference-warning", "observationLimitations": "Sample-index phase is not elapsed-time phase on nonuniform accepted steps. Pressure versus time and pressure versus volume have different curvature because ejection flow varies. Resolution, pressure loading and the selected episode affect these summaries; RV and LV cannot be assigned the same physiological contour solely by analogy.", "evidenceGap": "No matched healthy LV or RV reference interval was identified for centralRangeFraction 0.08-0.35 or peakPhase01 0.2-0.8. These values remain visible warnings, not independent scientific validation or permission to accept unexplained ringing.", "sourceComparisons": [ { "sourceId": "murgo-1980-human-aortic-waveforms", "locator": "Author-institution abstract; ascending aortic pressure waveform groups", "targetPopulation": "18 elective catheterization patients in whom no heart disease was found; not a population reference sample.", "observationMeaning": "Simultaneous ascending aortic pressure and flow; early versus late systolic pressure, not the model's ventricular central-range or peak-index fractions.", "sourceRange": "Late greater than early in 7, nearly equal in 7, early greater than late in 4.", "comparisonToChosenBounds": "Demonstrates aortic contour diversity and reflection-related interpretation, but supplies no numeric cutoff for LV/RV roundness and does not justify reflection-like oscillation in this model." }, { "sourceId": "kohli-2017-normalized-human-pv-loops", "locator": "Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7", "targetPopulation": "13 catheterization subjects selected for normal LV function, sinus rhythm and valves; 9 had hypertension. This is not a strictly healthy normative cohort.", "observationMeaning": "Simultaneous Millar conductance-catheter LV pressure/volume sampled at 250 Hz; observed inter- and intra-subject PV contours.", "sourceRange": null, "comparisonToChosenBounds": "The displayed contours vary, including a relatively flat upper limb (visual inference, not digitized statistics). No central-range, ejection peak-phase or PV-curvature normal interval was reported." } ] }, { "groupId": "aortic-valve-gradient", "checkIds": [ "aortic-valve.mean-gradient", "aortic-valve.peak-gradient" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Time-weighted mean and maximum raw LV-minus-Ao node pressure difference during native aortic forward flow.", "changeReason": "Constrain the non-stenotic baseline while retaining the model's explicit pressure-station limitation.", "analysisPartition": "objective", "evaluationRole": "construction-guard", "observationLimitations": "This hydraulic node gradient is neither a Doppler Bernoulli gradient nor a simultaneous catheter LV-to-recovered-aortic pressure difference; pressure recovery and spatial acceleration are not observed.", "evidenceGap": "No matching healthy-population source establishes the exact mean or peak cutoffs for these model pressure stations. Stenosis diagnostic thresholds would not validate them.", "sourceComparisons": [] }, { "groupId": "aortic-ejection-time", "checkIds": [ "aortic-valve.ejection-time" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Native AoV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.", "changeReason": "Prevent a gradient reduction obtained by implausibly shortening or prolonging ejection.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "A single complete ejection episode is required. This hydraulic duration is shared with left ICT, IRT and Tei calculations, but is not color-TDI, Doppler-envelope or ECG timing; HR and population selection matter.", "evidenceGap": "The frozen construction interval is provisional. Similarity to the retrospective Copenhagen interval does not establish its historical derivation or cross-method validity.", "sourceComparisons": [ { "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals", "locator": "Table 2; Methods, Cardiac time intervals", "targetPopulation": "1,969 Danish adults without cardiovascular disease or risk factors; median age 46 (IQR 33-58) years, 61.5% women, HR 63 +/- 10/min.", "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.", "sourceRange": "LVET 248-336 ms.", "comparisonToChosenBounds": "The chosen interval is slightly broader at both endpoints; no observer-specific calibration has established equivalence." } ] }, { "groupId": "left-ventricular-pressure-rate", "checkIds": [ "left-ventricle.maximum-dpdt", "left-ventricle.minimum-dpdt" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary LV pressure over the completed beat.", "changeReason": "Retain plausible contraction and relaxation rates while adjusting aortic ejection morphology.", "analysisPartition": "objective", "evaluationRole": "reference-warning", "observationLimitations": "Accepted-step bandwidth, pressure loading, HR, preload, medication and catheter filtering affect extrema. Published negative dP/dt is often a positive magnitude, whereas this model stores a signed minimum; this is not a transmural derivative.", "evidenceGap": "The positive corridor overlaps small normal-LV patient series, but the frozen negative corridor excludes their resting means. Neither series supplies a population-normal acceptance interval; keep both corridors as warnings rather than validated pass/fail physiology.", "sourceComparisons": [ { "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve", "locator": "Abstract; resting values before ergometer exercise", "targetPopulation": "13 patients described as having a normal LV; not a population-based, sex/age-stratified healthy sample.", "observationMeaning": "Invasive maximal LV pressure rise and pressure-fall magnitude; the accessible abstract does not fully establish acquisition bandwidth.", "sourceRange": "Resting maximum +1721 +/- 378 mmHg/s; negative magnitude 1862 +/- 343 mmHg/s (mean +/- SD).", "comparisonToChosenBounds": "The positive mean lies within the frozen corridor; the signed negative mean does not. Exercise values cannot justify a resting cutoff." }, { "sourceId": "hirota-1980-lv-relaxation", "locator": "Methods p. 757; normal-control table p. 759; abstract", "targetPopulation": "18 normal controls including patients investigated for chest pain, murmurs or other indications; not a healthy population reference sample.", "observationMeaning": "Millar LV micromanometer and continuous differentiator; average of five sinus beats, after premedication.", "sourceRange": "Maximum +1674 +/- 421 mmHg/s; negative magnitude 1864 +/- 390 mmHg/s (observed negative-magnitude range 1275-2772).", "comparisonToChosenBounds": "The frozen relaxation corridor excludes the control mean and much of the observed range. Means/SDs and observed extrema are context, not newly selected cutoffs." } ] }, { "groupId": "mitral-e-to-a", "checkIds": [ "mitral-flow.peak-e-to-a" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Ratio of peak native mitral forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.", "changeReason": "Retain the recorded corridor as context only: native volumetric E/A is not Doppler velocity E/A. Positive resolved waves remain required; no numeric widening or candidate-specific target change.", "analysisPartition": "objective", "evaluationRole": "reference-warning", "observationLimitations": "Volume-flow peaks are not leaflet-tip Doppler velocities; varying effective valve area can change their ratio. A complete post-capture inlet closure and identifiable E/A windows are required, and age, rhythm, HR and loading affect interpretation.", "evidenceGap": "The fixed corridor is provisional, not an age-specific Doppler normal interval. Better event anchoring does not remove the flow-versus-velocity observation mismatch.", "sourceComparisons": [ { "sourceId": "nagueh-2025-lv-diastolic-function", "locator": "Tables 3 and 5 (p. 551)", "targetPopulation": "Healthy reference data grouped by age; guideline echocardiographic assessment in adults, with age- and sex-aware supplementary data.", "observationMeaning": "PW Doppler mitral leaflet-tip E and A velocities, identified relative to ECG T and P waves; estimated fifth-to-95th percentiles.", "sourceRange": "E/A: ages 20-39, 0.88-2.73; ages 40-60, 0.69-2.07; ages 60-80, 0.50-1.40.", "comparisonToChosenBounds": "The chosen bounds truncate some healthy age-specific ranges and admit values outside others; numerical overlap cannot validate a native volume-flow ratio." } ] }, { "groupId": "left-ventricular-timing", "checkIds": [ "timing.ict", "timing.irt", "timing.tei-index" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "ICT from exact MV closure to AoV zero-flow opening, IRT from exact AoV closure to MV zero-flow opening, and (ICT + IRT) divided by the matched aortic ejection duration.", "changeReason": "Demote method-mismatched ICT/IRT/Tei corridors to context; retain complete ordered hydraulic events, positivity and exact Tei arithmetic. ET remains an explicitly chosen baseline operating target, not proof of a population-normal timing pattern.", "analysisPartition": "objective", "evaluationRole": "reference-warning", "observationLimitations": "Closure landmarks and trace-interpolated openings must describe one complete beat. Tei is algebraically linked to ICT, IRT and the separately checked ejection time, so these are not independent constraints.", "evidenceGap": "The intervals remain provisional hydraulic timing targets. Matching some published endpoints does not establish a measurement-equivalence study or historical source derivation.", "sourceComparisons": [ { "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals", "locator": "Table 2; Methods, Cardiac time intervals", "targetPopulation": "1,969 Danish adults without cardiovascular disease or risk factors; median age 46 (IQR 33-58) years, 61.5% women, HR 63 +/- 10/min.", "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.", "sourceRange": "IVCT 20-59 ms; IVRT 59-134 ms; MPI 0.29-0.65.", "comparisonToChosenBounds": "IRT and Tei endpoints match this pooled table, while the chosen ICT upper bound is wider. The source expressly limits generalization across measurement methods." } ] }, { "groupId": "systemic-pressure", "checkIds": [ "aortic-pressure.maximum", "aortic-pressure.minimum", "central-venous-pressure.mean" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Completed-beat extrema of absolute Ao root-compliance-node pressure and time-weighted mean absolute RA pressure; the active AoP display uses this same Ao node.", "changeReason": "Maintain broad resting systemic-pressure compatibility as a construction safety envelope.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "The lumped central Ao node has no arterial propagation, peripheral amplification or pressure recovery and is not a brachial cuff observation. RA pressure is intracavitary, not transmural; its beat mean does not reproduce end-expiratory catheter averaging or IVC-based RAP estimation.", "evidenceGap": "No verified primary healthy central-aortic source establishes both chosen Ao ranges. The RA range is broader than the invasive reference below. All three are provisional resting construction targets.", "sourceComparisons": [ { "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11; section 5.1.12.1", "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort.", "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.", "sourceRange": "Mean RAP 2-6 mmHg; systemic systolic/diastolic pressure is illustrated as 120/80 mmHg, not a reference interval.", "comparisonToChosenBounds": "The chosen RA corridor is wider. A single illustrative arterial pressure cannot substantiate either Ao endpoint." } ] }, { "groupId": "pulmonary-artery-pressure", "checkIds": [ "pulmonary-artery-pressure.maximum", "pulmonary-artery-pressure.minimum" ], "evidenceRole": "construction", "thresholdBasis": "literature-context-plus-engineering-envelope", "contextEvidenceIds": [ "mukherjee-ase-right-heart-2025" ], "measurementMeaning": "Extrema of absolute model PA root-node pressure over the exact completed beat.", "changeReason": "Use broad resting pressure context as a sentinel while withholding a pulmonary-waveform validation claim.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "This is an invasive-like lumped pressure signal, not TR-derived RVSP/PASP or a spatially resolved catheter waveform; respiratory reference and averaging differ. RVSP is not PASP when an RV-to-PA gradient is present.", "evidenceGap": "The chosen systolic and diastolic upper bounds are broader than both cited invasive references. This remains a provisional pressure envelope, not confirmation of normal PAP or pulmonary waveform shape.", "sourceComparisons": [ { "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11; section 5.1.12.1", "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort.", "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.", "sourceRange": "PAP systolic 15-30 mmHg; diastolic 4-12 mmHg.", "comparisonToChosenBounds": "The chosen lower bounds match; the upper bounds are deliberately wider and are not the guideline's normal interval." }, { "sourceId": "kovacs-2009-healthy-pap-review", "locator": "Table 1; healthy resting supine catheterization data", "targetPopulation": "47 studies, 1,187 healthy participants overall; resting supine systolic PAP available in 625, with heterogeneous age and sex representation.", "observationMeaning": "Invasive resting supine PAP pooled across cohorts; mean +/- SD rather than a joint systolic/diastolic normal region.", "sourceRange": "Systolic 20.8 +/- 4.4 mmHg (upper limit 29.6); diastolic 8.8 +/- 3.0 mmHg.", "comparisonToChosenBounds": "These distributions provide context but do not establish the chosen wider systolic and diastolic corridors." } ] }, { "groupId": "pcwp-surrogate", "checkIds": [ "pcwp-surrogate.mean" ], "evidenceRole": "construction", "thresholdBasis": "literature-context-plus-engineering-envelope", "contextEvidenceIds": [ "kovacs-pawp-healthy-meta-2024" ], "measurementMeaning": "Time-weighted completed-beat mean absolute LA pressure, exposed only as a labelled PCWP surrogate.", "changeReason": "Bound left-sided filling pressure while preserving the explicit station and measurement mismatch.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "Mean intracavitary LA pressure is not LVEDP, transmural LA pressure or an actual wedged-catheter observation. Wedge zero, respiratory sampling and transmission through the pulmonary circulation are not reproduced.", "evidenceGap": "The chosen upper limit has healthy PAWP context, but the lower bound lacks an exact source and no observation study establishes this model's LA-mean-to-PAWP equivalence.", "sourceComparisons": [ { "sourceId": "zeder-2024-healthy-pawp-meta-analysis", "locator": "Main results; individual-data and zero-reference subgroup analyses", "targetPopulation": "960 mainly nonobese healthy participants from 49 studies; individual-data subset n=159, median age 26 (IQR 23-53), 67% men.", "observationMeaning": "Resting supine catheter PAWP, with heterogeneous zero references and respiratory conventions; significant sex differences.", "sourceRange": "Pooled PAWP 9.4 +/- 1.82 mmHg; upper limit 13 mmHg (mid-thoracic-zero subgroup 12.2 mmHg).", "comparisonToChosenBounds": "The chosen upper limit matches the pooled upper limit, not every subgroup. The study does not establish the chosen lower limit or validate mean model LA pressure as a wedge observation." } ] }, { "groupId": "left-ventricular-indexed-size-function", "checkIds": [ "left-ventricle.edv-index", "left-ventricle.esv-index", "left-ventricle.ejection-fraction" ], "evidenceRole": "construction", "thresholdBasis": "literature-context-plus-engineering-envelope", "contextEvidenceIds": [ "lang-ase-eacvi-2015", "kou-norre-2014", "cmr-consolidated-normal-reference-2016" ], "measurementMeaning": "Valve-event-defined 0D LV volumes indexed to the reference BSA and their event-defined ejection fraction.", "changeReason": "Create a deliberately broad cross-modality construction corridor rather than a joint population-normal claim.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "ED/ES are volumes at native inlet/outlet closure, not necessarily global extrema. Event definitions can align with imaging, but 0D cavity boundaries lack echo/CMR segmentation conventions. Fixed reference BSA does not select a sex/age cohort; EF is derived from the two volumes.", "evidenceGap": "The frozen corridor combines context across methods; its volume endpoints do not reproduce the cited echo or CMR intervals, and its independent marginal gates are not a joint healthy distribution.", "sourceComparisons": [ { "sourceId": "lang-2015-chamber-quantification", "locator": "Table 2 (p. 7); ED/ES definition (p. 6)", "targetPopulation": "Adult sex-specific echocardiographic reference data.", "observationMeaning": "2D biplane LV volumes indexed to BSA; ED/ES may use valve events or cavity extrema; normal ranges based on mean +/- 2 SD.", "sourceRange": "Men: EDVi 34-74, ESVi 11-31 mL/m2, EF 52-72%; women: 29-61, 8-24, 54-74%.", "comparisonToChosenBounds": "Chosen EF is the sex-union; the volume corridor is not the sex-union and admits larger volumes." }, { "sourceId": "kou-2014-norre-chamber-reference", "locator": "Table 2, pp. 684-685", "targetPopulation": "734 healthy adults (320 men, 414 women), age 45.8 +/- 13.3 years, predominantly white Europeans from 22 institutions.", "observationMeaning": "Biplane Simpson 2D echo, excluding papillary muscles and trabeculae from the cavity; BSA indexing does not remove age/sex effects.", "sourceRange": "Men: EDVi 34.8-75.7, ESVi 11.7-28.8 mL/m2, EF 55.8-71.3%; women: 34.2-67.6, 10.5-25.9, 57.3-72.6%.", "comparisonToChosenBounds": "The chosen volume and EF bounds are broader than these sex-specific intervals; the source does not support their exact endpoints." }, { "sourceId": "kawel-boehm-2015-cmr-normal-values", "locator": "Table 2 (p. 2)", "targetPopulation": "Pooled adult European cohorts, ages 20-80 years; sex-specific results.", "observationMeaning": "1.5 T SSFP CMR with LV papillary muscles included in mass; mean +/- 2 SD.", "sourceRange": "Men: EDVi 57-105, ESVi 14-38 mL/m2, EF 57-77%; women: 56-96, 14-34, 57-77%.", "comparisonToChosenBounds": "The chosen corridor is not a CMR normal interval and can exclude source-normal EDVi or EF while admitting much lower volumes." }, { "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Sections 2-3; Table 2 (papillary muscles/trabeculations in mass)", "targetPopulation": "Pooled healthy adult CMR cohorts, sex-specific and mixed ages; not an age-40-49 or single joint population interval.", "observationMeaning": "Short-axis bSSFP anatomical cavity volumes; random-effects aggregation with reference-limit estimation. Myocardial tissue is excluded from the blood pool; imaging events and spatial segmentation are not reproduced by a 0D cavity.", "sourceRange": "Men: EDVi 46-104, ESVi 11-41 mL/m2, EF 53-79%; women: 46-91, 11-34, 55-80%.", "thresholdVerification": "context-only", "comparisonToChosenBounds": "An updated, method-declared comparison, not support for the retained cross-modality endpoints or a demographic assignment to the synthetic model." }, { "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables", "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, LV rows", "targetPopulation": "Illustrative same-study White adults aged 40-49; variable-dependent N 378-447 men and 458-518 women. Neither stratum is assigned to the model.", "observationMeaning": "CMR anatomical segmentation, BSA-indexed volumes and EF; both ventricles can be compared in the same stratum without joining different modalities.", "sourceRange": "Men: EDVi 51-102, ESVi 13-40 mL/m2, EF 53-77%; women: 49-88, 13-33, 56-78%.", "thresholdVerification": "context-only", "comparisonToChosenBounds": "Retain both comparisons rather than selecting the sex that admits the candidate; no new gate or joint-95-percent normality claim." } ] }, { "groupId": "right-ventricular-indexed-size-function", "checkIds": [ "right-ventricle.edv-index", "right-ventricle.esv-index", "right-ventricle.ejection-fraction" ], "evidenceRole": "construction", "thresholdBasis": "literature-context-plus-engineering-envelope", "contextEvidenceIds": [ "lang-ase-eacvi-2015-3de-rv" ], "measurementMeaning": "Valve-event-defined 0D RV volumes indexed to the reference BSA and their event-defined ejection fraction.", "changeReason": "Retain broad RV size/function safety bounds without extending the current systemic and left-heart claim.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "Native TV/PV closure volumes and derived EF do not specify a 3D-echo or CMR segmentation method. BSA indexing alone does not remove sex/age effects; EF and the two event volumes are algebraically linked.", "evidenceGap": "The volume bounds match a union of male/female 3D-echo ranges, not a population-specific or cross-modality range. The EF endpoints combine age/sex subgroup extremes rather than defining a single healthy cohort.", "sourceComparisons": [ { "sourceId": "lang-2015-chamber-quantification", "locator": "Table 8 (p. 20); Supplemental Table 8 (p. 39.e13)", "targetPopulation": "Adult sex-specific 3D-echo data; supplemental RV EF limits further stratified by age.", "observationMeaning": "3D-echo RV volume segmentation and BSA indexing; subgroup EF limits are fifth/95th percentiles.", "sourceRange": "Men: EDVi 35-87, ESVi 10-44 mL/m2; women: 32-74, 8-36. Subgroup EF extremes include 42% and 82%; general RV EF below 45% is abnormal.", "comparisonToChosenBounds": "Volume bounds reproduce the sex-union. EF bounds span subgroup extremes, not a universal normal range." }, { "sourceId": "kawel-boehm-2015-cmr-normal-values", "locator": "Table 6 (p. 7)", "targetPopulation": "Healthy adult cohorts aged 20-68 years, sex-specific results; indexed RV ESV uses the Hudsmith cohort.", "observationMeaning": "1.5 T SSFP CMR with RV trabeculations and papillary muscles in the cavity; mean +/- 2 SD.", "sourceRange": "Men: EDVi 61-121, ESVi 19-59 mL/m2, EF 52-72%; women: 48-112, 12-52, 51-71%.", "comparisonToChosenBounds": "Chosen volume bounds exclude substantial CMR-normal values; the 3D-echo corridor cannot be called a broad cross-modality RV normal interval." }, { "sourceId": "kawel-boehm-2025-scmr-reference-values", "locator": "Sections 2 and 4; Table 8 (papillary muscles/trabeculations in mass), not smooth-segmentation Table 9", "targetPopulation": "Pooled healthy adult CMR cohorts, sex-specific and mixed ages. Constituent cohorts differ from LV Table 2; marginal limits do not define a joint healthy subject.", "observationMeaning": "Short-axis bSSFP anatomical RV cavity volume with myocardial tissue excluded from blood volume; event, geometric and segmentation correspondence to 0D remains approximate.", "sourceRange": "Men: EDVi 49-117, ESVi 12-56 mL/m2, EF 44-77%; women: 47-99, 11-43, 49-77%.", "thresholdVerification": "context-only", "comparisonToChosenBounds": "This uses the anatomical RV counterpart of the LV comparison. Do not substitute age-specific smooth-contour RV rows or retroactively replace old check bounds." }, { "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables", "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, RV rows", "targetPopulation": "Illustrative same-study White adults aged 40-49; variable-dependent N 378-447 men and 458-518 women. Neither stratum is assigned to the model.", "observationMeaning": "CMR anatomical segmentation and BSA indexation, same subject strata and measurement convention as the LV comparison.", "sourceRange": "Men: EDVi 61-118, ESVi 21-55 mL/m2, EF 44-71%; women: 53-97, 17-42, 49-73%.", "thresholdVerification": "context-only", "comparisonToChosenBounds": "Provides a coherent same-study alternative for future prospective design. BSA1.9 alone does not select either column, and the current upper EDVi bound is not verified by this study." } ] }, { "groupId": "indexed-systemic-forward-flow", "checkIds": [ "systemic-forward-flow.cardiac-index", "systemic-forward-flow.stroke-volume-index" ], "evidenceRole": "construction", "thresholdBasis": "literature-context-plus-engineering-envelope", "contextEvidenceIds": [ "cardiac-index-clinical-reference", "resting-indexed-flow-reference" ], "measurementMeaning": "Positive-only native AoV flow integrated for stroke volume and converted to cardiac output over the completed beat, both indexed to reference BSA.", "changeReason": "Maintain broad resting forward-flow compatibility across the admitted HR values.", "analysisPartition": "objective", "evaluationRole": "physiological-target", "observationLimitations": "Forward volume is not signed net aortic flow or EDV-minus-ESV when regurgitation or other routes exist. CI and SVI are linked by HR, so at a fixed HR they are not independent targets; reference BSA and body habitus remain relevant.", "evidenceGap": "CI has an exact guideline interval, but SVI is a cross-source construction choice. The retained Barratt-Boyes binding was metadata-verified only and does not provide a verified quantitative derivation here.", "sourceComparisons": [ { "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension", "locator": "Table 11; section 5.1.12.1", "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort.", "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.", "sourceRange": "CI 2.5-4.0 L/min/m2; SVI 33-47 mL/m2.", "comparisonToChosenBounds": "CI endpoints match exactly; SVI endpoints do not. Fick/thermodilution output is not necessarily the model's positive-only valve-flow output." }, { "sourceId": "carlsson-2012-cmr-cardiac-output", "coveredCheckIds": [ "systemic-forward-flow.cardiac-index", "systemic-forward-flow.stroke-volume-index" ], "thresholdVerification": "context-only", "thresholdRationale": "Methods and healthy-group results checked in full text on 2026-09-06. These are cohort summaries, not direct verification of the retained construction endpoints; passage verification alone must not qualify those endpoints.", "locator": "Methods; healthy-group results and age analysis", "targetPopulation": "144 healthy nonathletic adults, 68 women, ages 21-81 (mean 39 +/- 16) years; BMI <=30, no cardiovascular disease or medication.", "observationMeaning": "Supine free-breathing ascending-aortic phase-contrast CMR at pulmonary-bifurcation level, distal to coronary origins; signed whole-cycle flow integrated for SV, Mosteller BSA. The paper attributes expected Qp/Qs around 1.04 to coronary flow of 3-5 percent, so absence of regurgitation alone does not equate this plane to native AoV output.", "sourceRange": "CI 3.2 +/- 0.5 L/min/m2; SVI 51 +/- 7 mL/m2 (mean +/- SD).", "comparisonToChosenBounds": "The chosen SVI interval is close to, but not identical to, a calculated mean +/- 2 SD interval of 37-65. Such a calculation is not a published universal normal cutoff." } ] }, { "groupId": "pulmonary-valve-gradient", "checkIds": [ "pulmonary-valve.mean-gradient", "pulmonary-valve.peak-gradient" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Time-weighted mean and maximum raw RV-minus-PA node pressure difference while native PV flow is positive over the completed beat.", "changeReason": "Record the existing Standard70 right-heart gradient sentinels without promoting them to left-objective groups or changing their numerical limits.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "construction-guard", "observationLimitations": "The model's hydraulic gradient is not a Doppler Bernoulli or recovered catheter gradient; an explicit outlet node does not provide spatial velocity, pressure recovery or an invasive sensor model.", "evidenceGap": "No source establishes the exact mean and peak healthy cutoffs for these pressure stations. These remain non-stenotic construction guards, not clinical normal-gradient intervals.", "sourceComparisons": [] }, { "groupId": "pulmonary-ejection-time", "checkIds": [ "pulmonary-valve.ejection-time" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Native PV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.", "changeReason": "Record the existing Standard70 pulmonary ejection-time corridor with its missing method-matched normative evidence.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "physiological-target", "observationLimitations": "A complete single ejection episode is required. This duration also enters right ICT, IRT and Tei calculations; hydraulic timing is not a Doppler-envelope or tissue-Doppler measurement and depends on HR/loading.", "evidenceGap": "No exact primary normal interval was identified for this observer and target population. Retain the frozen interval only as a provisional physiological target; left-sided LVET data do not establish a right-sided range.", "sourceComparisons": [] }, { "groupId": "right-ventricular-pressure-rate", "checkIds": [ "right-ventricle.maximum-dpdt", "right-ventricle.minimum-dpdt" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary RV pressure over the completed beat.", "changeReason": "Reclassify the existing Standard70 RV derivative corridors as reference warnings without altering the recorded numerical bounds.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "reference-warning", "observationLimitations": "These load- and bandwidth-dependent extrema are neither transmural pressure derivatives nor the mean RV-to-RA pressure-gradient rise inferred over a selected TR velocity interval. Signed negative extrema must not be confused with published pressure-fall magnitudes.", "evidenceGap": "No verified source establishes either frozen normal corridor. Sparse normal-PAP invasive data and a method-specific abnormal Doppler threshold justify contextual warnings, not hard healthy-population acceptance limits.", "sourceComparisons": [ { "sourceId": "mukherjee-2025-right-heart-guideline", "locator": "RV dP/dt section, pp. 158-159", "targetPopulation": "Adult right-heart echocardiography; normal-reference data are limited.", "observationMeaning": "TR Doppler 1-to-2 m/s upslope converted to a 12 mmHg pressure-gradient rise divided by time.", "sourceRange": "RV dP/dt below 400 mmHg/s is abnormal for this Doppler method.", "comparisonToChosenBounds": "This is not the maximum native intracavitary derivative and does not establish either chosen endpoint or a normal upper limit." }, { "sourceId": "stein-1980-rv-pressure-fall", "locator": "Abstract; normal-PAP and pulmonary-hypertension groups", "targetPopulation": "34 patients: eight with normal PAP, 17 with pulmonary hypertension, nine with pulmonary hypertension and RV failure; not a general healthy reference cohort.", "observationMeaning": "Maximal invasive RV pressure-fall magnitude; strong pressure-load dependence, with acquisition detail incompletely resolved by the abstract.", "sourceRange": "Normal-PAP group 170 +/- 20 mmHg/s; pulmonary-hypertension groups 670 +/- 60 mmHg/s, with or without RV failure.", "comparisonToChosenBounds": "Both loading groups can fit the broad signed negative corridor. The reported summary values are not a healthy reference interval and cannot define its bounds." } ] }, { "groupId": "tricuspid-e-to-a", "checkIds": [ "tricuspid-flow.peak-e-to-a" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Ratio of peak native tricuspid forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.", "changeReason": "Demote the native tricuspid flow-ratio corridor to context because Doppler velocity and respiratory averaging are different observations; resolved positive filling waves remain required.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "reference-warning", "observationLimitations": "Requires identifiable windows and an observed post-capture inlet closure. Volume-flow peaks do not equal Doppler velocities if effective valve area changes; respiration, HR, rhythm, age and loading remain relevant.", "evidenceGap": "The numerical corridor resembles a guideline Doppler interval but remains provisional for the native-flow observer; the source upper endpoint is exclusive whereas the frozen gate is inclusive.", "sourceComparisons": [ { "sourceId": "mukherjee-2025-right-heart-guideline", "locator": "Table 1; RV diastolic function, pp. 168-169", "targetPopulation": "Adult echocardiographic reference context.", "observationMeaning": "PW tricuspid inflow E/A velocities; end-expiratory averaging over at least five beats.", "sourceRange": "Tricuspid E/A >=0.8 and <2.0.", "comparisonToChosenBounds": "The chosen numeric endpoints match, but flow-versus-velocity and respiratory averaging differ; this is not method-matched validation." } ] }, { "groupId": "right-ventricular-timing", "checkIds": [ "right-timing.ict", "right-timing.irt", "right-timing.tei-index" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "ICT from exact TV closure to PV zero-flow opening, IRT from exact PV closure to TV zero-flow opening, and (ICT + IRT) divided by the matched pulmonary ejection duration.", "changeReason": "Demote the unsupported hydraulic right ICT/IRT/Tei numeric corridors to context. Ordered complete valve events and algebraic consistency remain mandatory; a short RV isovolumic phase is not automatically pathological.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "reference-warning", "observationLimitations": "One complete valve-event sequence is required. Tei is algebraically linked to ICT, IRT and the separately checked pulmonary ET; PW-Doppler, TDI and hydraulic timings are different observations.", "evidenceGap": "No primary source was identified for the chosen joint ICT/IRT/Tei corridors. The source below supplies method-specific context, not equivalent normal intervals; all three remain provisional physiological targets.", "sourceComparisons": [ { "sourceId": "mukherjee-2025-right-heart-guideline", "locator": "RV MPI, pp. 158-159; IVRT, pp. 168-169", "targetPopulation": "Adult right-heart echocardiography.", "observationMeaning": "PW-Doppler or tissue-Doppler MPI and tissue-Doppler IVRT, not native valve-flow events.", "sourceRange": "MPI <0.40 by PW Doppler or <0.55 by TDI; IVRT <=73 ms by TDI.", "comparisonToChosenBounds": "The chosen upper IRT and Tei bounds are wider, and no chosen lower bound or ICT interval follows from these thresholds." } ] }, { "groupId": "pulmonary-root-morphology", "checkIds": [ "waveform.PAP.single-peak-no-ringing", "waveform.PV-flow.single-forward-episode", "waveform.PV-flow.single-peak-no-ringing", "waveform.PAP.post-PV-closure-rebound" ], "evidenceRole": "construction", "thresholdBasis": "engineering-guess", "contextEvidenceIds": [], "measurementMeaning": "Algorithmic full-cycle PA pressure peak count, thresholded PV forward-episode count, primary-episode PV flow peak count and maximal post-episode PA rebound.", "changeReason": "Record Standard70 pulmonary ringing and re-ejection guards as construction-only waveform criteria.", "analysisPartition": "right-heart-sentinel", "evaluationRole": "construction-guard", "observationLimitations": "The episode threshold and peak-prominence algorithm define these observations; the post-episode rebound is not an invasive dicrotic-notch metric. One peak does not characterize the entire pressure or flow contour.", "evidenceGap": "No primary normal distribution supports the exact one-peak, one-episode or rebound cutoffs. A qualitative Doppler flow shape must not be cited as proof of these pressure-waveform thresholds.", "sourceComparisons": [ { "sourceId": "mukherjee-2025-right-heart-guideline", "locator": "RVOT Doppler flow, p. 158", "targetPopulation": "Adult resting right-heart echocardiography.", "observationMeaning": "Qualitative RVOT Doppler velocity waveform: parabolic with a midsystolic peak.", "sourceRange": null, "comparisonToChosenBounds": "Qualitative flow context only; it establishes no peak-prominence, PAP peak-count or post-PV-closure rebound cutoff." } ] } ], "policyRevisions": [ { "revisionId": "main-wire-standard68-baseline-policy-r1", "policySha256": "74f5b1ca712b56f304fee1ccf20da3e9dee8c7102213a2cb60dc2e7701cf3356", "evidenceRole": "construction", "changeReason": "Capture the current Standard68 mint policy and healthy-reference context after retrospective provenance repair." } ], "preloadReservePolicyRevisions": [ { "revisionId": "main-wire-standard69-preload-reserve-policy-r1", "policySha256": "dec7d6cdf587522c67892f0f94c910a2a8871a1aada6620c1a8778869109f4d5", "evidenceRole": "construction", "decisionTiming": "post-hoc-after-exploratory-candidate-inspection", "changeReason": "Freeze the Standard69-specific relative CO, pressure-flow slope, and relative EDV floors after exploratory candidate inspection. These are construction-only non-regression thresholds, not independently validated physiological cutoffs." } ] }, "morphologyPolicy": { "requiredForwardEpisodeCount": 1, "requiredSignificantPeakCount": 1, "maximumTotalVariationRatio": 2.2, "minimumCentralRangeFraction": 0.08, "maximumCentralRangeFraction": 0.35, "minimumPeakPhase01": 0.2, "maximumPeakPhase01": 0.8 }, "settlementPolicy": { "policyId": "integrated-full-accepted-state-periodic-policy-v3-preregistered", "period1NormalizedTolerance": 0.001, "period2NormalizedTolerance": 0.001, "period2MinimumPeriod1NormalizedDelta": 0.005, "consecutiveCycles": 3, "coronaryAutoregulationResponseTimeConstantSec": 25, "canonicalSlowTimeConstantMultiples": 10, "canonicalMaximumPhysicalTimeSec": 250, "canonicalSinusCycleLengthSec": 1, "defaultMaximumCycleCount": 250, "maximumCycleCount": 250, "boundedSmokeDefaultMaximumCycleCount": 1, "boundedSmokeMaximumCycleCount": 2, "minimumNominalDtSec": 0.001, "maximumNominalDtSec": 0.01, "referenceScaleSetId": "fixed-dimensional-reference-scales-integrated-composed-rhythm-v3", "thresholdProvenance": "copied-before-integrated-v3-evaluation-from-the-current-coronary-full-state-periodic-policy-not-fit-to-integrated-output", "canonicalMaximumHorizonProvenance": "ten-times-the-explicit-25-second-coronary-controller-coefficient-divided-by-the-fixed-one-second-sinus-cycle" }, "tauPolicy": { "pressureBasis": "intracavitary-LV", "window": "minimum-dpdt-midpoint-to-next-EDP-plus-5-before-MVO", "primaryMethod": "Weiss-zero-asymptote-time-weighted-log-linear", "sensitivityMethod": "Glantz-free-asymptote-time-weighted-dpdt-pressure", "minimumSamples": 6, "minimumDurationSec": 0.015, "minimumPressureDropMmHg": 10, "minimumWeissRSquared": 0.97, "minimumGlantzRSquared": 0.95, "maximumNormalizedPressureRmse": 0.05, "endPressureAboveNextEdpMmHg": 5, "referenceUpperMs": 48, "referenceRole": "context-only-not-a-normal-interval-or-automatic-rejection", "referenceSourceIds": [ "nagueh-2025-lv-diastolic-function" ] }, "provenance": { "generator": "tools/scientific/generateMainWireStandard71DocumentationV1.ts", "bindingSha256": "e463b683c5f5f4a8209b356bd687af27c3eb625faf675bc70ed8e74ca22de0d1", "admissionSource": { "path": "artifacts/physiology-evaluation-2026-09-07/prospective-admission-candidate-v4.json", "sha256": "76f38faf7e685f1447eed6f825452ce5b35c9acf8bffe786a56c913a4f493bf7" }, "evidenceSha256": "f86b1d3ded38990d6133dec6f9a5af76b56d9a6c0b220bb4419db94d6aec5e95" } }