採用プリセット · 教育用の比較例

baseline

この症例の入力・独立した2/1 ms計算・原波形を確認し、1/2レビューを経て採用しています。疾患全体の代表値や、臨床診断の妥当性を保証するものではありません。

全体像と回路

心筋が張力を生み、圧差が血液を動かし、変わった体積が再び筋長と圧に影響します。心筋・心臓の形状・弁・血管の相互作用から、圧波形とPV loopを計算する0Dモデルです。

四心腔と11の主循環血管区画に、16の冠血管区画を接続します。各区画は血液を蓄える場所で、接続部が流れにくさを表します。名前は代表する領域を示すもので、カテーテル先端の正確な位置を指定するものではありません。中隔は心筋壁であり、血液を蓄えるnodeではありません。

体循環

左室 (LV)
近位大動脈 (Ao)
体動脈 (SA)
体抵抗血管側 (Art)
体毛細管 (Cap)
体静脈 (SV)
大静脈 (VC)
右房 (RA)

肺循環

右室 (RV)
近位肺動脈 (PA)
肺抵抗血管側 (PArt)
肺毛細管 (PCap)
肺細静脈側 (PVen)
肺静脈・左房流入口側 (PVein)
左房 (LA)

左房 —MV→ 左室、右房 —TV→ 右室で閉じた回路になります。矢印は流量の正方向です。逆流を許す接続では、負の流量も体積収支に含めます。冠循環はAoから分岐し、RAへ戻ります。

Ao・SA・Artを分けることで、近位の血液貯留と末梢へ向かう圧低下を別々に扱います。ただし、区画の間を脈波が伝わる時間や反射は表していません。SVは主な静脈貯留部、VCは胸腔圧の影響を受ける右房直前の区画です。肺側では、PCapに肺胞圧、PVen・PVeinに胸腔圧を作用させ、左房までの貯留と流入抵抗を分けています。この分割は、各血管を解剖学的に一本ずつ再現するためではありません。

主循環の全区画：役割と圧の基準
区画	圧を決める関係	外圧	表示との対応
左室 (LV)	心筋・形状の釣り合い	$P_{\mathrm{th}}+P_{\mathrm{peri}}$	LVP
左房 (LA)	心筋・形状の釣り合い	$P_{\mathrm{th}}+P_{\mathrm{peri}}$	LAP
右室 (RV)	心筋・形状の釣り合い	$P_{\mathrm{th}}+P_{\mathrm{peri}}$	RVP
右房 (RA)	心筋・形状の釣り合い	$P_{\mathrm{th}}+P_{\mathrm{peri}}$	RAP / CVP
近位大動脈 (Ao)	動脈の指数則	0（基準圧）	AoP
体動脈 (SA)	動脈の指数則	0（基準圧）	ABP
体抵抗血管側 (Art)	動脈の指数則	0（基準圧）	—
体毛細管 (Cap)	線形容量則	0（基準圧）	—
体静脈 (SV)	静脈型の非線形容量則	0（基準圧）	—
大静脈 (VC)	静脈型の非線形容量則	$P_{\mathrm{th}}$	—
近位肺動脈 (PA)	動脈の指数則	$P_{\mathrm{th}}$	PAP
肺抵抗血管側 (PArt)	動脈の指数則	$P_{\mathrm{th}}$	—
肺毛細管 (PCap)	静脈型の非線形容量則	$P_{\mathrm{alv}}$	—
肺細静脈側 (PVen)	静脈型の非線形容量則	$P_{\mathrm{th}}$	—
肺静脈・左房流入口側 (PVein)	静脈型の非線形容量則	$P_{\mathrm{th}}$	—

AoP・PAPはAo・PA区画の内圧で、表示の段階でZcQを足しません。ABPはSAの代表圧で、上腕カフ圧の再現ではありません。CVPは平均右房圧、PCWPは平均左房圧を代用する表示であり、肺毛細管楔入の手技は計算していません。PV loopは心室経壁圧を使います。

\dot V_i=\sum_j N_{ij}Q_j,\qquad N_{ij}=\begin{cases}+1&j\text{ enters }i\\-1&j\text{ leaves }i\\0&\text{otherwise}\end{cases},\qquad\sum_{i=1}^{31}V_i=TBV

接続行列Nは、プリセットの接続表から組み立てられます。どの接続も一方から出た量が他方へ入るため、閉回路全体では血液量が保存されます。心筋体積・心嚢液量はこの合計とは別です。TBVを変更しない限り、圧や拍出量を合わせるための血液の追加・削除は行いません。

構成と数式

以下はこのモデルに共通する構成則です。係数の採用値・形状・初期状態は、baselineまたは各プリセットの「設定」にまとめています。両方を合わせて、選んだ作動点のモデルを組み立てられます。

係数・形状・初期状態を見る

興奮とCa：収縮のきっかけ

心房・心室が興奮すると、細胞内のCa濃度が一過性に上昇します。このCaの変化を入力として、筋原線維の張力を計算します。

\dot x_r=-x_r/\tau_r,\quad \dot x_d=-x_d/\tau_d,\qquad [Ca]=\mathrm{Ca}_0+g(x_d-x_r)

時定数が異なる場合の式です。興奮時に二つの状態変数へ同じ量を加えます。速く減る成分と遅く減る成分の差によって、Caが立ち上がり、その後低下します。

数式・仮定を詳しく

baselineは規則的な洞調律です。心房の興奮と、遅れて起こる心室の興奮を扱います。心室では二つの指数関数を組み合わせてCa波形を定め、心房には別の設定を使います。細胞内のCa輸送や活動電位の全過程は解きません。前の拍の成分が残るため、Ca₀と実際の1拍の最低Ca濃度は異なります。

$x_r,\;x_d$: Ca波形を作る無次元の状態変数
$\tau_r,\;\tau_d$: 各成分が減衰する時定数（s）
$\mathrm{Ca}_0,\;g$: 興奮が長く途絶えたときのCa濃度と、波形の振幅係数（µM）

興奮時刻・状態の更新

時間の単位はsです。規則的洞調律では、心房興奮の間隔T＝60/HR、心室興奮はその120 ms後（房室伝導80 ms＋遠位伝導40 ms）です。各心房・心室のCaへの入力は、対応する興奮の12 ms後に加えます。各壁は独立した二つのCa状態を持ちます。

qは興奮ごとの入力強度です。baselineでは両心房・三つの心室壁ともq＝1です。イベント間は指数関数で厳密に減衰し、イベント直後に両状態へqを加えます。下式の周期解は規則的なq＝1の場合で、心腔容積やLand状態の初期値を定めるものではありません。

t_{A,k}=t_{A,0}+kT,\quad t_{V,k}=t_{A,k}+0.120,\quad t_{Ca,w,k}=t_{A\text{ or }V,k}+0.012

x_j(t+\Delta t)=x_j(t)e^{-\Delta t/\tau_j},\quad x_j(t_k^+)=x_j(t_k^-)+q_k\quad(j=r,d)

x_j(t_k^+)=\frac{1}{1-e^{-T/\tau_j}}\quad\text{(periodic, }q_k=1\text{)}

心拍間隔とCa入力強度

心室には拍間隔依存の離散的な負荷状態Lを持たせます。Iは直前の心室興奮からの間隔、aは回復割合、qは次のCa入力強度です。LはSR負荷を規格化した量で、実測のSR内Ca濃度ではありません。係数と規則的洞調律での基準状態は下の表に示します。基準心拍数に対応するL・aとq＝1が固定点を作ります。

ここで記載する起動条件は規則的洞調律・補助循環なしです。異所性刺激・ペーシング・補助循環装置を有効にした場合の全モードは、このbaselineの方程式系には含めません。

a_k=1-e^{-I_k/\tau_{\mathrm{rec}}},\quad q_k=a_k\beta L_k,\qquad L_{k+1}=L_k-(1-r)q_k+\gamma(1-ha_k)

筋原線維：Caから張力へ

アクチンとミオシンが結びつくクロスブリッジの割合と、その歪みから能動張力を計算します。同じCa濃度でも、心筋の長さや短縮速度、過去に受けた負荷によって力が変わります。

T_a=\frac{h(\lambda)T_{\mathrm{ref}}}{r_s}\left[S(1+\zeta_s)+W\zeta_w\right]

Land由来の能動線維応力の出力式（Pa）。W/Sは弱・強結合の割合、ζは歪み、hは長さ依存係数。心腔圧そのものではありません。

数式・仮定を詳しく

Landら（2017）の収縮モデルを基礎に、心室の張力係数・Ca感受性・結合速度を調整しています。さらに、Ca結合が低下したときに強結合の余剰分を非結合状態へ戻す項を加えました。各状態の割合の合計は保ちますが、追加した機構の生理的妥当性には別途検証が必要です。

$T_a,\;T_{\mathrm{ref}}$: 能動線維応力と、その大きさを決める係数（Pa）
$\lambda,\;h(\lambda)$: 線維の長さ／基準長と、長さ依存の補正係数（無次元）
$W,\;S,\;r_s$: 弱結合・強結合の割合と、基準の強結合割合（無次元）
$\zeta_w,\;\zeta_s$: 結合したクロスブリッジの歪み（無次元）。短縮速度と過去の変形に依存

J_{\mathrm{exit}}=k_{\mathrm{max}}\left(\frac{\theta^n}{\theta^n+c^n}\right)^p\max(S-rW,0),\quad \dot S|_{\mathrm{exit}}=-J_{\mathrm{exit}},\quad \dot U|_{\mathrm{exit}}=J_{\mathrm{exit}}

追加した強結合離脱の式。cはCaが結合したトロポニンの割合、θはその基準値、nとpは感受性を決める指数です。kmaxは最大離脱速度（s⁻¹）、r＝kws/ksuは歪みゼロでの強／弱結合比、Uは非結合割合です。SがrWを超えた分だけを移します。

六つの状態と保存条件

各壁でc＝Ca結合トロポニンの割合、b＝結合が阻害された割合、W＝弱結合、S＝強結合、ζw・ζs＝架橋の歪みを持ちます。結合可能な非結合割合Uは独立状態ではなく、U＝1−b−W−Sです。0＜c≤1、b・U・W・S≥0を満たす解を使います。bは血管・弁の二次抵抗係数とは別の記号です。

Caは自由Ca濃度（µM）、λはLandに入力する伸長比です。gwu・gsuは歪みに伴う離脱速度（s⁻¹）です。Jexitは上で示した追加離脱項で、心室壁に適用します。心房ではJexit＝0です。離脱した割合はUへ戻ります。

\begin{aligned}\dot c&=k_{\mathrm{TRPN}}\{(\mathrm{Ca}/\mathrm{Ca}_{50})^{n_{\mathrm{TRPN}}}(1-c)-c\},\\\dot b&=k_b\min(c^{-n_{\mathrm{Tm}}/2},100)U-k_u c^{n_{\mathrm{Tm}}/2}b,\\\dot W&=k_{\mathrm{uw}}U-(k_{\mathrm{wu}}+k_{\mathrm{ws}}+g_{\mathrm{wu}})W,\\\dot S&=k_{\mathrm{ws}}W-(k_{\mathrm{su}}+g_{\mathrm{su}})S-J_{\mathrm{exit}},\\\dot\zeta_w&=A_w\dot\lambda-c_w\zeta_w,\qquad\dot\zeta_s=A_s\dot\lambda-c_s\zeta_s.\end{aligned}

\begin{aligned}\lambda_c&=\min(\lambda,1.2),\\\mathrm{Ca}_{50}&=\mathrm{Ca}_{50,\mathrm{ref}}+\beta_1(\lambda_c-1),\\h(\lambda)&=\max\{0,1+\beta_0[\lambda_c+\min(\lambda_c,0.87)-1.87]\},\\g_{\mathrm{wu}}&=\gamma_w|\zeta_w|,\quad g_{\mathrm{su}}=\gamma_s\max(-\zeta_s-1,\zeta_s,0).\end{aligned}

派生係数と心臓壁への結合

表に示す独立係数から、以下の係数を計算します。rₛ・r𝓌は基準結合割合、θ＝TRPN50です。k・cの単位はs⁻¹、Aは無次元です。Ca50が正でない場合は有効な材料条件ではありません。長さ依存をλ＝1.2で飽和させる処理と、トロポニン項の上限100も採用した式の一部です。

形状の対数歪みをeとするとλ＝s₀ exp(e)。s₀は筋長基準の倍率で、baselineは全壁で1です。短縮速度には(λn+1−λn)/Δtを使います。Landの出力Tₐをλ・線維配向割合fo・活動割合faで変換し、Kirchhoff応力として受動・粘弾性応力に加えます。fo＝fa＝1です。心室の収縮力倍率はTrefだけに、受動倍率は受動応力と粘弾性弾性率に掛かります。

\begin{aligned}k_b&=\frac{k_u\theta^{n_{\mathrm{Tm}}}}{(1-r_s)(1-r_w)},\quad k_{\mathrm{wu}}=k_{\mathrm{uw}}(1/r_w-1)-k_{\mathrm{ws}},\\k_{\mathrm{su}}&=k_{\mathrm{ws}}r_w(1/r_s-1),\quad A_w=A_s=\frac{A_{\mathrm{eff}}r_s}{(1-r_s)r_w+r_s},\\c_w&=\frac{\phi k_{\mathrm{uw}}(1-r_w)}{r_w},\quad c_s=\frac{\phi k_{\mathrm{ws}}(1-r_s)r_w}{r_s},\\\tau_f&=\lambda f_o f_aT_a+\tau_{\mathrm{pass}}+\tau_{\mathrm{vis}}.\end{aligned}

Land et al. 2017

受動特性：伸びにくさと変形の履歴

拡張期の圧には、心筋が伸ばされたときの抵抗と、時間をかけて緩む粘弾性が関わります。これらを能動張力に加えて、心臓壁に働く応力を求めます。

e=\ln\lambda_g,\quad \tau_{\mathrm{pass}}=\frac{d\Psi}{de},\quad \tau_{\mathrm{vis}}=E_v(e-\alpha),\quad \dot\alpha=\frac{e-\alpha}{\tau_v}

受動・粘弾性部分の関係式です。能動部分はLandの応力に線維伸長比と配向・活動割合を掛け、同じ応力基準に変換して加えます。

数式・仮定を詳しく

心室の受動応力は、伸びに対して増加する弾性エネルギーから求めます。心房には別の受動則を使います。粘弾性は、変形の履歴を一つの変数で持つMaxwell要素で表します。心室の受動則はKlotzの心室全体のEDPVRを参考にした設計であり、個々の心筋の物性を直接測定した値ではありません。

$\lambda_g,\;e,\;\alpha$: 形状から求めた伸長比、その対数歪み、粘性部分の歪み（無次元）
$\Psi,\;\tau_{\mathrm{pass}},\;\tau_{\mathrm{vis}}$: 弾性エネルギー密度（J/m³）と、受動・粘性のKirchhoff応力（Pa）
$E_v,\;\tau_v$: 粘弾性の弾性率（Pa）と材料の緩和時間（s）。LVPから測る弛緩時定数τとは別

心室の弾性エネルギー

e＝ln λg、p＝Hδ(e)、q＝Hδ(−e)とします。K0は原点付近の弾性率、Kt・aは伸張時の指数的な硬化、Kcは圧縮側の追加弾性率です。Hδは正の歪みだけを滑らかに取り出す関数で、u＝z/δです。心室三壁には同じ式を使い、エネルギーとその微分に各壁の受動倍率sₚ,ｗを掛けます。倍率はbaselineの設定表に示します。

H_\delta(z)=\begin{cases}0&z\le0\\\delta(u^3-\tfrac12u^4)&0<z<\delta\\z-\delta/2&z\ge\delta\end{cases}

\Psi(e)=\tfrac12K_0e^2+\frac{K_t}{a^2}(e^{ap}-1-ap)+\tfrac12K_cq^2,\qquad \tau_{\mathrm{pass}}=s_{p,w}\,\frac{d\Psi}{de}

心房の受動則と粘弾性

心房は等二軸変形に縮約した別の材料則を使います。下式のsₚ,ｗは各壁の受動倍率です。λg＝exp(e)、C1・C2・C3はPa、C4は無次元です。線維項は伸張側のみ働きます。対応するエネルギーはΨ(e)＝∫₀ᵉτpass(s)dsで定まります。支持する歪み範囲は−0.5≤e≤0.5です。左房由来の材料を右房にも適用する点は外挿です。

全壁の粘弾性は1状態のMaxwell枝です。αは粘性歪み、Evは弾性率、τvは緩和時間です。下式は採用している後退Euler更新で、各力学ステップにつき1回適用します。Evの表は受動倍率を適用済みです。

\tau_{\mathrm{pass}}=s_{p,w}\left[4C_1(\lambda_g^2-\lambda_g^{-4})+4C_2(\lambda_g^4-\lambda_g^{-2})+\begin{cases}C_3(e^{C_4(\lambda_g-1)}-1)&e>0\\0&e\le0\end{cases}\right]

\alpha_{n+1}=\frac{\alpha_n+(\Delta t/\tau_v)e_{n+1}}{1+\Delta t/\tau_v},\qquad \tau_{vis,n+1}=E_v(e_{n+1}-\alpha_{n+1})

Klotz et al. 2006心室全体のEDPVRの参照。採用した心筋の受動則そのものの出典ではありません。

Moyer et al. 2015心房受動材料の出発点。ここでは等二軸変形に縮約して使います。

心房・心室：張力から圧へ

左室自由壁・中隔・右室自由壁を結合し、左右の心室が中隔を介して影響し合います。これに左右心房を加えた五壁構成です。圧は決め打ちの時間波形ではなく、壁応力と形状の釣り合いから求まります。

\delta W=\sum_w V_{\mathrm{m},w}\tau_{\mathrm{f},w}\,\delta\ln\lambda_w,\qquad P_{\mathrm{cavity}}=P_{\mathrm{tm}}+P_{\mathrm{ext}}

壁をわずかに変形させたときの仕事と、内外の圧の関係です。壁の仕事と心腔の圧–体積仕事を対応させて圧を求め、中隔位置と接合円半径についても力の釣り合いを解きます。

数式・仮定を詳しく

左室自由壁・中隔・右室自由壁を、共通の円で接する三つの球冠として表します。これがTriSegの形状近似です。患者の3D画像を再現するものではなく、局所的な壁応力やねじれは扱いません。PV loopの縦軸は経壁圧、圧波形の縦軸は心腔内圧です。心膜圧や胸腔圧が変わると、両者の差も変わります。

$\delta W,\;V_{\mathrm{m},w}$: 仮想的な微小変形に伴う仕事（J）と、壁wの心筋体積（m³）
$\tau_{\mathrm{f},w},\;\lambda_w$: 各壁のKirchhoff線維応力（Pa）と、形状から決まる伸長比。ここでの応力を表すτは、LVPから測る弛緩時定数とは別の量
$P_{\mathrm{cavity}},\;P_{\mathrm{tm}},\;P_{\mathrm{ext}}$: 心腔内圧、壁を内側から広げる経壁圧、壁の外側にかかる圧。同じ単位で加算

三つの壁が同じ円で接する球冠近似の模式図です。断面形状や壁厚の実測図ではありません。hは接合面から各球冠頂点までの符号付き高さです。

三つの球冠と心筋長

以下の力学式はm・m²・m³・PaのSI単位で書きます。VL・VRは心腔血液量、Mwは各壁の心筋体積、vSは中隔の符号付き球冠体積、y＞0は三壁が接する円の半径です。心筋体積MはTBVには含めません。球冠高さhは右室方向を正とし、左室自由壁では通常負になります。

各壁wについて球冠体積vwからhを求め、面積Aw・曲率κw・厚さ補正zwを計算します。Aref,wは基準中壁面積です。ここでのzwはLandの架橋歪みζとは別物です。形状から得たewを材料則へ入力します。

v_L=-V_L-\tfrac12(M_L+M_S)+v_S,\qquad v_R=V_R+\tfrac12(M_R+M_S)+v_S

v_w=\frac{\pi h_w(h_w^2+3y^2)}6,\quad A_w=\pi(h_w^2+y^2),\quad\kappa_w=\frac{2h_w}{h_w^2+y^2}

z_w=\frac{3\kappa_wM_w}{2A_w},\qquad e_w=\frac12\ln\frac{A_w}{A_{\mathrm{ref},w}}-\frac{z_w^2}{12}-0.019z_w^4

内部の釣り合いと圧の決定

Fは球冠体積方向、Gは接合円半径方向の一般化力です。各壁の応力は材料状態と候補形状から求め、その時点の応力を掛けて歪みの幾何学微分を計算します。これを『能動応力がポテンシャルから生じる』と仮定して微分するわけではありません。

心腔容積を与え、三壁の力が釣り合うvS・yを連立して求めます。その解からLV・RV経壁圧が定まります。両心房には球状の一線維近似を使い、Vrefは表の基準心腔血液量です。圧に任意の時間波形や追加の壁別圧倍率を掛けません。

F_w=M_w\tau_{\mathrm{f},w}\left.\frac{\partial e_w}{\partial v_w}\right|_y,\qquad G_w=M_w\tau_{\mathrm{f},w}\left.\frac{\partial e_w}{\partial y}\right|_{v_w}

F_L+F_S+F_R=0,\quad G_L+G_S+G_R=0,\qquad P_{\mathrm{tm},L}=-F_L,\quad P_{\mathrm{tm},R}=F_R

e_A=\frac13\ln\frac{V_A+M_A/2}{V_{\mathrm{ref},A}+M_A/2},\qquad P_{\mathrm{tm},A}=\frac{M_A\tau_{\mathrm{f},A}}{3(V_A+M_A/2)}

胸腔圧・心膜圧の加算

心膜内を占める容積VHは、四心腔の血液量＋五壁の心筋体積＋処方した心嚢液量です。冠血液量をここへもう一度加える処理はありません。四心腔に同じ心膜外圧を加えます。V0は基準容量、P*は圧係数、kは硬化係数です。

Hは心膜が張り始める領域を滑らかにした関数です。δ＝0.001、u＝(x＋δ)/(2δ)とします。H′はxでの微分です。baselineでは圧オフセット0、心嚢液0 mL、胸腔・肺胞の呼吸振幅0です。心膜の張りがなければ、心腔内圧と経壁圧は一致します。

V_H=\sum_{c=LA,LV,RA,RV}V_c+\sum_w M_w+V_{\mathrm{fluid}},\quad x=(V_H-V_0)/V_0

H(x)=\begin{cases}0&x\le-\delta\\\delta(2u^3-u^4)&|x|<\delta\\x&x\ge\delta\end{cases}

P_{peri}=P_{\mathrm{offset}}+P_*[e^{kH(x)}-1]H'(x),\qquad P_c=P_{\mathrm{tm},c}+P_{\mathrm{th}}+P_{peri}

Lumens et al. 2009 · TriSeg三つの壁の形状近似の基礎です。心筋の構成則や圧への変換は本モデルの実装に従い、原著モデル全体の再現とは区別します。

四弁：圧差から流れへ

僧帽弁・大動脈弁・三尖弁・肺動脈弁は、共通の開口・圧損失の構造を使います。面積や逆流口の設定は弁ごとに異なります。

\Delta P=R Q+B(A)Q|Q|,\qquad B(A)\propto \rho/A^2

弁を通る流れがある場合の式です。Qと面積Aの単位換算は係数に含めます。完全閉鎖時は、圧差が残っていてもQ＝0となる閉鎖条件を別に適用します。

数式・仮定を詳しく

各時刻の流量は圧差から代数的に求め、流量そのものの慣性は持たせません。弁尖の開口割合は過去の状態を引き継ぎ、0〜1の範囲で変わります。有効開口面積（EOA）には縮流の影響を含めるため、流出係数Cdを別に掛けません。弁通過後の圧回復は組み込んでいません。この圧差を、Dopplerのジェット速度から求める勾配や、異なる時刻の圧ピーク同士の差と読み替えることはできません。

$\Delta P,\;Q$: 弁前後の同時圧差（mmHg）と流量（mL/s）。順行を正とする
$A,\;\rho$: その時点の有効開口面積と血液密度。面積は最大面積と開口割合から求める
$R,\;B$: 線形抵抗（mmHg·s/mL）と二次損失係数（mmHg·s²/mL²）

開口状態の時間発展

ξは開口割合（0〜1）、ΔPは上流圧−下流圧です。dは不感帯、pₒは圧オフセット（baselineは四弁とも0 mmHg）、kₒは開口感度です。Fεは正の開口駆動を滑らかにした関数で、ε＝0.1 mmHgです。ξ∞が直前のξより大きければ開口時定数、それ以外は閉鎖時定数を使います。

F_\epsilon(z)=\begin{cases}0&z\le0\\z^2/(2\epsilon)&0<z<\epsilon\\z-\epsilon/2&z\ge\epsilon\end{cases},\quad \xi_\infty=1-e^{-k_oF_\epsilon(\Delta P-d-p_o)}

\dot\xi=\frac{\xi_\infty-\xi}{\tau_\xi},\qquad \xi_{n+1}=\frac{\xi_n+(\Delta t/\tau_\xi)\xi_\infty(\Delta P_{n+1})}{1+\Delta t/\tau_\xi}

面積・方向・完全閉鎖

Amaxは最大順行EOA、Arは閉鎖時の逆流EOAです。順行では残存開口Arにξで開く部分を加え、逆行ではξによらずArだけを使います。従ってArを増やすと、逆行だけでなく閉鎖近くの順行流も変わります。baselineは全弁Ar＝0です。

QはmL/s、Aはcm²、圧はmmHg、ρ＝1060 kg/m³、cP＝133.322387415 Pa/mmHgです。面積が0ならQ＝0とし、残る圧差を閉鎖支持反力として扱います。小さな面積の下限や流量の平滑化は置きません。Rは面積に応じて再スケールしません。

A=\begin{cases}A_r+\xi(A_{\mathrm{max}}-A_r)&\Delta P\ge0\\A_r&\Delta P<0\end{cases},\quad B(A)=\frac{\rho}{2c_P}\left(\frac{10^{-6}}{10^{-4}A}\right)^2

Q=\begin{cases}0&A=0\text{ or }\Delta P=0\\\operatorname{sgn}(\Delta P)\frac{2|\Delta P|}{R+\sqrt{R^2+4B(A)|\Delta P|}}&\text{otherwise}\end{cases}

血管：蓄える・流す

血管のコンプライアンスは血液を蓄える性質、抵抗は流れにくさを表します。体循環と肺循環を閉じた回路として結び、各部の体積と圧を同時に求めます。

\frac{dV_i}{dt}=\sum Q_{\mathrm{in},i}-\sum Q_{\mathrm{out},i},\qquad C_i(P_{\mathrm{tm}})=\frac{dV_i}{dP_{\mathrm{tm},i}}

体積保存とコンプライアンスの定義。静脈を含む圧–体積関係は必ずしも一定Cの直線ではありません。

数式・仮定を詳しく

大動脈と肺動脈の近位部では、流体の慣性係数Lを0としています。AoPとPAPには、それぞれの血管区画の圧を表示します。特性インピーダンスと流量の積（ZcQ）を表示時に足す処理はありません。SAは下流の体動脈をまとめた区画です。圧波の伝播や反射を解かないため、カフや特定の動脈ライン位置の波形とは区別します。

$V_i,\;Q_{\mathrm{in}},\;Q_{\mathrm{out}}$: 区画iの血液量（mL）と、流入・流出量（mL/s）
$C_i,\;P_{\mathrm{tm},i}$: 圧に応じたコンプライアンス（mL/mmHg）と、血管の経壁圧（mmHg）

血管区画の圧–容量関係

圧はmmHg、容積はmL、流量はmL/sです。Pは内圧、p＝P−Pextは経壁圧です。Vuはp＝0での容量で、V−Vuをstressed volumeと呼びます。動脈のVsは表では硬さ・コンプライアンス倍率を適用した値です。Ao・SA・ArtはVs,元×0.65/1.42、PA・PArtはVs,元/1.42です。

静脈型区画は、虚脱時Cc・開通時Co・高圧伸展時Cdを滑らかに接続します。S(z)＝ln(1＋exp z)、σ(z)＝1/(1＋exp(−z))、ΔS(p;a,d)＝S((p−a)/d)−S(−a/d)とします。静脈トーンuはVu＝Vu,元−G uとして作用し、baselineのu＝0.15を適用したVuを表に示します。

静脈の逆計算は−20〜45 mmHgに制限し、範囲外では端の圧を返します。動脈は(V−Vu)/Vsの下限をln(0.05)とします。これは正常範囲ではなく計算上の境界で、境界に達した結果を生理的な予測として外挿できません。コンプライアンス評価には下限10⁻⁴ mL/mmHgがありますが、V(p)自体を別の曲線に置き換える処理ではありません。

p=P_0\left(e^{\max[(V-V_u)/V_s,\ln0.05]}-1\right)\quad\text{(arterial)},\qquad p=(V-V_u)/C\quad\text{(linear)}

V(p)=V_u+C_cp+(C_o-C_c)d_o\Delta S(p;p_o,d_o)-(C_o-C_d)d_s\Delta S(p;p_s,d_s)

\frac{dV}{dp}=C_c+(C_o-C_c)\sigma\left(\frac{p-p_o}{d_o}\right)-(C_o-C_d)\sigma\left(\frac{p-p_s}{d_s}\right)

接続部の流量・虚脱・外圧

非弁接続はΔP＝RQ＋BQ|Q|を解きます。現行baselineの非弁接続はB＝0、慣性L＝0なので、通常はQ＝(Pup−Pdown)/Rです。体・肺抵抗倍率は表に示した対象の接続だけに掛かり、全静脈抵抗を一括で変えるものではありません。

大静脈→右房と肺毛細管→肺細静脈では、外圧により流出が制限されるwaterfallと、虚脱に伴う抵抗増加を使います。M±は平滑な最大・最小、ε＝0.25 mmHg。χmin＝0.08、幅w＝1 mmHg、臨界圧pc＝0です。χは補正前の両端圧から計算し、下流有効圧を二重に代入しません。

胸腔圧Pthと肺胞圧Palvを受ける区画は回路表で区別します。frespはHz、各振幅はmmHgです。操作画面のPEEPはcmH₂Oで、式には0.7355592401を掛けてmmHgへ換算します。baselineでは下式の全入力が0です。

M_\pm(a,b)=\frac{a+b\pm\sqrt{(a-b)^2+\epsilon^2}}2

\begin{aligned}P_{\mathrm{down,eff}}&=M_+(P_{\mathrm{down}},P_{\mathrm{ext}}+p_c),\\\chi&=\chi_{\mathrm{min}}+(1-\chi_{\mathrm{min}})\sigma\left(\frac{M_-(P_{\mathrm{up}}-P_{\mathrm{ext}},P_{\mathrm{down}}-P_{\mathrm{ext}})-p_c}{w}\right),\\Q&=\frac{P_{\mathrm{up}}-P_{\mathrm{down,eff}}}{R/\chi^2}.\end{aligned}

P_{\mathrm{th}}=P_{th,0}+0.20\,PEEP+A_{\mathrm{th}}\sin(2\pi f_{\mathrm{resp}}t),\quad P_{\mathrm{alv}}=PEEP+A_{\mathrm{alv}}\sin(2\pi f_{\mathrm{resp}}t)

冠循環・外圧：心臓と循環の結合

冠動脈への流入と静脈への還流も全体の体積収支に含みます。心筋収縮による血管の圧迫が冠血流に影響し、心膜・胸腔圧は心腔や血管を外側から負荷します。

数式・仮定を詳しく

冠循環は、左前下行枝・回旋枝・右冠動脈の領域を、それぞれ心外膜側と心内膜側に分けます。血管の抵抗と容量に加え、心筋内圧による圧迫・虚脱と自己調節を扱います。一部の係数には、正常成人を想定した暫定値を使っています。baselineでは補助循環・弁逆流・呼吸性変動を加えていません。

LAD・LCx・RCAそれぞれにこの分岐があり、CVだけを共有します。Art・CVには共通心外圧、C1・C2には各領域・層の心筋内圧が作用します。

冠血管の容量と抵抗

各領域（LAD・LCx・RCA）は1つの大動脈側容量Artを持ち、そこから心外膜側・心内膜側の2経路へ分かれます。各経路は近位容量C1と遠位容量C2を持ち、共通冠静脈容量CVへ合流して右房へ戻ります。C1・C2という名称は区画名で、コンプライアンスそのものの数値ではありません。合計16容量を主循環と重複なくTBVへ含めます。

全冠区画に以下の圧–容量関係を使います。v＝V/Vref、m＝4、n＝2。CrefはV＝Vrefでの接線コンプライアンスです。虚脱による抵抗倍率fには別の基準容量Vhを使うため、Vrefと混同しないでください。a＝0.67、x＝min(1,max(0,V/Vh))とします。

各枝の流量は両端圧差／有効抵抗です。R1には自己調節トーンθとC1の虚脱倍率、Rmには両区画の虚脱倍率の幾何平均、R2にはC2の虚脱倍率を掛けます。構造的な抵抗倍率はbaselineで1、局所狭窄による追加損失は0です。

p=P_*(v^m-v^{-n}),\quad P_*=\frac{V_{\mathrm{ref}}}{C_{\mathrm{ref}}(m+n)},\quad V>0

f(V)=\{a+(1-a)x^2(3-2x)\}^{-2}

R_{1,eff}=R_1\theta f(V_{C1}),\quad R_{\mathrm{m},eff}=R_m\sqrt{f(V_{C1})f(V_{C2})},\quad R_{2,eff}=R_2f(V_{C2})

心筋内圧と拍ごとの自己調節

ArtとCVの外圧は共通心外圧Pe＝Pth＋Pperi、C1とC2の外圧は心筋内圧PIMです。壁重みwL・wS・wR、層深さd、短縮圧係数Kは表を参照します。中隔の深さsはLAD/LCxでd、RCAで1−dです。eMVC,wは直前の僧帽弁閉鎖時に更新する各壁の歪み。Fは弁の節で定義した正部分関数で幅0.005です。

短縮の基準更新には、受理されたステップでMV順行流が1 mL/s超から1 mL/s以下へ変わったときの歪みを使います。更新した基準は次のステップから使います。これは画像上の弁尖接合時刻や、指標計算で補間した弁閉鎖時刻と同じ定義ではありません。

自己調節は各心周期を終えたときに更新し、その周期内ではトーンを保持します。Q̄mはRmを通る符号付き流量の周期平均、Qtargetは領域・層の安静目標です。ℓ＝ln θ、Tは周期長、τa＝25 s、θmin＝4/45、θmax＝2です。baselineでは需要倍率1・充血駆動0で、下式を使います。これは酸素需要から自律的に収縮力を変える機構ではありません。

P_{\mathrm{IM}}=P_e+(w_Ld+w_Ss)P_{\mathrm{tm},L}+[w_Rd+w_S(1-s)]P_{\mathrm{tm},R}+K\sum_w w_wF_{0.005}(1-e^{e_w-e_{\mathrm{MVC},w}})

\bar Q_{\mathrm{m},k}=\frac{1}{T}\sum_{n\text{ in cycle }k}\Delta t_n Q_{m,n+1}

\ell_{k+1}=\operatorname{clip}_{\ln\theta_{\mathrm{min}},\ln\theta_{\mathrm{max}}}\left[\ell_k+\frac{T}{\tau_a}\ln\max\left(\frac{\bar Q_{\mathrm{m},k}}{Q_{\mathrm{target}}},0.05\right)\right]

酸素輸送：血流から供給と消費を計算

1拍平均の血流と、Hb・吸入酸素濃度・酸素消費量の設定から、全身の酸素需給を計算します。心筋の収縮モデルとは別の計算です。

\dot D_{\mathrm{O_2}}=10\,\mathrm{CO}\,C_{\mathrm{aO}_2},\qquad \dot V_{\mathrm{O_2}}=10\,\mathrm{CO}(C_{\mathrm{aO}_2}-C_{\mathrm{vO}_2})

数式・仮定を詳しく

肺胞気式、酸素解離曲線、シャント血の混合を使って動脈血酸素含量を求めます。Fickの関係から必要な混合静脈血酸素含量を逆算し、負の含量を必要とする条件は計算上成立しないと判定します。局所組織の酸素拡散や代謝適応の全過程は再現しません。

$\mathrm{\mathrm{CO}}$: 1拍平均の血流量（L/min）
$C_{\mathrm{aO}_2},\;C_{\mathrm{vO}_2}$: 動脈血と混合静脈血の酸素含量（mL O₂/dL）
$\dot D_{\mathrm{O}_2},\;\dot V_{\mathrm{O}_2}$: 酸素供給量と設定した酸素消費量（mL O₂/min）。係数10はLからdLへの換算

拍平均の酸素収支

酸素輸送は循環の解から計算する拍平均の代数評価で、血液量・張力へはフィードバックしません。Pは酸素分圧（mmHg）、Sは飽和度、Hbはg/dL、CはmL O₂/dLです。肺胞気と肺毛細管終末の酸素分圧を等しいと仮定します。PBは気圧、Rは呼吸交換比です。

COはL/min、VO₂はmL/min、sは酸素混合上のシャント率です。sは循環回路に追加する血流接続ではありません。肺毛細管終末含量Cc、静脈含量Cv、動脈含量CaをFick収支と混合から求めます。CO≤0や負の必要含量なら評価不能とし、飽和度を見栄えのよい値に置換しません。

P_{\mathrm{AO}_2}=F_{\mathrm{IO}_2}(P_B-47)-P_{\mathrm{aCO}_2}/R>0,\quad S(P)=\frac{P^{2.7}}{26.8^{2.7}+P^{2.7}}

C(P)=1.34\,Hb\,S(P)+0.0031P,\quad D=\frac{VO_2}{10\mathrm{CO}},\quad C_a=C_c-\frac{s}{1-s}D,\quad C_v=C_a-D

解析：負荷を変えて心臓の応答を調べる

1拍のPV loopはシミュレーションが作る軌道です。ESPVR・EDPVR・Starling/Guyton曲線やPVA/PEは、別の負荷条件を計算する解析から得ます。

数式・仮定を詳しく

解析用に状態を複製するため、操作中のシミュレーションは変わりません。収縮末期圧–容積関係（ESPVR）は低容量側からbaselineまでの複数条件で求めます。拡張末期圧–容積関係（EDPVR）とStarling曲線には高容量側も含めます。推定値は負荷範囲や各条件の定常化に依存し、ESPVRが直線になるとは限りません。曲線や面積の推定が成立しない場合は未評価と表示します。

結合と時間積分

独立した血液量は31区画に分布し、その総和をTBVに固定します（独立自由度は30）。各壁にLandの6状態・粘性歪み1状態・Ca源2状態、四弁に開口状態を持ちます。さらに冠循環の6トーンと、拍時刻・Ca入力強度・直前の僧帽弁閉鎖時歪みを引き継ぎます。心腔圧・血管圧・流量・中隔位置・接合円半径は、その時点の連立条件で求める量です。

\begin{aligned}V_{n+1}-V_n&=\Delta t\,NQ_{n+1},\\z_{n+1}-z_n&=\Delta t\,f(z_{n+1},Ca_{n+1},\lambda_{n+1},\dot\lambda_{n+1}),\\0&=g(V_{n+1},z_{n+1},P_{n+1},Q_{n+1},v_{S,n+1},y_{n+1}).\end{aligned}

zはLand・粘弾性・開口の状態、fは各節の時間発展式、gは圧–容量関係・流量則・力の釣り合いです。全体を後退Eulerで連立し、Ca源はイベント間の指数解を使います。候補容積→形状・筋長→材料応力→圧→流量→容積収支が同時に整合するまで解きます。血管だけを先に更新して古い心腔圧を使い続ける手順ではありません。

通常刻みは2 msです。興奮・Ca入力・制御周期の境界ではステップを分けます。冠トーンは完了周期の流量積分を用いて更新します。状態の非負性・有限性・体積保存・非線形残差を満たさない試行は採用しません。別の数値積分法でも同じ連続モデルを組めますが、有限刻みのピーク・弁イベント・保存されたbaselineとの一致は別途検証が必要です。

適用範囲と限界

各区画は空間的な分布を平均した代表値です。局所ジェット、波の伝播・反射、心室内の圧分布、局所虚血や組織の不均一性をそのまま再現しません。測定位置・解析方法が異なる実測値を、同じ名称だけで直接比較することはできません。

数式を定めること、ある設定で計算が安定すること、その症例の生理的妥当性を示すことは別です。採用条件・文献との比較・操作後の検証範囲は、各プリセットに記録しています。教育・研究のためのモデルで、患者の診断や治療判断を目的としません。

この設定の評価 · 2 ms

作動点の目標・構造の検査・文献との比較は別の役割です。参考範囲外を必須条件の不適合と混同しないでください。

CI作動点の目標2.95 L/min/m²適合

大動脈弁を通る正味拍出量をBSAで補正します。CI＝HR×SVI/1000なので、HR一定では両者は独立な測定ではありません。

参照先は右心カテーテル検査の指標です。モデルでは大動脈弁を通る正味流量を使います。循環全体の心拍出量と対応させるには、定常・補助循環なし・循環を短絡する血流なしの条件が必要です。CIとSVIを別々の独立した目標として数えません。

採用範囲 · 文献を参考: 2.5 ≤ x ≤ 4 L/min/m²

成人安静時・右心カテーテル · 文献の参照範囲: 2.5 ≤ x ≤ 4 L/min/m²

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, CI

CVP / mean RAP作動点の目標3.08 mmHg適合

指定した区画の心腔内／血管内圧について、定常1拍の最大・最小・時間平均、または指定イベント時の値を求めます。外圧の基準と測定位置を合わせて解釈します。

参照先は安静時の右心カテーテル検査です。実測値は臥位・呼気終末・圧のゼロ点をそろえて比較します。モデルにはカテーテルの応答特性や、baselineの呼吸性変動を含めていません。

採用範囲 · 文献を参考: 2 ≤ x ≤ 6 mmHg

成人安静時・右心カテーテル · 文献の参照範囲: 2 ≤ x ≤ 6 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, mean RAP

mean PAP作動点の目標17.89 mmHg適合

採用範囲 · 文献を参考: 8 ≤ x ≤ 20 mmHg

成人安静時・右心カテーテル · 文献の参照範囲: 8 ≤ x ≤ 20 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, mean PAP

AoP max構造・負荷の検査111.3 mmHg適合

採用範囲は、安静時の血圧を極端な負荷条件にしないための設計値です。参考文献の中心血圧はカフで校正した非侵襲推定値で、モデルの大動脈内圧とは測定法が異なります。年齢・性別ごとの第10〜90百分位は、95%正常範囲として扱いません。拡張期の中心血圧について、同論文から正常上下限は採っていません。

設計上の範囲（正常範囲ではない）: 90 ≤ x ≤ 140 mmHg

女性 20-29 · 第10〜90百分位: 80 ≤ x ≤ 110 mmHg

男性 20-29 · 第10〜90百分位: 92 ≤ x ≤ 115 mmHg

女性 30-39 · 第10〜90百分位: 84 ≤ x ≤ 119 mmHg

男性 30-39 · 第10〜90百分位: 88 ≤ x ≤ 120 mmHg

女性 40-49 · 第10〜90百分位: 87 ≤ x ≤ 123 mmHg

男性 40-49 · 第10〜90百分位: 90 ≤ x ≤ 123 mmHg

女性 50-59 · 第10〜90百分位: 93 ≤ x ≤ 127 mmHg

男性 50-59 · 第10〜90百分位: 96 ≤ x ≤ 126 mmHg

女性 60-69 · 第10〜90百分位: 97 ≤ x ≤ 129 mmHg

男性 60-69 · 第10〜90百分位: 97 ≤ x ≤ 128 mmHg

女性 70+ · 第10〜90百分位: 100 ≤ x ≤ 131 mmHg

男性 70+ · 第10〜90百分位: 99 ≤ x ≤ 130 mmHg

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors · Methods, invasive versus cuff-calibrated pressure distinction

AoP min構造・負荷の検査77.52 mmHg適合

設計上の範囲（正常範囲ではない）: 60 ≤ x ≤ 90 mmHg

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors · Methods, DBP calibration; no central-DBP reference interval

LV充満終了時の圧構造・負荷の検査10.92 mmHg適合

左室への流入が終わる時点の心腔内圧です。過大な充満圧を避ける上限を設けていますが、カテーテルで測るLVEDPとの時刻の同等性は未検証です。下限を正常値として新設してはいません。

設計上の範囲（正常範囲ではない）: x ≤ 16 mmHg

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 · Section2, Table1 p539 (>16), Figure1 p540

AV ET参考258 ms参考

半月弁の順行流がある時間の合計です。一度だけ連続して駆出しているかは別の形状検査で確認します。

参照研究のLVETは、僧帽弁の組織Dopplerで測った区間です。集団の心拍数は63±10 bpmで、ここでは心拍数による補正をしていません。測定法の違いがあるため、公開された95%予測区間を参考として併記します。

Copenhagenの健康成人・HR 63±10 bpm · 文献の参照範囲: 248 ≤ x ≤ 336 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval

PV ET参考258 ms参考

半月弁の順行流がある時間の合計です。一度だけ連続して駆出しているかは別の形状検査で確認します。

成人の肺動脈弁駆出時間について、測定法が対応する数値範囲は確認できていません。加速時間・組織Dopplerの収縮期波の持続時間・左室ETから上下限を代用していません。

Reference values for pulsed Doppler signals from the blood flow velocity on both sides of the pulmonary valve · Abstract: population and recording stations; no numeric adult ET interval verified

PAP max参考26.17 mmHg参考

成人安静時・右心カテーテル · 文献の参照範囲: 15 ≤ x ≤ 30 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, systolic PAP; section 5.1.12.1

PAP min参考12.06 mmHg参考範囲外

成人安静時・右心カテーテル · 文献の参照範囲: 4 ≤ x ≤ 12 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, diastolic PAP; section 5.1.12.1

平均左房圧（PCWP参考）参考8.4 mmHg参考

ここで計算しているのは左房圧の拍平均です。肺動脈楔入圧の測定過程は再現しておらず、PCWP/PAWPの文献値との比較は参考にとどまります。

文献のPAWP上限は臨床上の参照値です。左房圧から楔入圧への換算関係を検証した値でも、健康な人の分布の上下限でもありません。

成人・肺動脈楔入圧 · 臨床上の参照上限: x ≤ 15 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, PAWP; section 5.1.12.1

LV EDVI作動点の目標75.64 mL/m²適合

弁閉鎖に対応する心腔内血液量からEDV/ESVとEFを求め、体積はBSAで割ります。CMRでは乳頭筋・肉柱の扱いが異なり得るため、分割方法を含めて比較します。男女の範囲を両方表示し、都合のよい方だけを選びません。

参照先は、乳頭筋・肉柱を血液量から除く心臓MRI（CMR）の集計です。年齢・性別を特定しないbaselineの設計として、男女の範囲の共通部分を採用しました。各指標が範囲内でも、その組み合わせ全体の正常性が証明されるわけではありません。EF＝(EDV−ESV)/EDVであり、これらは独立した指標ではありません。

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 46 ≤ x ≤ 91 mL/m²

男性・成人全体 · 文献の参照範囲: 46 ≤ x ≤ 104 mL/m²

女性・成人全体 · 文献の参照範囲: 46 ≤ x ≤ 91 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

LV ESVI作動点の目標33.47 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 11 ≤ x ≤ 34 mL/m²

男性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 41 mL/m²

女性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 34 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

LVEF作動点の目標55.75 %適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 55 ≤ x ≤ 79 %

男性・成人全体 · 文献の参照範囲: 53 ≤ x ≤ 79 %

女性・成人全体 · 文献の参照範囲: 55 ≤ x ≤ 80 %

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

RV EDVI作動点の目標74.09 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 49 ≤ x ≤ 99 mL/m²

男性・成人全体 · 文献の参照範囲: 49 ≤ x ≤ 117 mL/m²

女性・成人全体 · 文献の参照範囲: 47 ≤ x ≤ 99 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

RV ESVI作動点の目標31.92 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 12 ≤ x ≤ 43 mL/m²

男性・成人全体 · 文献の参照範囲: 12 ≤ x ≤ 56 mL/m²

女性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 43 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

RVEF作動点の目標56.92 %適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 49 ≤ x ≤ 77 %

男性・成人全体 · 文献の参照範囲: 44 ≤ x ≤ 77 %

女性・成人全体 · 文献の参照範囲: 49 ≤ x ≤ 77 %

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

SVI参考42.17 mL/m²参考

大動脈弁を通る正味拍出量をBSAで補正します。CI＝HR×SVI/1000なので、HR一定では両者は独立な測定ではありません。

成人安静時・右心カテーテル · 文献の参照範囲: 33 ≤ x ≤ 47 mL/m²

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, SVI; section 5.1.12.1

1拍ごとの定常性数値品質1 適合

対応する周期境界で全状態の差を規格化し、連続する周期で許容差内に入ることを確認します。生理学的な正常性とは別の数値検査です。

1拍ごとに同じ状態へ戻るかを確認します。循環血液量だけでなく、心筋や血管が持つ内部状態も含めて比較し、偶然1拍だけ一致した場合を除きます。

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

LVPの振動構造・負荷の検査1 適合

計算した圧・流量から、ピーク数・順行流の区間数・波形の変動・閉鎖後の再上昇を調べます。ヒトの正常波形を一つの形に定める検査ではありません。

ピークや再上昇の許容値は、モデルの動作を調べる設計上の基準です。駆出中の原因不明の振動を調べる検査と、正常波形の形を断定することは分けています。測定法と確認結果は検証記録に残します。

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

LVPの丸み参考20.46 %参考

丸みやピーク位置の範囲は開発時の参考値です。実測波形は負荷や圧反射で変わるため、一律のドーム形状を必須にはしていません。

旧評価範囲 · 参考のみ: 8 ≤ x ≤ 35 %

Aortic input impedance in normal man: relationship to pressure wave forms · Author-institution abstract; ascending aortic pressure waveform groups
The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop · Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7

RVPの振動構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

RVPの丸み参考18.98 %参考

丸みやピーク位置の範囲は開発時の参考値です。実測波形は負荷や圧反射で変わるため、一律のドーム形状を必須にはしていません。

旧評価範囲 · 参考のみ: 8 ≤ x ≤ 35 %

Aortic input impedance in normal man: relationship to pressure wave forms · Author-institution abstract; ascending aortic pressure waveform groups
The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop · Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7

AV mean ΔP構造・負荷の検査4.19 mmHg適合

弁の上流と下流の圧を同時刻で引き算し、順行流がある時間の平均値・最大値を求めます。Dopplerのジェット速度から求める勾配や、異なる時刻の圧ピーク同士の差とは区別します。

この上下限は、十分な弁口面積を持つbaselineで過大な圧損失を見逃さないための設計値です。モデル内の圧差に対する検査であり、ASやPSの臨床的な重症度判定の閾値には使いません。

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 5 mmHg

AV peak ΔP構造・負荷の検査7.82 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 10 mmHg

LV +dP/dt参考2,564.3 mmHg/s参考範囲外

隣り合う計算時刻の心室内圧の差を経過時間で割り、1拍の最大値・最小値を採ります。表示用の間引きや平滑化は行わず、等容期に限定しません。値は時間刻みに依存します。

この範囲は開発時に置いた暫定的な参照値です。心室内圧の変化速度は、心筋特性に加えて心拍数・前負荷・圧の振幅・測定帯域にも依存します。範囲外だけで候補を棄却せず、時間刻みを半分にしたときのピークの変化を別に確認します。

旧評価範囲 · 参考のみ: 1,200 ≤ x ≤ 2,500 mmHg/s

Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle · Abstract; resting values before ergometer exercise
A clinical study of left ventricular relaxation · Methods p. 757; normal-control table p. 759; abstract

LV −dP/dt参考-1,538.9 mmHg/s参考範囲外

旧評価範囲 · 参考のみ: -1,400 ≤ x ≤ -700 mmHg/s

Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle · Abstract; resting values before ergometer exercise
A clinical study of left ventricular relaxation · Methods p. 757; normal-control table p. 759; abstract

MV E/A参考0.94 参考

心房興奮を基準に分けた拡張早期・心房収縮期の、弁を通る体積流量のピーク比です。Dopplerの局所速度を直接測ったものではありません。

E/Aは年齢・心拍数・充満条件・測定位置に左右されます。モデルの流量比とエコーの速度比の同等性は未確立です。この範囲は開発時の参考値として示し、範囲外だけで候補を棄却しません。

旧評価範囲 · 参考のみ: 0.8 ≤ x ≤ 2

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 · Tables 3 and 5 (p. 551)

LV ICT参考89.14 ms参考範囲外

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

ICTは流入弁閉鎖から駆出開始まで、IRTは駆出終了から流入開始までの時間です。提示した範囲は開発時の参考値で、モデルの測定法に対応する正常上下限としては未確立です。Teiは時間配分の比であり、負荷に依存しない収縮力の測定値ではありません。

旧評価範囲 · 参考のみ: 20 ≤ x ≤ 70 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

LV IRT参考92 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 59 ≤ x ≤ 134 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

LV Tei参考0.7 参考範囲外

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 0.29 ≤ x ≤ 0.65

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

PV mean ΔP構造・負荷の検査4.45 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 5 mmHg

PV peak ΔP構造・負荷の検査7.37 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 10 mmHg

RV +dP/dt参考585.6 mmHg/s参考

旧評価範囲 · 参考のみ: 300 ≤ x ≤ 1,000 mmHg/s

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV dP/dt section, pp. 158-159
Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle · Abstract; normal-PAP and pulmonary-hypertension groups

RV −dP/dt参考-371.9 mmHg/s参考

旧評価範囲 · 参考のみ: -700 ≤ x ≤ -150 mmHg/s

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV dP/dt section, pp. 158-159
Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle · Abstract; normal-PAP and pulmonary-hypertension groups

TV E/A参考1.1 参考

心房興奮を基準に分けた拡張早期・心房収縮期の、弁を通る体積流量のピーク比です。Dopplerの局所速度を直接測ったものではありません。

旧評価範囲 · 参考のみ: 0.8 ≤ x ≤ 2

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · Table 1; RV diastolic function, pp. 168-169

RV ICT参考28 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 20 ≤ x ≤ 90 ms

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

RV IRT参考64 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 30 ≤ x ≤ 120 ms

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

RV Tei参考0.36 参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 0.25 ≤ x ≤ 0.65

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

PAPのピーク数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁の駆出区間数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁流量のピーク数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁閉鎖後のPAP再上昇構造・負荷の検査0 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 0.5 mmHg

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

LV τ (Weiss)参考32.04 ms参考

大動脈弁が閉じた後、dP/dtが最小となった二つの計算時刻の中点から近似を始めます。終了は、左室圧が『その後に来る僧帽弁閉鎖時の圧＋5 mmHg』まで下がる時点です。この時点が僧帽弁開放より前にあることを確認します。時間幅で重み付けして指数関数を当てはめ、漸近圧を0に固定します。

τの値と、サンプル数・近似残差・評価窓依存性は別の評価です。圧波形を平滑化していません。

延長の参考上限 · 正常分布ではない: x ≤ 48 ms

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 · Invasive relaxation reference; Weiss asymptote/method must be matched

この設定の評価 · 1 ms

作動点の目標・構造の検査・文献との比較は別の役割です。参考範囲外を必須条件の不適合と混同しないでください。

CI作動点の目標2.95 L/min/m²適合

大動脈弁を通る正味拍出量をBSAで補正します。CI＝HR×SVI/1000なので、HR一定では両者は独立な測定ではありません。

採用範囲 · 文献を参考: 2.5 ≤ x ≤ 4 L/min/m²

成人安静時・右心カテーテル · 文献の参照範囲: 2.5 ≤ x ≤ 4 L/min/m²

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, CI

CVP / mean RAP作動点の目標3.08 mmHg適合

採用範囲 · 文献を参考: 2 ≤ x ≤ 6 mmHg

成人安静時・右心カテーテル · 文献の参照範囲: 2 ≤ x ≤ 6 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, mean RAP

mean PAP作動点の目標17.87 mmHg適合

採用範囲 · 文献を参考: 8 ≤ x ≤ 20 mmHg

成人安静時・右心カテーテル · 文献の参照範囲: 8 ≤ x ≤ 20 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, mean PAP

AoP max構造・負荷の検査111.4 mmHg適合

設計上の範囲（正常範囲ではない）: 90 ≤ x ≤ 140 mmHg

女性 20-29 · 第10〜90百分位: 80 ≤ x ≤ 110 mmHg

男性 20-29 · 第10〜90百分位: 92 ≤ x ≤ 115 mmHg

女性 30-39 · 第10〜90百分位: 84 ≤ x ≤ 119 mmHg

男性 30-39 · 第10〜90百分位: 88 ≤ x ≤ 120 mmHg

女性 40-49 · 第10〜90百分位: 87 ≤ x ≤ 123 mmHg

男性 40-49 · 第10〜90百分位: 90 ≤ x ≤ 123 mmHg

女性 50-59 · 第10〜90百分位: 93 ≤ x ≤ 127 mmHg

男性 50-59 · 第10〜90百分位: 96 ≤ x ≤ 126 mmHg

女性 60-69 · 第10〜90百分位: 97 ≤ x ≤ 129 mmHg

男性 60-69 · 第10〜90百分位: 97 ≤ x ≤ 128 mmHg

女性 70+ · 第10〜90百分位: 100 ≤ x ≤ 131 mmHg

男性 70+ · 第10〜90百分位: 99 ≤ x ≤ 130 mmHg

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors · Methods, invasive versus cuff-calibrated pressure distinction

AoP min構造・負荷の検査77.55 mmHg適合

設計上の範囲（正常範囲ではない）: 60 ≤ x ≤ 90 mmHg

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors · Methods, DBP calibration; no central-DBP reference interval

LV充満終了時の圧構造・負荷の検査10.94 mmHg適合

設計上の範囲（正常範囲ではない）: x ≤ 16 mmHg

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 · Section2, Table1 p539 (>16), Figure1 p540

AV ET参考255 ms参考

半月弁の順行流がある時間の合計です。一度だけ連続して駆出しているかは別の形状検査で確認します。

Copenhagenの健康成人・HR 63±10 bpm · 文献の参照範囲: 248 ≤ x ≤ 336 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval

PV ET参考258 ms参考

半月弁の順行流がある時間の合計です。一度だけ連続して駆出しているかは別の形状検査で確認します。

Reference values for pulsed Doppler signals from the blood flow velocity on both sides of the pulmonary valve · Abstract: population and recording stations; no numeric adult ET interval verified

PAP max参考26.17 mmHg参考

成人安静時・右心カテーテル · 文献の参照範囲: 15 ≤ x ≤ 30 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, systolic PAP; section 5.1.12.1

PAP min参考12.03 mmHg参考範囲外

成人安静時・右心カテーテル · 文献の参照範囲: 4 ≤ x ≤ 12 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, diastolic PAP; section 5.1.12.1

平均左房圧（PCWP参考）参考8.38 mmHg参考

ここで計算しているのは左房圧の拍平均です。肺動脈楔入圧の測定過程は再現しておらず、PCWP/PAWPの文献値との比較は参考にとどまります。

文献のPAWP上限は臨床上の参照値です。左房圧から楔入圧への換算関係を検証した値でも、健康な人の分布の上下限でもありません。

成人・肺動脈楔入圧 · 臨床上の参照上限: x ≤ 15 mmHg

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, PAWP; section 5.1.12.1

LV EDVI作動点の目標75.64 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 46 ≤ x ≤ 91 mL/m²

男性・成人全体 · 文献の参照範囲: 46 ≤ x ≤ 104 mL/m²

女性・成人全体 · 文献の参照範囲: 46 ≤ x ≤ 91 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

LV ESVI作動点の目標33.45 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 11 ≤ x ≤ 34 mL/m²

男性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 41 mL/m²

女性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 34 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

LVEF作動点の目標55.78 %適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 55 ≤ x ≤ 79 %

男性・成人全体 · 文献の参照範囲: 53 ≤ x ≤ 79 %

女性・成人全体 · 文献の参照範囲: 55 ≤ x ≤ 80 %

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 2, anatomical segmentation, sex-specific indexed volume/EF rows

RV EDVI作動点の目標74.06 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 49 ≤ x ≤ 99 mL/m²

男性・成人全体 · 文献の参照範囲: 49 ≤ x ≤ 117 mL/m²

女性・成人全体 · 文献の参照範囲: 47 ≤ x ≤ 99 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

RV ESVI作動点の目標31.87 mL/m²適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 12 ≤ x ≤ 43 mL/m²

男性・成人全体 · 文献の参照範囲: 12 ≤ x ≤ 56 mL/m²

女性・成人全体 · 文献の参照範囲: 11 ≤ x ≤ 43 mL/m²

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

RVEF作動点の目標56.97 %適合

採用範囲 · 男女両範囲の共通部分（設計上の選択）: 49 ≤ x ≤ 77 %

男性・成人全体 · 文献の参照範囲: 44 ≤ x ≤ 77 %

女性・成人全体 · 文献の参照範囲: 49 ≤ x ≤ 77 %

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update · Table 8, anatomical segmentation, sex-specific indexed volume/EF rows

SVI参考42.19 mL/m²参考

大動脈弁を通る正味拍出量をBSAで補正します。CI＝HR×SVI/1000なので、HR一定では両者は独立な測定ではありません。

成人安静時・右心カテーテル · 文献の参照範囲: 33 ≤ x ≤ 47 mL/m²

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension · Table 11, SVI; section 5.1.12.1

1拍ごとの定常性数値品質1 適合

対応する周期境界で全状態の差を規格化し、連続する周期で許容差内に入ることを確認します。生理学的な正常性とは別の数値検査です。

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

LVPの振動構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

LVPの丸み参考20.48 %参考

丸みやピーク位置の範囲は開発時の参考値です。実測波形は負荷や圧反射で変わるため、一律のドーム形状を必須にはしていません。

旧評価範囲 · 参考のみ: 8 ≤ x ≤ 35 %

Aortic input impedance in normal man: relationship to pressure wave forms · Author-institution abstract; ascending aortic pressure waveform groups
The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop · Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7

RVPの振動構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

RVPの丸み参考18.71 %参考

丸みやピーク位置の範囲は開発時の参考値です。実測波形は負荷や圧反射で変わるため、一律のドーム形状を必須にはしていません。

旧評価範囲 · 参考のみ: 8 ≤ x ≤ 35 %

Aortic input impedance in normal man: relationship to pressure wave forms · Author-institution abstract; ascending aortic pressure waveform groups
The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop · Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7

AV mean ΔP構造・負荷の検査4.27 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 5 mmHg

AV peak ΔP構造・負荷の検査7.86 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 10 mmHg

LV +dP/dt参考2,600.1 mmHg/s参考範囲外

旧評価範囲 · 参考のみ: 1,200 ≤ x ≤ 2,500 mmHg/s

Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle · Abstract; resting values before ergometer exercise
A clinical study of left ventricular relaxation · Methods p. 757; normal-control table p. 759; abstract

LV −dP/dt参考-1,556.3 mmHg/s参考範囲外

旧評価範囲 · 参考のみ: -1,400 ≤ x ≤ -700 mmHg/s

Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle · Abstract; resting values before ergometer exercise
A clinical study of left ventricular relaxation · Methods p. 757; normal-control table p. 759; abstract

MV E/A参考0.93 参考

心房興奮を基準に分けた拡張早期・心房収縮期の、弁を通る体積流量のピーク比です。Dopplerの局所速度を直接測ったものではありません。

旧評価範囲 · 参考のみ: 0.8 ≤ x ≤ 2

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 · Tables 3 and 5 (p. 551)

LV ICT参考93.14 ms参考範囲外

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 20 ≤ x ≤ 70 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

LV IRT参考94 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 59 ≤ x ≤ 134 ms

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

LV Tei参考0.73 参考範囲外

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 0.29 ≤ x ≤ 0.65

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study · Table 2; Methods, Cardiac time intervals

PV mean ΔP構造・負荷の検査4.45 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 5 mmHg

PV peak ΔP構造・負荷の検査7.42 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 10 mmHg

RV +dP/dt参考602.8 mmHg/s参考

旧評価範囲 · 参考のみ: 300 ≤ x ≤ 1,000 mmHg/s

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV dP/dt section, pp. 158-159
Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle · Abstract; normal-PAP and pulmonary-hypertension groups

RV −dP/dt参考-375.7 mmHg/s参考

旧評価範囲 · 参考のみ: -700 ≤ x ≤ -150 mmHg/s

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV dP/dt section, pp. 158-159
Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle · Abstract; normal-PAP and pulmonary-hypertension groups

TV E/A参考1.09 参考

心房興奮を基準に分けた拡張早期・心房収縮期の、弁を通る体積流量のピーク比です。Dopplerの局所速度を直接測ったものではありません。

旧評価範囲 · 参考のみ: 0.8 ≤ x ≤ 2

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · Table 1; RV diastolic function, pp. 168-169

RV ICT参考28 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 20 ≤ x ≤ 90 ms

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

RV IRT参考64 ms参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 30 ≤ x ≤ 120 ms

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

RV Tei参考0.36 参考

流入弁・流出弁の閉鎖と流量のゼロ交差から等容期を測ります。Tei＝(ICT＋IRT)/ET。エコーの組織Dopplerや弁尖運動からの時刻と同一とは限りません。

旧評価範囲 · 参考のみ: 0.25 ≤ x ≤ 0.65

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RV MPI, pp. 158-159; IVRT, pp. 168-169

PAPのピーク数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁の駆出区間数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁流量のピーク数構造・負荷の検査1 適合

設計上の範囲（正常範囲ではない）: 1 ≤ x ≤ 1

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

肺動脈弁閉鎖後のPAP再上昇構造・負荷の検査0 mmHg適合

設計上の範囲（正常範囲ではない）: 0 ≤ x ≤ 0.5 mmHg

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography · RVOT Doppler flow, p. 158

LV τ (Weiss)参考31.74 ms参考

τの値と、サンプル数・近似残差・評価窓依存性は別の評価です。圧波形を平滑化していません。

延長の参考上限 · 正常分布ではない: x ≤ 48 ms

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 · Invasive relaxation reference; Weiss asymptote/method must be matched

この設定の係数・形状・初期状態

ノブの倍率だけでなく、起動に用いる全入力と状態を記録します。

構成に使う全係数・初期状態

興奮とCa：収縮のきっかけ

Ca源の採用係数
壁	$\tau_r$ (s)	$\tau_d$ (s)	$\mathrm{Ca}_0$ (µM)	g (µM)
左房 (LA)	0.0125	0.3	0.0631545706813	0.604696429446
左室自由壁 (LVFW)	0.11853637422	0.131707082467	0.120706159272	12.0780349398
心室中隔 (SEP)	0.11853637422	0.131707082467	0.120706159272	12.0780349398
右室自由壁 (RVFW)	0.11853637422	0.131707082467	0.120706159272	12.0780349398
右房 (RA)	0.0125	0.3	0.0631545706813	0.604696429446

拍間隔依存の係数と基準状態
記号・意味	採用値
τrec (s)	0.5
β	0.8
r	0.5
h	0.2
γ	0.598072916413
$T_{\mathrm{ref}}$ (s)	0.857142857143
aref	0.819907687852
Lref	1.52456187266

筋原線維：Caから張力へ

以下は数理モデルの基準係数です。能動倍率は壁ごとのTrefに適用します。有効値は受動・粘弾性の節の表にも示しています。

Land独立係数：心室と心房
記号・意味	心室三壁	両心房	単位
$k_{\mathrm{TRPN}}$ トロポニン結合速度	100	100	s⁻¹
$n_{\mathrm{TRPN}}$ Ca結合の指数	2	2	1
$\mathrm{Ca}_{50,\mathrm{ref}}$ Ca感受性	0.6	0.86	µM
$k_u$ 薄いフィラメントの活性化速度	1000	1000	s⁻¹
$n_{\mathrm{Tm}}$ 薄いフィラメントの指数	5	5	1
$\theta$ 基準結合割合	0.35	0.35	1
$k_{\mathrm{uw}}$ 非結合→弱結合	104	182	s⁻¹
$k_{\mathrm{ws}}$ 弱結合→強結合	4.8	36	s⁻¹
$r_w$ 基準弱結合割合	0.5	0.5	1
$r_s$ 基準強結合割合	0.25	0.25	1
$\gamma_s$ 強結合の歪み依存離脱	8.5	8.5	s⁻¹
$\gamma_w$ 弱結合の歪み依存離脱	615	615	s⁻¹
$\phi$ 歪み緩和倍率	2.23	2.23	1
$A_{\mathrm{eff}}$ 速度感受性	26.5	25	1
$\beta_0$ 張力の長さ依存	2.3	2.3	1
$\beta_1$ Ca感受性の長さ依存	-1.2	-2.4	µM
$T_{\mathrm{ref}}$ 張力係数	238816.546281	11661.1510106	Pa
$T$ 実験温度（速度の可変係数ではない）	310.15	310.15	K

式から定まるLand派生係数
	心室	心房
$k_b$	14.0058333333	14.0058333333
$A_w$	10.6	10
$A_s$	10.6	10
$k_{\mathrm{wu}}$	99.2	146
$k_{\mathrm{su}}$	7.2	54
$c_w$	231.92	405.86
$c_s$	16.056	120.42

心室の追加離脱：kmax＝60 s⁻¹、p＝16。心房は追加離脱なしです。原著値との比較・調整の来歴は「baselineの設定」に掲載しています。これらは同一被験者から独立に測定された材料定数ではありません。

受動特性：伸びにくさと変形の履歴

受動則の基準係数（壁ごとの倍率は別途適用）
記号・意味	採用値
$K_0$ (Pa)	1200
$K_t$ (Pa)	22345.9396953
a	18
$K_c$ (Pa)	0
δ	0.001
$C_1$ (Pa)	1650
$C_2$ (Pa)	0
$C_3$ (Pa)	15
$C_4$	13.37

各壁の倍率と有効材料係数
壁	能動倍率	受動倍率	$T_{\mathrm{ref}}$ (Pa)	$E_v$ (Pa)	$\tau_v$ (s)
左房 (LA)	1	1	11661.1510106	5947	0.3
左室自由壁 (LVFW)	1	1.04	238816.546281	19307.6	0.3
心室中隔 (SEP)	1	1.04	238816.546281	19307.6	0.3
右室自由壁 (RVFW)	1	1.04	238816.546281	19307.6	0.3
右房 (RA)	1	1	11661.1510106	5947	0.3

粘弾性の0.3 s枝は健康羊RV組織のProny係数を参考に各材料へ縮約した設計値で、ヒトの全壁で同定された値ではありません。 Acta Biomaterialia 2022

心房・心室：張力から圧へ

心室壁の形状定数
壁	M (m³)	$A_{\mathrm{ref}}$ (m²)
左室自由壁 (LVFW)	0.0000670754366407	0.00935435289387
心室中隔 (SEP)	0.0000357735662083	0.00396508199259
右室自由壁 (RVFW)	0.0000360873694207	0.012911294586

心房の形状定数
壁	M (mL)	$V_{\mathrm{ref}}$ (mL)
左房 (LA)	25.9829059829	22.8900425619
右房 (RA)	23.3998100665	32.5968711181

心膜の係数
記号・意味	採用値
$V_0$ (m³)	0.000600126542735
$P_*$ (Pa)	500
k	8
$P_{\mathrm{offset}}$ (Pa)	0
$V_{\mathrm{fluid}}$ (m³)	0

体格はBSA 1.9 m²、心筋密度1053 kg/m³です。形状定数は集団の画像・心筋量を組み合わせた構成値で、同一人物の全測定ではありません。基準面積は負荷時の基準伸長比1.1から定めた設計値です。心膜係数も機構検査のための設定であり、ヒト正常範囲として同定したものではありません。

四弁：圧差から流れへ

四弁の全係数（L＝0）
弁	R (mmHg·s/mL)	$A_{\mathrm{max}}$ (cm²)	$k_o$ (mmHg⁻¹)	d (mmHg)	$\tau_{\mathrm{open}}$ (s)	$\tau_{\mathrm{close}}$ (s)
MV	0.0027	5.5	2	0.6	0.024	0.016
AV	0.0015	3.5	3	0	0.006	0.008
TV	0.0035	8	2	0	0.018	0.01
PV	0.005	4	2	0	0.01	0.006

血管：蓄える・流す

動脈・線形区画の有効係数
区画	$P_0$ (mmHg)	$V_s$ (mL)	C (mL/mmHg)
近位大動脈 (Ao)	50	68.661971831	—
体動脈 (SA)	50	183.098591549	—
体抵抗血管側 (Art)	45	54.9295774648	—
体毛細管 (Cap)	—	—	15
近位肺動脈 (PA)	20	42.2535211268	—
肺抵抗血管側 (PArt)	20	63.3802816901	—

静脈型区画の有効係数
区画	$V_u$ (mL)	$C_c / C_o / C_d$ (mL/mmHg)	$p_o / p_s$ (mmHg)	$d_o / d_s$ (mmHg)	Vu,元 / G (mL)
体静脈 (SV)	1538.409	15 / 130 / 35	-2 / 16	1.5 / 4	1653.909 / 770
大静脈 (VC)	150.091	5 / 45 / 12	-1 / 12	1 / 3	169.591 / 130
肺毛細管 (PCap)	105	1 / 2 / 1	0 / 14	1 / 3	105 / 0
肺細静脈側 (PVen)	160	1.2 / 3 / 1.2	-1 / 14	1 / 3	160 / 0
肺静脈・左房流入口側 (PVein)	215	1.5 / 4 / 1.5	-1 / 14	1 / 3	215 / 0

主循環の接続と非弁抵抗（倍率適用済み）
接続：正方向	R (mmHg·s/mL)	倍率対象	追加条件
左房 (LA) → 左室 (LV)	四弁の表を参照	—	弁の開口・方向則
左室 (LV) → 近位大動脈 (Ao)	四弁の表を参照	—	弁の開口・方向則
右房 (RA) → 右室 (RV)	四弁の表を参照	—	弁の開口・方向則
右室 (RV) → 近位肺動脈 (PA)	四弁の表を参照	—	弁の開口・方向則
近位大動脈 (Ao) → 体動脈 (SA)	0.048369152	体抵抗 ×1.04	—
体動脈 (SA) → 体抵抗血管側 (Art)	0.0773906432	体抵抗 ×1.04	—
体抵抗血管側 (Art) → 体毛細管 (Cap)	0.628798976	体抵抗 ×1.04	—
体毛細管 (Cap) → 体静脈 (SV)	0.15	—	—
体静脈 (SV) → 大静脈 (VC)	0.05	—	—
大静脈 (VC) → 右房 (RA)	0.04	—	waterfall + χ (Pth)
近位肺動脈 (PA) → 肺抵抗血管側 (PArt)	0.00625	肺抵抗 ×0.625	—
肺抵抗血管側 (PArt) → 肺毛細管 (PCap)	0.025	肺抵抗 ×0.625	—
肺毛細管 (PCap) → 肺細静脈側 (PVen)	0.03	—	waterfall + χ (Palv)
肺細静脈側 (PVen) → 肺静脈・左房流入口側 (PVein)	0.01	—	—
肺静脈・左房流入口側 (PVein) → 左房 (LA)	0.03025	—	—

血管区画の係数と直列抵抗の配分は集中定数モデルの構成・校正値です。各値を特定のヒト血管部位で直接測った値と解釈しないでください。表のRへ操作倍率を重ねて掛ける必要はありません。

冠循環・外圧：心臓と循環の結合

冠区画の圧–容量定数
区画	$V_{\mathrm{ref}}$ (mL)	$C_{\mathrm{ref}}$ (mL/mmHg)	$P_*$ (mmHg)	$V_h$ (mL)
LAD 大動脈側容量 (Art)	1.43391058398	0.00153221919053	155.973178516	1.53221919053
LAD 心外膜側 C1	0.48107452286	0.0030959673913	25.8979107366	0.496293624668
LAD 心外膜側 C2	0.276429025657	0.0928790217391	0.496037785643	0.496293624668
LAD 心内膜側 C1	0.48107452286	0.0030959673913	25.8979107366	0.496293624668
LAD 心内膜側 C2	0.276429025657	0.0928790217391	0.496037785643	0.496293624668
LCx 大動脈側容量 (Art)	0.943218749158	0.00100788562723	155.973178516	1.00788562723
LCx 心外膜側 C1	0.316448260285	0.00203651086957	25.8979107366	0.32645930444
LCx 心外膜側 C2	0.181833541592	0.061095326087	0.496037785643	0.32645930444
LCx 心内膜側 C1	0.316448260285	0.00203651086957	25.8979107366	0.32645930444
LCx 心内膜側 C2	0.181833541592	0.061095326087	0.496037785643	0.32645930444
RCA 大動脈側容量 (Art)	1.01084431002	0.00108014758225	155.973178516	1.08014758225
RCA 心外膜側 C1	0.339136519084	0.00218252173913	25.8979107366	0.349865320892
RCA 心外膜側 C2	0.194870385107	0.0654756521739	0.496037785643	0.349865320892
RCA 心内膜側 C1	0.339136519084	0.00218252173913	25.8979107366	0.349865320892
RCA 心内膜側 C2	0.194870385107	0.0654756521739	0.496037785643	0.349865320892
共通冠静脈容量 (CV)	4.12994828733	0.098037492	7.0210355295	4.9018746

冠血管の全接続と基準抵抗（トーン・虚脱倍率を掛ける前）
接続：正方向	R (mmHg·s/mL)
近位大動脈 (Ao) → LAD 大動脈側容量 (Art)	20.749926765
LAD 大動脈側容量 (Art) → LAD 心外膜側 C1	58.0014068184
LAD 心外膜側 C1 → LAD 心外膜側 C2	35.7263939068
LAD 心外膜側 C2 → 共通冠静脈容量 (CV)	11.9087979689
LAD 大動脈側容量 (Art) → LAD 心内膜側 C1	42.2821588661
LAD 心内膜側 C1 → LAD 心内膜側 C2	32.1859404566
LAD 心内膜側 C2 → 共通冠静脈容量 (CV)	10.7286468189
近位大動脈 (Ao) → LCx 大動脈側容量 (Art)	31.1248901474
LCx 大動脈側容量 (Art) → LCx 心外膜側 C1	94.8761406353
LCx 心外膜側 C1 → LCx 心外膜側 C2	53.5895908603
LCx 心外膜側 C2 → 共通冠静脈容量 (CV)	17.8631969534
LCx 大動脈側容量 (Art) → LCx 心内膜側 C1	64.2296097205
LCx 心内膜側 C1 → LCx 心内膜側 C2	48.2789106849
LCx 心内膜側 C2 → 共通冠静脈容量 (CV)	16.0929702283
近位大動脈 (Ao) → RCA 大動脈側容量 (Art)	29.049897471
RCA 大動脈側容量 (Art) → RCA 心外膜側 C1	89.1455943902
RCA 心外膜側 C1 → RCA 心外膜側 C2	50.0169514696
RCA 心外膜側 C2 → 共通冠静脈容量 (CV)	16.6723171565
RCA 大動脈側容量 (Art) → RCA 心内膜側 C1	74.0663831102
RCA 心内膜側 C1 → RCA 心内膜側 C2	45.0603166393
RCA 心内膜側 C2 → 共通冠静脈容量 (CV)	15.0201055464
共通冠静脈容量 (CV) → 右房 (RA)	2.44019138756

冠循環の結合重み・短縮圧係数
領域	$w_L / w_S / w_R$	K (mmHg)	安静Qtarget：心外膜 / 心内膜 (mL/s)
LAD	0.75 / 0.25 / 0	81.1546499712	0.485355450237 / 0.538744549763
LCx	1 / 0 / 0	79.6541200248	0.323570300158 / 0.359163033175
RCA	0 / 0.2 / 0.8	84.2078441934	0.346682464455 / 0.384817535545

層深さdは心外膜側0.25・心内膜側0.75です。容量配分はブタ冠循環の形態、C1/C2はイヌの有効コンプライアンスを出発点とし、拍動下の局所検査で一部を調整しています。ヒト個別データから一意に同定した回路ではありません。

Kassab et al. 1994 · Spaan et al. 2000

保存された初期状態

保存された設定の初期条件

以下は起動に使う定常化済み状態です。基準時刻t₀＝46.286 s。時刻を0へ移す場合は、興奮予定・最後の興奮・制御周期の時刻も同じだけ移します。容積だけを移して材料やCaを0にすると、同じ初期条件にはなりません。表示は有効数字12桁で、保存値全桁の表をCSVで取得できます。

初期血液量（mL）
区画	$V(t_0)$
近位大動脈 (Ao)	65.4367287014
体抵抗血管側 (Art)	53.4074756823
体毛細管 (Cap)	373.824096768
左房 (LA)	25.7898122897
左室 (LV)	143.711071184
近位肺動脈 (PA)	20.3142440781
肺抵抗血管側 (PArt)	30.3820470937
肺毛細管 (PCap)	126.862424703
肺静脈・左房流入口側 (PVein)	255.714506561
肺細静脈側 (PVen)	191.350541007
右房 (RA)	31.2031541035
右室 (RV)	140.092672085
体動脈 (SA)	173.420546231
体静脈 (SV)	2869.19213711
大静脈 (VC)	422.030448572
共通冠静脈容量 (CV)	4.49848733008
LAD 大動脈側容量 (Art)	1.52008136721
LAD 心内膜側 C1	0.54601764284
LAD 心外膜側 C1	0.542581530948
LAD 心内膜側 C2	0.247668811702
LAD 心外膜側 C2	0.340467873509
LCx 大動脈側容量 (Art)	1.00015438503
LCx 心内膜側 C1	0.359081996138
LCx 心外膜側 C1	0.355306395262
LCx 心内膜側 C2	0.167814565593
LCx 心外膜側 C2	0.25717706142
RCA 大動脈側容量 (Art)	1.07191786674
RCA 心内膜側 C1	0.381977788163
RCA 心外膜側 C1	0.380987565009
RCA 心内膜側 C2	0.299665178334
RCA 心外膜側 C2	0.298706473768

初期Land状態（全て無次元）
壁	c	b	W	S	$\zeta_w$	$\zeta_s$
左房 (LA)	0.28113915674	0.704874682088	0.102054035966	0.0936506021977	0.013402384343	0.0338115707429
左室自由壁 (LVFW)	0.0712952557971	0.997572779339	0.000978883693389	0.00048162586185	-0.000156025626448	0.159371858597
心室中隔 (SEP)	0.0634436395191	0.998179427826	0.000729140483623	0.000368919301831	0.00056671701343	0.159647291732
右室自由壁 (RVFW)	0.0581013236786	0.998543071477	0.000573074250909	0.000304279966973	0.00241313043082	0.171438507274
右房 (RA)	0.240173486467	0.846068649473	0.0529103777129	0.048855794844	0.0158771615395	0.0473305726281

初期歪みとCa状態（無次元）
壁	$e(t_0)$	$\alpha(t_0)$	$x_r(t_0)$	$x_d(t_0)$
左房 (LA)	0.0259051860097	0.136283812906	0.0000661982094573	0.71048708409
左室自由壁 (LVFW)	0.101624278419	0.0379694626707	0.998315089971	0.999323563371
心室中隔 (SEP)	0.0785520120923	0.0107355090136	0.998315089971	0.999323563371
右室自由壁 (RVFW)	0.0602577439257	-0.00661841196296	0.998315089971	0.999323563371
右房 (RA)	-0.0106562564514	0.040966058947	0.0000661982094573	0.71048708409

初期開口・形状
量	値
AV ξ	3.79608635874e-27
MV ξ	0.053059576747
PV ξ	4.99723843977e-35
TV ξ	0.257165066582
$v_S$ (m³)	0.0000380009976933
y (m)	0.0335157366463

冠トーン・周期途中の積分
領域・層	$\theta(t_0)$	$\int Q_m\,dt$ (mL)
LAD 心外膜側	1.13168252266	0.00015300710174
LAD 心内膜側	1.14365945334	0.000171660683095
LCx 心外膜側	1.12241435777	0.0000968015110365
LCx 心内膜側	1.14314290996	0.000114829817841
RCA 心外膜側	1.14000395771	0.000101981803205
RCA 心内膜側	1.1845135399	0.000116389854937

引き継ぐ時刻と離散状態
量	値
次の心房興奮 (s)	47.0108571429
直前の心室興奮 (s)	46.2737142857
$L(t_0)$	1.52456187266
冠制御周期の開始 (s)	46.2857142857
冠制御周期の経過 (s)	0.000285714285717
$e_{\mathrm{MVC},\mathrm{LVFW}}$	0.101690533274
$e_{\mathrm{MVC},\mathrm{RVFW}}$	0.0586290629596
$e_{\mathrm{MVC},\mathrm{SEP}}$	0.0782742972666

この時刻に未処理のCa入力・伝導イベントはありません。次のCa入力時刻は、上の次回心房興奮に12 ms（心房）または132 ms（心室）を加えます。冠制御周期は元の時刻0からT＝60/70 sごとです。初期状態から再計算し、少なくとも複数周期の整合を確認してください。収束の一意性や全症例での安定性まで、この状態表が保証するものではありません。

採用値・初期条件の表を保存（CSV）

測定記録・根拠・評価の範囲

baselineでは両時間刻みで、左室の±dP/dt、等容収縮時間（ICT）、Tei指数に既存の参考区間からの逸脱が残ります。観測方法が文献と異なるため、臨床的な正常・異常の判定へは置き換えません。生波形では僧帽弁閉鎖後に圧がゆっくり上昇する区間があり、等容収縮は約89–93 msです。これは時間刻みを細かくしても残る、この構成の特徴です。僧帽弁流量E/Aは約0.93です。

この採用は新しい数値モデルの4つの固定構成を対象とします。既存の表示・解析方法とチェックポイントの保存形式を継承しています。識別名にStandard73が含まれていても、Standard73と数値軌道が同じという意味ではありません。今回の独立した2/1 ms冷開始検証にはStandard73の対照実行を含めていません。候補実装・正式な実行ファイル・ソースの継続一致は別に確認しています。

静脈の圧は体積から安全化Newton法で求めます。圧の上下限で解を挟み、Newton更新が十分に縮小しない場合は区間を二分します。既定の反復上限は96回、体積残差と圧区間幅の許容値はそれぞれ10⁻¹⁰ mL、10⁻¹⁰ mmHgです。収束しない場合は未確認の圧を採用せず、計算失敗として扱います。構成則の範囲外では従来の圧の上下限を用います。

表示用のTBV–PV・Starling曲線は、固定した制御条件で局所収束を確認した短時間の応答です。全身の血液分布が完全に定常化した曲線とは区別します。baselineの採用に用いる、血液分布の変化も確認したpreload応答試験とは異なる解析です。

各資料の対象集団と測定条件を、今回の測定と区別して読みます。下の原記録には出典の言語をそのまま残しています。

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors

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.

出典を見る

Reference values for pulsed Doppler signals from the blood flow velocity on both sides of the pulmonary valve

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.

出典を見る

Aortic input impedance in normal man: relationship to pressure wave forms

出典を見る

The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop

出典を見る

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

出典を見る

Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study

出典を見る

Normal values for cardiovascular magnetic resonance in adults and children

出典を見る

Cardiac output and cardiac index measured with cardiovascular magnetic resonance in healthy subjects, elite athletes and patients with congestive heart failure

出典を見る

Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update

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.

出典を見る

Cardiovascular Magnetic Resonance Reference Ranges From the Healthy Hearts Consortium: author-published anatomical segmentation tables

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.

出典を見る

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

出典を見る

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography

出典を見る

Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

出典を見る

Pulmonary arterial wedge pressure in healthy subjects: a meta-analysis

出典を見る

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

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.

出典を見る

Age- and sex-based normal reference ranges of the cardiac time intervals: the Copenhagen City Heart Study

出典を見る

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

出典を見る

Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle

出典を見る

A clinical study of left ventricular relaxation

出典を見る

Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle

出典を見る

採択記録

以下の原記録は資料生成時の状態を保持しています。採択前のreview-pendingを成功へ書き換えず、その後の判断を別に記録します。

レビューと採択判断を見る

資料生成時の自動確認・レビュー項目

{
  "referenceId": "baseline",
  "title": "baseline",
  "qualification": {
    "schemaId": "main-wire-static-baseline-paired-qualification-v1",
    "modelId": "circleheart.main-wire-integrated-transaction-v3.static-anatomy.standard-74",
    "status": "qualified",
    "issues": [],
    "pressureRateQuality": [
      {
        "checkId": "left-ventricle.maximum-dpdt",
        "status": "passed",
        "relativeDifference": 0.013774618477385607,
        "coarse": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": 2564.2544594929004,
          "observedMmHgPerSec": 2564.2544594929004,
          "peakStartTimeSec": 45.49057142857142,
          "peakEndTimeSec": 45.492571428571424,
          "peakPhase01": 0.22750000000003429,
          "previousSameSignFraction": 0.9947538377737861,
          "nextSameSignFraction": 0.9770417168298144
        },
        "fine": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": 2600.069423820747,
          "observedMmHgPerSec": 2600.069423820747,
          "peakStartTimeSec": 47.20785714285714,
          "peakEndTimeSec": 47.20885714285714,
          "peakPhase01": 0.2304166666667149,
          "previousSameSignFraction": 0.9979841741319788,
          "nextSameSignFraction": 0.8773633964824585
        }
      },
      {
        "checkId": "left-ventricle.minimum-dpdt",
        "status": "passed",
        "relativeDifference": 0.011221245761181156,
        "coarse": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": -1538.8738086615583,
          "observedMmHgPerSec": -1538.8738086615583,
          "peakStartTimeSec": 45.78057142857142,
          "peakEndTimeSec": 45.78257142857142,
          "peakPhase01": 0.5658333333333762,
          "previousSameSignFraction": 0.9986276173637125,
          "nextSameSignFraction": 0.9963479298059111
        },
        "fine": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": -1556.3378582564847,
          "observedMmHgPerSec": -1556.3378582564847,
          "peakStartTimeSec": 47.494857142857136,
          "peakEndTimeSec": 47.49585714285714,
          "peakPhase01": 0.5652500000000483,
          "previousSameSignFraction": 0.9991654458116853,
          "nextSameSignFraction": 0.9995242446773392
        }
      },
      {
        "checkId": "right-ventricle.maximum-dpdt",
        "status": "passed",
        "relativeDifference": 0.028530101467659035,
        "coarse": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": 585.6274034994009,
          "observedMmHgPerSec": 585.6274034994009,
          "peakStartTimeSec": 45.48457142857142,
          "peakEndTimeSec": 45.48657142857142,
          "peakPhase01": 0.220500000000034,
          "previousSameSignFraction": 0.9445425974662539,
          "nextSameSignFraction": 0.9928735992661226
        },
        "fine": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": 602.8260931029814,
          "observedMmHgPerSec": 602.8260931029814,
          "peakStartTimeSec": 47.20085714285714,
          "peakEndTimeSec": 47.201857142857136,
          "peakPhase01": 0.22225000000004236,
          "previousSameSignFraction": 0.9782843612029176,
          "nextSameSignFraction": 0.9961449981083355
        }
      },
      {
        "checkId": "right-ventricle.minimum-dpdt",
        "status": "passed",
        "relativeDifference": 0.010084895459211167,
        "coarse": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": -371.8957345875963,
          "observedMmHgPerSec": -371.8957345875963,
          "peakStartTimeSec": 45.76857142857143,
          "peakEndTimeSec": 45.77057142857142,
          "peakPhase01": 0.5518333333333756,
          "previousSameSignFraction": 0.9964889970458835,
          "nextSameSignFraction": 0.9981989459080302
        },
        "fine": {
          "status": "passed",
          "issue": null,
          "reportedMmHgPerSec": -375.68447322572655,
          "observedMmHgPerSec": -375.68447322572655,
          "peakStartTimeSec": 47.48385714285714,
          "peakEndTimeSec": 47.48485714285714,
          "peakPhase01": 0.5524166666667116,
          "previousSameSignFraction": 0.9995239745598291,
          "nextSameSignFraction": 0.9991443751109906
        }
      }
    ],
    "preloadReserve": {
      "policy": {
        "policyId": "main-wire-preload-reserve-admission-v1",
        "source": {
          "doi": "10.1097/01.CCM.0000114996.68110.C9",
          "locator": "Kumar 2004, healthy-volunteer saline-loading study; method context only, not our fixed-tone thresholds"
        },
        "rationale": "TBV is the controlled excitation, not atrial pressure. Positive pressure direction replaces the unsupported universal 1 mmHg amplitude. Remaining response floors are inherited engineering non-regression margins, not saline-response normal ranges.",
        "numericalRationale": "Require both settled grids to pass and response margins to exceed the observed two-grid sensitivity. Sum individual center and endpoint differences for primitive contrasts, avoiding cancellation. This is a sensitivity screen, not a rigorous error bound or convergence-order proof.",
        "regression": "__tests__/mainWireProspectiveBaselineAdmissionV1.test.ts"
      },
      "issues": [],
      "responses": [
        {
          "side": "left",
          "direction": "hypovolemic",
          "endpointDirectionsMatch": true,
          "screens": [
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 3.4062796627571057,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            },
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 3.3928278055867906,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            }
          ],
          "margins": [
            {
              "field": "directionalFillingPressureChangeMmHg",
              "floor": 0,
              "margin": 3.3928278055867906,
              "sensitivity": 0.03794117789595397,
              "passed": true
            },
            {
              "field": "directionalCardiacOutputChangeLPerMin",
              "floor": 0.05,
              "margin": 1.0694894569602356,
              "sensitivity": 0.006001096719002064,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicVolumeChangeMl",
              "floor": 1,
              "margin": 29.847758601899102,
              "sensitivity": 0.012387185792604782,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicTransmuralPressureChangeMmHg",
              "floor": 0.25,
              "margin": 6.12975204373651,
              "sensitivity": 0.032824916252536696,
              "passed": true
            }
          ],
          "ratioMargins": [
            {
              "field": "CardiacOutputLPerMin:fractional-floor-residual",
              "floor": 0.03,
              "margin": 0.9512381467631232,
              "sensitivity": 0.005903946223461531,
              "passed": true
            },
            {
              "field": "EndDiastolicVolumeMl:fractional-floor-residual",
              "floor": 0.03,
              "margin": 26.536518677248417,
              "sensitivity": 0.012058871600029022,
              "passed": true
            },
            {
              "field": "CO-pressure-secant-residual",
              "floor": 0.02,
              "margin": 1.0513638637050935,
              "sensitivity": 0.006759920276921143,
              "passed": true
            }
          ],
          "passed": true
        },
        {
          "side": "left",
          "direction": "hypervolemic",
          "endpointDirectionsMatch": true,
          "screens": [
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 4.619379859464242,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            },
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 4.619797889857988,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            }
          ],
          "margins": [
            {
              "field": "directionalFillingPressureChangeMmHg",
              "floor": 0,
              "margin": 4.619379859464242,
              "sensitivity": 0.05097500467252303,
              "passed": true
            },
            {
              "field": "directionalCardiacOutputChangeLPerMin",
              "floor": 0.05,
              "margin": 0.7926941683535247,
              "sensitivity": 0.008324394184453077,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicVolumeChangeMl",
              "floor": 1,
              "margin": 23.76034155040321,
              "sensitivity": 0.09643829769990475,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicTransmuralPressureChangeMmHg",
              "floor": 0.25,
              "margin": 9.212495234561677,
              "sensitivity": 0.1574947617578779,
              "passed": true
            }
          ],
          "ratioMargins": [
            {
              "field": "CardiacOutputLPerMin:fractional-floor-residual",
              "floor": 0.03,
              "margin": 0.6744428581564124,
              "sensitivity": 0.00842154467999361,
              "passed": true
            },
            {
              "field": "EndDiastolicVolumeMl:fractional-floor-residual",
              "floor": 0.03,
              "margin": 20.449101625752526,
              "sensitivity": 0.09676661189248051,
              "passed": true
            },
            {
              "field": "CO-pressure-secant-residual",
              "floor": 0.02,
              "margin": 0.7503065711642398,
              "sensitivity": 0.009343894277903537,
              "passed": true
            }
          ],
          "passed": true
        },
        {
          "side": "right",
          "direction": "hypovolemic",
          "endpointDirectionsMatch": true,
          "screens": [
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 0.9558643033481333,
                "passed": false
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            },
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 0.9558838160309797,
                "passed": false
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            }
          ],
          "margins": [
            {
              "field": "directionalFillingPressureChangeMmHg",
              "floor": 0,
              "margin": 0.9558643033481333,
              "sensitivity": 0.007323285402944357,
              "passed": true
            },
            {
              "field": "directionalCardiacOutputChangeLPerMin",
              "floor": 0.05,
              "margin": 1.0698257130237214,
              "sensitivity": 0.005476177546863248,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicVolumeChangeMl",
              "floor": 1,
              "margin": 29.576366456886092,
              "sensitivity": 0.064325167842199,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicTransmuralPressureChangeMmHg",
              "floor": 0.25,
              "margin": 0.8793112054485952,
              "sensitivity": 0.0846154109995656,
              "passed": true
            }
          ],
          "ratioMargins": [
            {
              "field": "CardiacOutputLPerMin:fractional-floor-residual",
              "floor": 0.03,
              "margin": 0.9515727181923483,
              "sensitivity": 0.005388704571375822,
              "passed": true
            },
            {
              "field": "EndDiastolicVolumeMl:fractional-floor-residual",
              "floor": 0.03,
              "margin": 26.355156579059866,
              "sensitivity": 0.06300926164845946,
              "passed": true
            },
            {
              "field": "CO-pressure-secant-residual",
              "floor": 0.02,
              "margin": 1.1007084269567589,
              "sensitivity": 0.005622643254922135,
              "passed": true
            }
          ],
          "passed": true
        },
        {
          "side": "right",
          "direction": "hypervolemic",
          "endpointDirectionsMatch": true,
          "screens": [
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 1.6256438377475693,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            },
            {
              "policyId": "main-wire-preload-reserve-research-screen-v2",
              "status": "directional-screen-passed",
              "invalidDomain": false,
              "nonfiniteFields": [],
              "inconsistentFields": [],
              "failedCriteria": [],
              "historicalPressureAmplitude": {
                "minimumMmHg": 1,
                "observedMmHg": 1.6206693965753498,
                "passed": true
              },
              "pressureCoordinateResolved": false,
              "numericalQualificationEstablished": false,
              "baselineAdmissionEstablished": false,
              "physiologicalNormalityClaimed": false,
              "requiredBeforeAdmission": "Separate settled-endpoint and same-construction coarse/fine review; inspect endpoint pressures, not only cancelling contrasts. Finite or large secant slope does not prove pressure-coordinate resolvability."
            }
          ],
          "margins": [
            {
              "field": "directionalFillingPressureChangeMmHg",
              "floor": 0,
              "margin": 1.6206693965753498,
              "sensitivity": 0.012278213892317424,
              "passed": true
            },
            {
              "field": "directionalCardiacOutputChangeLPerMin",
              "floor": 0.05,
              "margin": 0.792041506383544,
              "sensitivity": 0.008397867985384444,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicVolumeChangeMl",
              "floor": 1,
              "margin": 31.096475595909823,
              "sensitivity": 0.04764656961665992,
              "passed": true
            },
            {
              "field": "directionalEndDiastolicTransmuralPressureChangeMmHg",
              "floor": 0.25,
              "margin": 1.6450651626088861,
              "sensitivity": 0.08203178311131865,
              "passed": true
            }
          ],
          "ratioMargins": [
            {
              "field": "CardiacOutputLPerMin:fractional-floor-residual",
              "floor": 0.03,
              "margin": 0.6737885115521709,
              "sensitivity": 0.008485340960871869,
              "passed": true
            },
            {
              "field": "EndDiastolicVolumeMl:fractional-floor-residual",
              "floor": 0.03,
              "margin": 27.873949811889858,
              "sensitivity": 0.04896247581039944,
              "passed": true
            },
            {
              "field": "CO-pressure-secant-residual",
              "floor": 0.02,
              "margin": 0.8095286296285926,
              "sensitivity": 0.008643432263230793,
              "passed": true
            }
          ],
          "passed": true
        }
      ],
      "status": "passed",
      "physiologicalNormalityClaimed": false,
      "fullNumericalConvergenceClaimed": false
    },
    "execution": {
      "independentColdGrids": true,
      "reserveProtocol": {
        "hypovolemicGlobalTbvScale": 0.88,
        "hypervolemicGlobalTbvScale": 1.12,
        "minimumDirectionalFillingPressureChangeMmHg": 1,
        "minimumDirectionalCardiacOutputChangeLPerMin": 0.05,
        "minimumDirectionalCardiacOutputChangeFraction01": 0.02,
        "minimumCardiacOutputSlopeLPerMinPerMmHg": 0.015,
        "minimumDirectionalEndDiastolicVolumeChangeMl": 1,
        "minimumDirectionalEndDiastolicVolumeChangeFraction01": 0.02,
        "minimumDirectionalEndDiastolicTransmuralPressureChangeMmHg": 0.25
      },
      "reserveSettlement": {
        "policyId": "main-wire-fixed-tone-reservoir-closure-v2",
        "consecutiveComparisonCount": 3,
        "maximumRedistributedVolumePerBeatMl": 0.05,
        "maximumNormalizedOutputDelta": 0.1,
        "maximumNormalizedLandmarkDelta": 1,
        "maximumCompleteBeatCount": 50,
        "maximumMeasurementDurationSec": 54,
        "maximumObservationGapSec": 0.010001
      },
      "selectedOutputProjection": true,
      "nominalDtSec": [
        0.002,
        0.001
      ],
      "afterloadTest": false
    },
    "clinicalNormalityClaimed": false,
    "publicPromotionAuthorized": false,
    "reportSha256": "348c5f8f181cc83ec9bdd9d3c0c59565713fd6b7cb5aaa24ffd522b2628179c8"
  },
  "caseTargetIssues": [],
  "searchHoldIssues": [],
  "reviewItems": [
    {
      "id": "representative-baseline-selection",
      "status": "review-pending"
    },
    {
      "id": "raw-waveform-and-pv-review",
      "status": "review-pending"
    }
  ],
  "status": "review-pending",
  "historicalEvidence": "not-revalidated",
  "publicPromotionAuthorized": false,
  "runStatus": "review-pending"
}

症例仕様・文献・測定法

{
  "reference": {
    "referenceId": "baseline",
    "label": "baseline",
    "target": {
      "kind": "construction-corridors",
      "evidenceRegistryId": "main-wire-normal-reference-evidence-v1",
      "evaluationRolePolicyId": "main-wire-standard70-baseline-evaluation-roles-v3",
      "admissionPolicyId": "main-wire-prospective-baseline-admission-v1",
      "comparisonProfileId": "main-wire-resting-reference-profile-v1",
      "referenceOutputsAreTargets": false
    },
    "evidenceRole": "construction",
    "clinicalValidationClaimed": false
  },
  "methodId": "main-wire-baseline-observation-v2",
  "assessmentPolicy": {
    "policy": {
      "policyId": "main-wire-prospective-baseline-admission-v1",
      "scope": "Resting unassisted nonshunting sinus research construction, BSA1.9, HR60 or70, zero intrathoracic reference. Scientific eligibility for exact-model promotion, not public mint or clinical normality.",
      "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"
        },
        {
          "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"
        },
        {
          "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"
        },
        {
          "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"
        },
        {
          "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"
        },
        {
          "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"
        }
      ],
      "loadGuardRationale": "Keep a baseline away from low/high systemic load and high native end-filling pressure. Ao bounds are retained design choices, not derived from Herbert. LV native flow cessation may precede the pressure upstroke; <=16 is an approximate end-filling design ceiling, not validated catheter LVEDP equivalence or a lower normal limit.",
      "anatomyRule": "For this sex-unspecified generic baseline only, automatic eligibility requires all six valid anatomical CMR comparisons inside BOTH declared sex strata. Otherwise require demographic/method review, not automatic disease rejection. This conservative design intersection does not assign sex or claim joint population normality; preset/patient fitting must use its own profile.",
      "warningRule": "Keep strict source comparisons for phasic PAP, ET, anatomy and SVI plus historical timing/E-A/dPdt/roundness context. A warning never excuses missing, nonfinite or invalid observations. Preserve unexplained ringing/closure-rebound construction holds; pressure-peak phase and PV roundness are not universal normality gates.",
      "numericalAndConstructionProvenance": "Inherited numerical/gradient/ringing checks resolve their existing per-check evidence; new rest criteria do not reinterpret the old physiological corridors or clear the old provenance audit.",
      "regression": "__tests__/mainWireProspectiveBaselineAdmissionV1.test.ts"
    },
    "evidence": {
      "schemaVersion": 1,
      "registryId": "main-wire-normal-reference-evidence-v1",
      "evaluationPolicyId": "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."
        }
      ]
    }
  }
}

2 / 1 msの全観測値と評価

[
  {
    "modelId": "circleheart.main-wire-integrated-transaction-v3.static-anatomy.standard-74",
    "numericalSourceSha256": "f92b231c6f11c4746bb9f47e96d89cbe6f17692f57f704cca5ff82eb1ee2b326",
    "resultSha256": "d01746c0373a761176db0da0243ba1711102ef55d6ab311649b0fae49b7d5a07",
    "nominalDtSec": 0.002,
    "initialization": {
      "kind": "cold"
    },
    "cycles": 54,
    "rest": {
      "assessment": {
        "anatomyReviewRequired": false,
        "comparison": {
          "admissionDecision": "not-performed",
          "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.",
          "endTimeSec": 46.153714285714244,
          "entries": [
            {
              "actual": 0.25800000000000267,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.248,
                    "upper": 0.336
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "Copenhagen pooled healthy adults; HR 63 +/- 10"
                }
              ],
              "locator": "Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval",
              "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.",
              "metricId": "aortic-valve.ejection-time",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
              "unit": "s"
            },
            {
              "actual": 0.25800000000000267,
              "comparisons": [],
              "locator": "Abstract: population and recording stations; no numeric adult ET interval verified",
              "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.",
              "metricId": "pulmonary-valve.ejection-time",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "van-oort-1988-pulmonary-doppler",
              "unit": "s"
            },
            {
              "actual": 111.29648919376602,
              "comparisons": [
                {
                  "range": {
                    "lower": 80,
                    "upper": 110
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "outside-source-range",
                  "stratum": "women 20-29"
                },
                {
                  "range": {
                    "lower": 92,
                    "upper": 115
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 20-29"
                },
                {
                  "range": {
                    "lower": 84,
                    "upper": 119
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 30-39"
                },
                {
                  "range": {
                    "lower": 88,
                    "upper": 120
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 30-39"
                },
                {
                  "range": {
                    "lower": 87,
                    "upper": 123
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 40-49"
                },
                {
                  "range": {
                    "lower": 90,
                    "upper": 123
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 40-49"
                },
                {
                  "range": {
                    "lower": 93,
                    "upper": 127
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 50-59"
                },
                {
                  "range": {
                    "lower": 96,
                    "upper": 126
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 50-59"
                },
                {
                  "range": {
                    "lower": 97,
                    "upper": 129
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 60-69"
                },
                {
                  "range": {
                    "lower": 97,
                    "upper": 128
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 60-69"
                },
                {
                  "range": {
                    "lower": 100,
                    "upper": 131
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 70+"
                },
                {
                  "range": {
                    "lower": 99,
                    "upper": 130
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 70+"
                }
              ],
              "locator": "Methods, Standardizing methodologies; Table 2, Normal population, all adult age rows",
              "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.",
              "metricId": "aortic-pressure.maximum",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "herbert-2014-central-pressure-reference",
              "unit": "mmHg"
            },
            {
              "actual": 77.52496258535398,
              "comparisons": [],
              "locator": "Methods, Standardizing methodologies; Table 1, brachial DBP summary",
              "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.",
              "metricId": "aortic-pressure.minimum",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "herbert-2014-central-pressure-reference",
              "unit": "mmHg"
            },
            {
              "actual": 3.0795269248997674,
              "comparisons": [
                {
                  "range": {
                    "lower": 2,
                    "upper": 6
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, mean RAP; section 5.1.12.1",
              "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.",
              "metricId": "central-venous-pressure.mean",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 26.17242118724626,
              "comparisons": [
                {
                  "range": {
                    "lower": 15,
                    "upper": 30
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, systolic PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.maximum",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 12.055592420313948,
              "comparisons": [
                {
                  "range": {
                    "lower": 4,
                    "upper": 12
                  },
                  "statistic": "published-reference-interval",
                  "status": "outside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, diastolic PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.minimum",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 17.89193948661483,
              "comparisons": [
                {
                  "range": {
                    "lower": 8,
                    "upper": 20
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, mean PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.mean",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 8.40282801978899,
              "comparisons": [
                {
                  "range": {
                    "lower": null,
                    "upper": 15
                  },
                  "statistic": "clinical-upper-limit",
                  "status": "not-above-source-upper-limit",
                  "stratum": "adult RHC PAWP clinical reference"
                }
              ],
              "locator": "Table 11, PAWP; section 5.1.12.1",
              "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.",
              "metricId": "pcwp-surrogate.mean",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 75.63750481521748,
              "comparisons": [
                {
                  "range": {
                    "lower": 46,
                    "upper": 104
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 46,
                    "upper": 91
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.edv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 33.46818399425799,
              "comparisons": [
                {
                  "range": {
                    "lower": 11,
                    "upper": 41
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 11,
                    "upper": 34
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.esv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 0.5575186664866747,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.53,
                    "upper": 0.79
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 0.55,
                    "upper": 0.8
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.ejection-fraction",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "fraction"
            },
            {
              "actual": 74.08611606820064,
              "comparisons": [
                {
                  "range": {
                    "lower": 49,
                    "upper": 117
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 47,
                    "upper": 99
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.edv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 31.917135985782327,
              "comparisons": [
                {
                  "range": {
                    "lower": 12,
                    "upper": 56
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 11,
                    "upper": 43
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.esv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 0.569188699858409,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.44,
                    "upper": 0.77
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 0.49,
                    "upper": 0.77
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.ejection-fraction",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "fraction"
            },
            {
              "actual": 2.951852448445143,
              "comparisons": [
                {
                  "range": {
                    "lower": 2.5,
                    "upper": 4
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "historicalCheckId": "systemic-forward-flow.cardiac-index",
              "locator": "Table 11, CI; section 5.1.12.1, direct Fick/thermodilution",
              "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.",
              "metricId": "systemic-net-flow.cardiac-index",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "L/min/m2"
            },
            {
              "actual": 42.16932069207332,
              "comparisons": [
                {
                  "range": {
                    "lower": 33,
                    "upper": 47
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "historicalCheckId": "systemic-forward-flow.stroke-volume-index",
              "locator": "Table 11, SVI; section 5.1.12.1",
              "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.",
              "metricId": "systemic-net-flow.stroke-volume-index",
              "observationStatus": "observed",
              "role": "coupled-flow-context",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mL/m2"
            }
          ],
          "flowCoupling": {
            "basis": "signed-native-AoV-net-flow",
            "ciConditionalSviIntervalMlPerM2": {
              "lower": 35.71428571428558,
              "upper": 57.14285714285693
            },
            "ciMinusHrTimesSviOver1000": -4.440892098500626e-16,
            "conditionalIntervalIsPublishedSviReference": false,
            "forwardMinusNetCi": 0,
            "pulmonaryMinusAorticNetFlowLPerMin": -0.00004530361777099756
          },
          "heartRateBpm": 70.00000000000026,
          "nativeLvEndDiastolicPressure": {
            "absolutePressureMmHg": 10.92333041706009,
            "differenceFromMeanLaMmHg": 2.5205023972711,
            "externalPressureMmHg": 0,
            "timeSec": 45.40342857142857,
            "transmuralPressureMmHg": 10.92333041706009
          },
          "observationApplicabilityEstablished": false,
          "physiologicalNormalityClaimed": false,
          "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.",
          "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.",
          "startTimeSec": 45.29657142857139,
          "subject": {
            "age": "unspecified",
            "allowedHeartRatesBpm": [
              60,
              70
            ],
            "bodySurfaceAreaM2": 1.9,
            "ethnicity": "unspecified",
            "sex": "unspecified"
          }
        },
        "historicalWarnings": [
          {
            "actual": 2564.2544594929004,
            "checkId": "left-ventricle.maximum-dpdt",
            "maximum": 2500,
            "minimum": 1200,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": -1538.8738086615583,
            "checkId": "left-ventricle.minimum-dpdt",
            "maximum": -700,
            "minimum": -1400,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": 0.08914285714285342,
            "checkId": "timing.ict",
            "maximum": 0.07,
            "minimum": 0.02,
            "status": "failed",
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          },
          {
            "actual": 0.7021040974529081,
            "checkId": "timing.tei-index",
            "maximum": 0.65,
            "minimum": 0.29,
            "status": "failed",
            "unit": "ratio"
          }
        ],
        "invalidOrFailedRetained": [],
        "operating": [
          {
            "actual": 2.951852448445143,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, CI",
            "lower": 2.5,
            "metricId": "systemic-net-flow.cardiac-index",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 4
          },
          {
            "actual": 3.0795269248997674,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, mean RAP",
            "lower": 2,
            "metricId": "central-venous-pressure.mean",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 6
          },
          {
            "actual": 17.89193948661483,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, mean PAP",
            "lower": 8,
            "metricId": "pulmonary-artery-pressure.mean",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 20
          },
          {
            "actual": 111.29648919376602,
            "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
            "locator": "Methods, invasive versus cuff-calibrated pressure distinction",
            "lower": 90,
            "metricId": "aortic-pressure.maximum",
            "sourceId": "herbert-2014-central-pressure-reference",
            "status": "passed",
            "upper": 140
          },
          {
            "actual": 77.52496258535398,
            "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
            "locator": "Methods, DBP calibration; no central-DBP reference interval",
            "lower": 60,
            "metricId": "aortic-pressure.minimum",
            "sourceId": "herbert-2014-central-pressure-reference",
            "status": "passed",
            "upper": 90
          },
          {
            "actual": 10.92333041706009,
            "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range",
            "locator": "Section2, Table1 p539 (>16), Figure1 p540",
            "lower": null,
            "metricId": "left-ventricle.native-end-filling-pressure",
            "sourceId": "nagueh-2025-lv-diastolic-function",
            "status": "passed",
            "upper": 16
          }
        ],
        "status": "passed",
        "unavailable": []
      },
      "observation": {
        "checks": [
          {
            "actual": 1,
            "checkId": "settlement.period1",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 1,
            "checkId": "waveform.LVP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 0.20455258328909098,
            "checkId": "waveform.LVP.rounded-not-plateau",
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            "minimum": 0.08,
            "status": "passed",
            "unit": "fraction"
          },
          {
            "actual": 1,
            "checkId": "waveform.RVP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 0.18979357650926013,
            "checkId": "waveform.RVP.rounded-not-plateau",
            "maximum": 0.35,
            "minimum": 0.08,
            "status": "passed",
            "unit": "fraction"
          },
          {
            "actual": 4.193858213219736,
            "checkId": "aortic-valve.mean-gradient",
            "maximum": 5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 7.820873008716177,
            "checkId": "aortic-valve.peak-gradient",
            "maximum": 10,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 0.25800000000000267,
            "checkId": "aortic-valve.ejection-time",
            "maximum": 0.34,
            "minimum": 0.24,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 2564.2544594929004,
            "checkId": "left-ventricle.maximum-dpdt",
            "maximum": 2500,
            "minimum": 1200,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": -1538.8738086615583,
            "checkId": "left-ventricle.minimum-dpdt",
            "maximum": -700,
            "minimum": -1400,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": 0.9379364716964619,
            "checkId": "mitral-flow.peak-e-to-a",
            "maximum": 2,
            "minimum": 0.8,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 0.08914285714285342,
            "checkId": "timing.ict",
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          {
            "actual": 0.09199999999999875,
            "checkId": "timing.irt",
            "maximum": 0.134,
            "minimum": 0.059,
            "status": "passed",
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          },
          {
            "actual": 0.7021040974529081,
            "checkId": "timing.tei-index",
            "maximum": 0.65,
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            "unit": "ratio"
          },
          {
            "actual": 111.29648919376602,
            "checkId": "aortic-pressure.maximum",
            "maximum": 140,
            "minimum": 90,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 77.52496258535398,
            "checkId": "aortic-pressure.minimum",
            "maximum": 90,
            "minimum": 60,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 26.17242118724626,
            "checkId": "pulmonary-artery-pressure.maximum",
            "maximum": 35,
            "minimum": 15,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 12.055592420313948,
            "checkId": "pulmonary-artery-pressure.minimum",
            "maximum": 15,
            "minimum": 4,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 3.0795269248997674,
            "checkId": "central-venous-pressure.mean",
            "maximum": 8,
            "minimum": 1,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 8.40282801978899,
            "checkId": "pcwp-surrogate.mean",
            "maximum": 13,
            "minimum": 4,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 75.63750481521748,
            "checkId": "left-ventricle.edv-index",
            "maximum": 99,
            "minimum": 34,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 33.46818399425799,
            "checkId": "left-ventricle.esv-index",
            "maximum": 40,
            "minimum": 10,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 0.5575186664866747,
            "checkId": "left-ventricle.ejection-fraction",
            "maximum": 0.74,
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            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 74.08611606820064,
            "checkId": "right-ventricle.edv-index",
            "maximum": 87,
            "minimum": 32,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 31.917135985782327,
            "checkId": "right-ventricle.esv-index",
            "maximum": 44,
            "minimum": 8,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 0.569188699858409,
            "checkId": "right-ventricle.ejection-fraction",
            "maximum": 0.82,
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            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 2.9518524484451434,
            "checkId": "systemic-forward-flow.cardiac-index",
            "maximum": 4,
            "minimum": 2.5,
            "status": "passed",
            "unit": "L/min/m2"
          },
          {
            "actual": 42.16932069207332,
            "checkId": "systemic-forward-flow.stroke-volume-index",
            "maximum": 65,
            "minimum": 35,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 4.448942655299428,
            "checkId": "pulmonary-valve.mean-gradient",
            "maximum": 5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 7.366248564154482,
            "checkId": "pulmonary-valve.peak-gradient",
            "maximum": 10,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 0.25800000000000267,
            "checkId": "pulmonary-valve.ejection-time",
            "maximum": 0.35,
            "minimum": 0.22,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 585.6274034994009,
            "checkId": "right-ventricle.maximum-dpdt",
            "maximum": 1000,
            "minimum": 300,
            "status": "passed",
            "unit": "mmHg/s"
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          {
            "actual": -371.8957345875963,
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            "maximum": -150,
            "minimum": -700,
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            "unit": "mmHg/s"
          },
          {
            "actual": 1.1040204787748886,
            "checkId": "tricuspid-flow.peak-e-to-a",
            "maximum": 2,
            "minimum": 0.8,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 0.027999999999998693,
            "checkId": "right-timing.ict",
            "maximum": 0.09,
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            "unit": "s"
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          {
            "actual": 0.06400000000000006,
            "checkId": "right-timing.irt",
            "maximum": 0.12,
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          {
            "actual": 0.3565891472868132,
            "checkId": "right-timing.tei-index",
            "maximum": 0.65,
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            "status": "passed",
            "unit": "ratio"
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          {
            "actual": 1,
            "checkId": "waveform.PAP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 1,
            "checkId": "waveform.PV-flow.single-forward-episode",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 1,
            "checkId": "waveform.PV-flow.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 0,
            "checkId": "waveform.PAP.post-PV-closure-rebound",
            "maximum": 0.5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          }
        ],
        "measured": {
          "LVP": {
            "centralRangeFraction": 0.20455258328909098,
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            "peakPhase01": 0.746031746031746,
            "significantPeakCount": 1,
            "totalVariationRatio": 1.162263974207825
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          "RVP": {
            "centralRangeFraction": 0.18979357650926013,
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            "peakPhase01": 0.6771653543307087,
            "significantPeakCount": 1,
            "totalVariationRatio": 1.2847060597553432
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          "aorticValve": {
            "ejectionTimeSec": 0.25800000000000267,
            "meanGradientMmHg": 4.193858213219736,
            "peakGradientMmHg": 7.820873008716177
          },
          "cardiacSizeAndFunction": {
            "bodySurfaceAreaM2": 1.9,
            "leftVentricle": {
              "ejectionFraction01": 0.5575186664866747,
              "endDiastolicVolumeIndexMlPerM2": 75.63750481521748,
              "endDiastolicVolumeMl": 143.7112591489132,
              "endSystolicVolumeIndexMlPerM2": 33.46818399425799,
              "endSystolicVolumeMl": 63.58954958909018
            },
            "rightVentricle": {
              "ejectionFraction01": 0.569188699858409,
              "endDiastolicVolumeIndexMlPerM2": 74.08611606820064,
              "endDiastolicVolumeMl": 140.7636205295812,
              "endSystolicVolumeIndexMlPerM2": 31.917135985782327,
              "endSystolicVolumeMl": 60.64255837298642
            },
            "systemicForwardFlow": {
              "cardiacIndexLPerMinPerM2": 2.9518524484451434,
              "cardiacOutputLPerMin": 5.608519652045772,
              "strokeVolumeIndexMlPerM2": 42.16932069207332,
              "strokeVolumeMl": 80.12170931493931
            }
          },
          "hemodynamicPressure": {
            "aortic": {
              "maximumMmHg": 111.29648919376602,
              "minimumMmHg": 77.52496258535398
            },
            "centralVenousMeanMmHg": 3.0795269248997674,
            "pcwpSurrogateMeanMmHg": 8.40282801978899,
            "pulmonaryArtery": {
              "maximumMmHg": 26.17242118724626,
              "minimumMmHg": 12.055592420313948
            }
          },
          "leftVentricle": {
            "maximumDpDtMmHgPerSec": 2564.2544594929004,
            "minimumDpDtMmHgPerSec": -1538.8738086615583
          },
          "mitralFlow": {
            "peakAMlPerSec": 419.0344622960538,
            "peakEMlPerSec": 393.0277050851848,
            "peakEToA": 0.9379364716964619
          },
          "pulmonaryRootMorphology": {
            "maximumPostClosurePapReboundMmHg": 0,
            "papSignificantPeakCount": 1,
            "pvFlowSignificantPeakCount": 1,
            "pvForwardEpisodeCount": 1
          },
          "pulmonaryValve": {
            "ejectionTimeSec": 0.25800000000000267,
            "meanGradientMmHg": 4.448942655299428,
            "peakGradientMmHg": 7.366248564154482
          },
          "rightTiming": {
            "ictSec": 0.027999999999998693,
            "irtSec": 0.06400000000000006,
            "teiIndex": 0.3565891472868132
          },
          "rightVentricle": {
            "maximumDpDtMmHgPerSec": 585.6274034994009,
            "minimumDpDtMmHgPerSec": -371.8957345875963
          },
          "timing": {
            "ictSec": 0.08914285714285342,
            "irtSec": 0.09199999999999875,
            "teiIndex": 0.7021040974529081
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          "tricuspidFlow": {
            "peakAMlPerSec": 320.2095227117433,
            "peakEMlPerSec": 353.51787057249743,
            "peakEToA": 1.1040204787748886
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        }
      },
      "referenceId": "baseline",
      "status": "passed"
    },
    "referenceContext": {
      "assessmentPolicy": {
        "evidence": {
          "checkGroups": [
            {
              "analysisPartition": "objective",
              "changeReason": "Fail closed before interpreting any derived baseline measurement.",
              "checkIds": [
                "settlement.period1"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "numerical-quality",
              "evidenceGap": "No clinical population interval applies to an exact periodic-classifier contract.",
              "evidenceRole": "construction",
              "groupId": "settlement",
              "measurementMeaning": "Whether the exact periodic classifier established the required period-one terminal state.",
              "observationLimitations": "Period-one settlement is numerical admissibility, not physiological normality or independent model validation.",
              "sourceComparisons": [],
              "thresholdBasis": "exact-contract"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "waveform.LVP.single-peak-no-ringing",
                "waveform.RVP.single-peak-no-ringing"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "ventricular-pressure-morphology",
              "measurementMeaning": "Algorithmic peak count, total variation and episode count of pressure during the associated semilunar-valve forward-flow episode.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "waveform.LVP.rounded-not-plateau",
                "waveform.RVP.rounded-not-plateau"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "ventricular-pressure-contour-reference",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Author-institution abstract; ascending aortic pressure waveform groups",
                  "observationMeaning": "Simultaneous ascending aortic pressure and flow; early versus late systolic pressure, not the model's ventricular central-range or peak-index fractions.",
                  "sourceId": "murgo-1980-human-aortic-waveforms",
                  "sourceRange": "Late greater than early in 7, nearly equal in 7, early greater than late in 4.",
                  "targetPopulation": "18 elective catheterization patients in whom no heart disease was found; not a population reference sample."
                },
                {
                  "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.",
                  "locator": "Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7",
                  "observationMeaning": "Simultaneous Millar conductance-catheter LV pressure/volume sampled at 250 Hz; observed inter- and intra-subject PV contours.",
                  "sourceId": "kohli-2017-normalized-human-pv-loops",
                  "sourceRange": null,
                  "targetPopulation": "13 catheterization subjects selected for normal LV function, sinus rhythm and valves; 9 had hypertension. This is not a strictly healthy normative cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Constrain the non-stenotic baseline while retaining the model's explicit pressure-station limitation.",
              "checkIds": [
                "aortic-valve.mean-gradient",
                "aortic-valve.peak-gradient"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "aortic-valve-gradient",
              "measurementMeaning": "Time-weighted mean and maximum raw LV-minus-Ao node pressure difference during native aortic forward flow.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Prevent a gradient reduction obtained by implausibly shortening or prolonging ejection.",
              "checkIds": [
                "aortic-valve.ejection-time"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "evidenceGap": "The frozen construction interval is provisional. Similarity to the retrospective Copenhagen interval does not establish its historical derivation or cross-method validity.",
              "evidenceRole": "construction",
              "groupId": "aortic-ejection-time",
              "measurementMeaning": "Native AoV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen interval is slightly broader at both endpoints; no observer-specific calibration has established equivalence.",
                  "locator": "Table 2; Methods, Cardiac time intervals",
                  "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.",
                  "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
                  "sourceRange": "LVET 248-336 ms.",
                  "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."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Retain plausible contraction and relaxation rates while adjusting aortic ejection morphology.",
              "checkIds": [
                "left-ventricle.maximum-dpdt",
                "left-ventricle.minimum-dpdt"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-pressure-rate",
              "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary LV pressure over the completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The positive mean lies within the frozen corridor; the signed negative mean does not. Exercise values cannot justify a resting cutoff.",
                  "locator": "Abstract; resting values before ergometer exercise",
                  "observationMeaning": "Invasive maximal LV pressure rise and pressure-fall magnitude; the accessible abstract does not fully establish acquisition bandwidth.",
                  "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve",
                  "sourceRange": "Resting maximum +1721 +/- 378 mmHg/s; negative magnitude 1862 +/- 343 mmHg/s (mean +/- SD).",
                  "targetPopulation": "13 patients described as having a normal LV; not a population-based, sex/age-stratified healthy sample."
                },
                {
                  "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.",
                  "locator": "Methods p. 757; normal-control table p. 759; abstract",
                  "observationMeaning": "Millar LV micromanometer and continuous differentiator; average of five sinus beats, after premedication.",
                  "sourceId": "hirota-1980-lv-relaxation",
                  "sourceRange": "Maximum +1674 +/- 421 mmHg/s; negative magnitude 1864 +/- 390 mmHg/s (observed negative-magnitude range 1275-2772).",
                  "targetPopulation": "18 normal controls including patients investigated for chest pain, murmurs or other indications; not a healthy population reference sample."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "mitral-flow.peak-e-to-a"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "mitral-e-to-a",
              "measurementMeaning": "Ratio of peak native mitral forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen bounds truncate some healthy age-specific ranges and admit values outside others; numerical overlap cannot validate a native volume-flow ratio.",
                  "locator": "Tables 3 and 5 (p. 551)",
                  "observationMeaning": "PW Doppler mitral leaflet-tip E and A velocities, identified relative to ECG T and P waves; estimated fifth-to-95th percentiles.",
                  "sourceId": "nagueh-2025-lv-diastolic-function",
                  "sourceRange": "E/A: ages 20-39, 0.88-2.73; ages 40-60, 0.69-2.07; ages 60-80, 0.50-1.40.",
                  "targetPopulation": "Healthy reference data grouped by age; guideline echocardiographic assessment in adults, with age- and sex-aware supplementary data."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "timing.ict",
                "timing.irt",
                "timing.tei-index"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "evidenceGap": "The intervals remain provisional hydraulic timing targets. Matching some published endpoints does not establish a measurement-equivalence study or historical source derivation.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-timing",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Table 2; Methods, Cardiac time intervals",
                  "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.",
                  "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
                  "sourceRange": "IVCT 20-59 ms; IVRT 59-134 ms; MPI 0.29-0.65.",
                  "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."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Maintain broad resting systemic-pressure compatibility as a construction safety envelope.",
              "checkIds": [
                "aortic-pressure.maximum",
                "aortic-pressure.minimum",
                "central-venous-pressure.mean"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "systemic-pressure",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen RA corridor is wider. A single illustrative arterial pressure cannot substantiate either Ao endpoint.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "Mean RAP 2-6 mmHg; systemic systolic/diastolic pressure is illustrated as 120/80 mmHg, not a reference interval.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Use broad resting pressure context as a sentinel while withholding a pulmonary-waveform validation claim.",
              "checkIds": [
                "pulmonary-artery-pressure.maximum",
                "pulmonary-artery-pressure.minimum"
              ],
              "contextEvidenceIds": [
                "mukherjee-ase-right-heart-2025"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-artery-pressure",
              "measurementMeaning": "Extrema of absolute model PA root-node pressure over the exact completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen lower bounds match; the upper bounds are deliberately wider and are not the guideline's normal interval.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "PAP systolic 15-30 mmHg; diastolic 4-12 mmHg.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                },
                {
                  "comparisonToChosenBounds": "These distributions provide context but do not establish the chosen wider systolic and diastolic corridors.",
                  "locator": "Table 1; healthy resting supine catheterization data",
                  "observationMeaning": "Invasive resting supine PAP pooled across cohorts; mean +/- SD rather than a joint systolic/diastolic normal region.",
                  "sourceId": "kovacs-2009-healthy-pap-review",
                  "sourceRange": "Systolic 20.8 +/- 4.4 mmHg (upper limit 29.6); diastolic 8.8 +/- 3.0 mmHg.",
                  "targetPopulation": "47 studies, 1,187 healthy participants overall; resting supine systolic PAP available in 625, with heterogeneous age and sex representation."
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Bound left-sided filling pressure while preserving the explicit station and measurement mismatch.",
              "checkIds": [
                "pcwp-surrogate.mean"
              ],
              "contextEvidenceIds": [
                "kovacs-pawp-healthy-meta-2024"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pcwp-surrogate",
              "measurementMeaning": "Time-weighted completed-beat mean absolute LA pressure, exposed only as a labelled PCWP surrogate.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Main results; individual-data and zero-reference subgroup analyses",
                  "observationMeaning": "Resting supine catheter PAWP, with heterogeneous zero references and respiratory conventions; significant sex differences.",
                  "sourceId": "zeder-2024-healthy-pawp-meta-analysis",
                  "sourceRange": "Pooled PAWP 9.4 +/- 1.82 mmHg; upper limit 13 mmHg (mid-thoracic-zero subgroup 12.2 mmHg).",
                  "targetPopulation": "960 mainly nonobese healthy participants from 49 studies; individual-data subset n=159, median age 26 (IQR 23-53), 67% men."
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Create a deliberately broad cross-modality construction corridor rather than a joint population-normal claim.",
              "checkIds": [
                "left-ventricle.edv-index",
                "left-ventricle.esv-index",
                "left-ventricle.ejection-fraction"
              ],
              "contextEvidenceIds": [
                "lang-ase-eacvi-2015",
                "kou-norre-2014",
                "cmr-consolidated-normal-reference-2016"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-indexed-size-function",
              "measurementMeaning": "Valve-event-defined 0D LV volumes indexed to the reference BSA and their event-defined ejection fraction.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Chosen EF is the sex-union; the volume corridor is not the sex-union and admits larger volumes.",
                  "locator": "Table 2 (p. 7); ED/ES definition (p. 6)",
                  "observationMeaning": "2D biplane LV volumes indexed to BSA; ED/ES may use valve events or cavity extrema; normal ranges based on mean +/- 2 SD.",
                  "sourceId": "lang-2015-chamber-quantification",
                  "sourceRange": "Men: EDVi 34-74, ESVi 11-31 mL/m2, EF 52-72%; women: 29-61, 8-24, 54-74%.",
                  "targetPopulation": "Adult sex-specific echocardiographic reference data."
                },
                {
                  "comparisonToChosenBounds": "The chosen volume and EF bounds are broader than these sex-specific intervals; the source does not support their exact endpoints.",
                  "locator": "Table 2, pp. 684-685",
                  "observationMeaning": "Biplane Simpson 2D echo, excluding papillary muscles and trabeculae from the cavity; BSA indexing does not remove age/sex effects.",
                  "sourceId": "kou-2014-norre-chamber-reference",
                  "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%.",
                  "targetPopulation": "734 healthy adults (320 men, 414 women), age 45.8 +/- 13.3 years, predominantly white Europeans from 22 institutions."
                },
                {
                  "comparisonToChosenBounds": "The chosen corridor is not a CMR normal interval and can exclude source-normal EDVi or EF while admitting much lower volumes.",
                  "locator": "Table 2 (p. 2)",
                  "observationMeaning": "1.5 T SSFP CMR with LV papillary muscles included in mass; mean +/- 2 SD.",
                  "sourceId": "kawel-boehm-2015-cmr-normal-values",
                  "sourceRange": "Men: EDVi 57-105, ESVi 14-38 mL/m2, EF 57-77%; women: 56-96, 14-34, 57-77%.",
                  "targetPopulation": "Pooled adult European cohorts, ages 20-80 years; sex-specific results."
                },
                {
                  "comparisonToChosenBounds": "An updated, method-declared comparison, not support for the retained cross-modality endpoints or a demographic assignment to the synthetic model.",
                  "locator": "Sections 2-3; Table 2 (papillary muscles/trabeculations in mass)",
                  "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.",
                  "sourceId": "kawel-boehm-2025-scmr-reference-values",
                  "sourceRange": "Men: EDVi 46-104, ESVi 11-41 mL/m2, EF 53-79%; women: 46-91, 11-34, 55-80%.",
                  "targetPopulation": "Pooled healthy adult CMR cohorts, sex-specific and mixed ages; not an age-40-49 or single joint population interval.",
                  "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.",
                  "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, LV rows",
                  "observationMeaning": "CMR anatomical segmentation, BSA-indexed volumes and EF; both ventricles can be compared in the same stratum without joining different modalities.",
                  "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
                  "sourceRange": "Men: EDVi 51-102, ESVi 13-40 mL/m2, EF 53-77%; women: 49-88, 13-33, 56-78%.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Retain broad RV size/function safety bounds without extending the current systemic and left-heart claim.",
              "checkIds": [
                "right-ventricle.edv-index",
                "right-ventricle.esv-index",
                "right-ventricle.ejection-fraction"
              ],
              "contextEvidenceIds": [
                "lang-ase-eacvi-2015-3de-rv"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-indexed-size-function",
              "measurementMeaning": "Valve-event-defined 0D RV volumes indexed to the reference BSA and their event-defined ejection fraction.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Volume bounds reproduce the sex-union. EF bounds span subgroup extremes, not a universal normal range.",
                  "locator": "Table 8 (p. 20); Supplemental Table 8 (p. 39.e13)",
                  "observationMeaning": "3D-echo RV volume segmentation and BSA indexing; subgroup EF limits are fifth/95th percentiles.",
                  "sourceId": "lang-2015-chamber-quantification",
                  "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.",
                  "targetPopulation": "Adult sex-specific 3D-echo data; supplemental RV EF limits further stratified by age."
                },
                {
                  "comparisonToChosenBounds": "Chosen volume bounds exclude substantial CMR-normal values; the 3D-echo corridor cannot be called a broad cross-modality RV normal interval.",
                  "locator": "Table 6 (p. 7)",
                  "observationMeaning": "1.5 T SSFP CMR with RV trabeculations and papillary muscles in the cavity; mean +/- 2 SD.",
                  "sourceId": "kawel-boehm-2015-cmr-normal-values",
                  "sourceRange": "Men: EDVi 61-121, ESVi 19-59 mL/m2, EF 52-72%; women: 48-112, 12-52, 51-71%.",
                  "targetPopulation": "Healthy adult cohorts aged 20-68 years, sex-specific results; indexed RV ESV uses the Hudsmith cohort."
                },
                {
                  "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.",
                  "locator": "Sections 2 and 4; Table 8 (papillary muscles/trabeculations in mass), not smooth-segmentation Table 9",
                  "observationMeaning": "Short-axis bSSFP anatomical RV cavity volume with myocardial tissue excluded from blood volume; event, geometric and segmentation correspondence to 0D remains approximate.",
                  "sourceId": "kawel-boehm-2025-scmr-reference-values",
                  "sourceRange": "Men: EDVi 49-117, ESVi 12-56 mL/m2, EF 44-77%; women: 47-99, 11-43, 49-77%.",
                  "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.",
                  "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.",
                  "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, RV rows",
                  "observationMeaning": "CMR anatomical segmentation and BSA indexation, same subject strata and measurement convention as the LV comparison.",
                  "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
                  "sourceRange": "Men: EDVi 61-118, ESVi 21-55 mL/m2, EF 44-71%; women: 53-97, 17-42, 49-73%.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Maintain broad resting forward-flow compatibility across the admitted HR values.",
              "checkIds": [
                "systemic-forward-flow.cardiac-index",
                "systemic-forward-flow.stroke-volume-index"
              ],
              "contextEvidenceIds": [
                "cardiac-index-clinical-reference",
                "resting-indexed-flow-reference"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "indexed-systemic-forward-flow",
              "measurementMeaning": "Positive-only native AoV flow integrated for stroke volume and converted to cardiac output over the completed beat, both indexed to reference BSA.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "CI endpoints match exactly; SVI endpoints do not. Fick/thermodilution output is not necessarily the model's positive-only valve-flow output.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "CI 2.5-4.0 L/min/m2; SVI 33-47 mL/m2.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                },
                {
                  "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.",
                  "coveredCheckIds": [
                    "systemic-forward-flow.cardiac-index",
                    "systemic-forward-flow.stroke-volume-index"
                  ],
                  "locator": "Methods; healthy-group results and age analysis",
                  "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.",
                  "sourceId": "carlsson-2012-cmr-cardiac-output",
                  "sourceRange": "CI 3.2 +/- 0.5 L/min/m2; SVI 51 +/- 7 mL/m2 (mean +/- SD).",
                  "targetPopulation": "144 healthy nonathletic adults, 68 women, ages 21-81 (mean 39 +/- 16) years; BMI <=30, no cardiovascular disease or medication.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record the existing Standard70 right-heart gradient sentinels without promoting them to left-objective groups or changing their numerical limits.",
              "checkIds": [
                "pulmonary-valve.mean-gradient",
                "pulmonary-valve.peak-gradient"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-valve-gradient",
              "measurementMeaning": "Time-weighted mean and maximum raw RV-minus-PA node pressure difference while native PV flow is positive over the completed beat.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record the existing Standard70 pulmonary ejection-time corridor with its missing method-matched normative evidence.",
              "checkIds": [
                "pulmonary-valve.ejection-time"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-ejection-time",
              "measurementMeaning": "Native PV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Reclassify the existing Standard70 RV derivative corridors as reference warnings without altering the recorded numerical bounds.",
              "checkIds": [
                "right-ventricle.maximum-dpdt",
                "right-ventricle.minimum-dpdt"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-pressure-rate",
              "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary RV pressure over the completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "This is not the maximum native intracavitary derivative and does not establish either chosen endpoint or a normal upper limit.",
                  "locator": "RV dP/dt section, pp. 158-159",
                  "observationMeaning": "TR Doppler 1-to-2 m/s upslope converted to a 12 mmHg pressure-gradient rise divided by time.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "RV dP/dt below 400 mmHg/s is abnormal for this Doppler method.",
                  "targetPopulation": "Adult right-heart echocardiography; normal-reference data are limited."
                },
                {
                  "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.",
                  "locator": "Abstract; normal-PAP and pulmonary-hypertension groups",
                  "observationMeaning": "Maximal invasive RV pressure-fall magnitude; strong pressure-load dependence, with acquisition detail incompletely resolved by the abstract.",
                  "sourceId": "stein-1980-rv-pressure-fall",
                  "sourceRange": "Normal-PAP group 170 +/- 20 mmHg/s; pulmonary-hypertension groups 670 +/- 60 mmHg/s, with or without RV failure.",
                  "targetPopulation": "34 patients: eight with normal PAP, 17 with pulmonary hypertension, nine with pulmonary hypertension and RV failure; not a general healthy reference cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "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.",
              "checkIds": [
                "tricuspid-flow.peak-e-to-a"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "tricuspid-e-to-a",
              "measurementMeaning": "Ratio of peak native tricuspid forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen numeric endpoints match, but flow-versus-velocity and respiratory averaging differ; this is not method-matched validation.",
                  "locator": "Table 1; RV diastolic function, pp. 168-169",
                  "observationMeaning": "PW tricuspid inflow E/A velocities; end-expiratory averaging over at least five beats.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "Tricuspid E/A >=0.8 and <2.0.",
                  "targetPopulation": "Adult echocardiographic reference context."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "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.",
              "checkIds": [
                "right-timing.ict",
                "right-timing.irt",
                "right-timing.tei-index"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-timing",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen upper IRT and Tei bounds are wider, and no chosen lower bound or ICT interval follows from these thresholds.",
                  "locator": "RV MPI, pp. 158-159; IVRT, pp. 168-169",
                  "observationMeaning": "PW-Doppler or tissue-Doppler MPI and tissue-Doppler IVRT, not native valve-flow events.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "MPI <0.40 by PW Doppler or <0.55 by TDI; IVRT <=73 ms by TDI.",
                  "targetPopulation": "Adult right-heart echocardiography."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record Standard70 pulmonary ringing and re-ejection guards as construction-only waveform criteria.",
              "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"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-root-morphology",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Qualitative flow context only; it establishes no peak-prominence, PAP peak-count or post-PV-closure rebound cutoff.",
                  "locator": "RVOT Doppler flow, p. 158",
                  "observationMeaning": "Qualitative RVOT Doppler velocity waveform: parabolic with a midsystolic peak.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": null,
                  "targetPopulation": "Adult resting right-heart echocardiography."
                }
              ],
              "thresholdBasis": "engineering-guess"
            }
          ],
          "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."
          },
          "evaluationPolicyId": "main-wire-standard70-baseline-evaluation-roles-v3",
          "evidenceBindings": [
            {
              "canonicalSourceIds": [
                "lang-2015-chamber-quantification"
              ],
              "evidenceId": "lang-ase-eacvi-2015",
              "limitations": "Modality-, sex-, age-, and body-size-dependent reference context; it does not directly define this model's joint admissible interval.",
              "measurementMeaning": "Adult echocardiographic LV chamber volumes and systolic function.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "kou-2014-norre-chamber-reference"
              ],
              "evidenceId": "kou-norre-2014",
              "limitations": "The cohort and measurement method do not identify a unique 0D-model parameter vector or a joint multivariate normal region.",
              "measurementMeaning": "Two-dimensional echocardiographic adult chamber-size reference ranges.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "kawel-boehm-2015-cmr-normal-values"
              ],
              "evidenceId": "cmr-consolidated-normal-reference-2016",
              "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.",
              "measurementMeaning": "CMR chamber-volume and function reference context across published cohorts.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "lang-2015-chamber-quantification"
              ],
              "evidenceId": "lang-ase-eacvi-2015-3de-rv",
              "limitations": "A 0D chamber volume is compared only as broad construction context; acquisition and segmentation conventions remain different.",
              "measurementMeaning": "Adult three-dimensional echocardiographic RV volumes and ejection fraction.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "carlsson-2012-cmr-cardiac-output",
                "barratt-boyes-wood-1958-healthy-hemodynamics"
              ],
              "evidenceId": "cardiac-index-clinical-reference",
              "limitations": "The model interval is an engineering synthesis across methods and cohorts, not a verbatim interval from either source.",
              "measurementMeaning": "Resting forward cardiac output indexed to body surface area.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "carlsson-2012-cmr-cardiac-output",
                "barratt-boyes-wood-1958-healthy-hemodynamics"
              ],
              "evidenceId": "resting-indexed-flow-reference",
              "limitations": "Stroke-volume index depends on heart rate, body-size convention, cohort, and acquisition method; the gate is a broad engineering envelope.",
              "measurementMeaning": "Resting systemic forward stroke volume indexed to body surface area.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "mukherjee-2025-right-heart-guideline",
                "kovacs-2009-healthy-pap-review"
              ],
              "evidenceId": "mukherjee-ase-right-heart-2025",
              "limitations": "This does not directly support the exact 10-35 mmHg model interval or validate the current pulmonary waveform shape.",
              "measurementMeaning": "Right-heart echocardiographic assessment and healthy pulmonary arterial pressure context.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "zeder-2024-healthy-pawp-meta-analysis"
              ],
              "evidenceId": "kovacs-pawp-healthy-meta-2024",
              "limitations": "The retained legacy evidence ID uses the last author's name; the model reports mean LA pressure, not a simulated wedged-catheter measurement.",
              "measurementMeaning": "Supine resting pulmonary arterial wedge pressure in healthy subjects.",
              "useRole": "construction-context"
            }
          ],
          "observationMethodId": "main-wire-baseline-observation-v2",
          "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.",
          "policyRevisions": [
            {
              "changeReason": "Capture the current Standard68 mint policy and healthy-reference context after retrospective provenance repair.",
              "evidenceRole": "construction",
              "policySha256": "74f5b1ca712b56f304fee1ccf20da3e9dee8c7102213a2cb60dc2e7701cf3356",
              "revisionId": "main-wire-standard68-baseline-policy-r1"
            }
          ],
          "preloadReservePolicyRevisions": [
            {
              "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.",
              "decisionTiming": "post-hoc-after-exploratory-candidate-inspection",
              "evidenceRole": "construction",
              "policySha256": "dec7d6cdf587522c67892f0f94c910a2a8871a1aada6620c1a8778869109f4d5",
              "revisionId": "main-wire-standard69-preload-reserve-policy-r1"
            }
          ],
          "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.",
          "registryId": "main-wire-normal-reference-evidence-v1",
          "schemaVersion": 1,
          "sourceComparisonTiming": "retrospective-provenance-audit-not-original-cutoff-derivation",
          "sources": [
            {
              "identifiers": {
                "doi": "10.1093/eurheartj/ehu293"
              },
              "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",
              "url": "https://academic.oup.com/eurheartj/article/35/44/3122/2293191",
              "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.",
              "year": 2014
            },
            {
              "identifiers": {
                "doi": "10.1093/oxfordjournals.eurheartj.a062515",
                "pmid": "3383877"
              },
              "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",
              "url": "https://pubmed.ncbi.nlm.nih.gov/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.",
              "year": 1988
            },
            {
              "identifiers": {
                "doi": "10.1161/01.CIR.62.1.105",
                "pmid": "7379273"
              },
              "sourceId": "murgo-1980-human-aortic-waveforms",
              "title": "Aortic input impedance in normal man: relationship to pressure wave forms",
              "url": "https://scholars.uthscsa.edu/es/publications/aortic-input-impedance-in-normal-man-relationship-to-pressure-wav/",
              "verification": "author-institution-abstract-checked-not-full-text",
              "year": 1980
            },
            {
              "identifiers": {
                "doi": "10.14814/phy2.13160",
                "pmid": "28351966"
              },
              "sourceId": "kohli-2017-normalized-human-pv-loops",
              "title": "The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop",
              "url": "https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.13160",
              "verification": "primary-full-text-methods-and-figures-4-5-checked",
              "year": 2017
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2014.10.003",
                "pmid": "25559473"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2016/02/2015_ChamberQuantificationREV.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2015
            },
            {
              "identifiers": {
                "doi": "10.1093/ehjci/jet284",
                "pmid": "24451180"
              },
              "sourceId": "kou-2014-norre-chamber-reference",
              "title": "Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study",
              "url": "https://orbi.uliege.be/bitstream/2268/169431/1/Eur%20Heart%20J%20Cardiovasc%20Imaging-2014-Kou-680-90.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2014
            },
            {
              "identifiers": {
                "doi": "10.1186/s12968-015-0111-7",
                "pmid": "25928314"
              },
              "sourceId": "kawel-boehm-2015-cmr-normal-values",
              "title": "Normal values for cardiovascular magnetic resonance in adults and children",
              "url": "https://link.springer.com/content/pdf/10.1186/s12968-015-0111-7.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2015
            },
            {
              "identifiers": {
                "doi": "10.1186/1532-429X-14-51",
                "pmid": "22839436"
              },
              "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",
              "url": "https://link.springer.com/article/10.1186/1532-429X-14-51",
              "verification": "primary-full-text-methods-and-results-checked",
              "year": 2012
            },
            {
              "identifiers": {
                "doi": "10.1016/j.jocmr.2025.101853",
                "pmcid": "PMC12159681"
              },
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "title": "Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update",
              "url": "https://pmc.ncbi.nlm.nih.gov/articles/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.",
              "year": 2025
            },
            {
              "identifiers": {
                "doi": "10.1016/j.jcmg.2024.01.009",
                "pmid": "38613554"
              },
              "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
              "title": "Cardiovascular Magnetic Resonance Reference Ranges From the Healthy Hearts Consortium: author-published anatomical segmentation tables",
              "url": "https://healthy-hearts.org.uk/tables/",
              "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.",
              "year": 2024
            },
            {
              "identifiers": {
                "pmid": "13514210"
              },
              "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",
              "url": "https://pubmed.ncbi.nlm.nih.gov/13514210/",
              "verification": "primary-source-metadata-checked",
              "year": 1958
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2025.01.006",
                "pmid": "40044341"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2025/03/PIIS0894731725000379.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2025
            },
            {
              "identifiers": {
                "doi": "10.1183/09031936.00145608"
              },
              "sourceId": "kovacs-2009-healthy-pap-review",
              "title": "Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review",
              "url": "https://publications.ersnet.org/highwire_display/entity_view/node/476971/full",
              "verification": "primary-source-metadata-checked",
              "year": 2009
            },
            {
              "identifiers": {
                "doi": "10.1183/13993003.00967-2024",
                "pmid": "38964777"
              },
              "sourceId": "zeder-2024-healthy-pawp-meta-analysis",
              "title": "Pulmonary arterial wedge pressure in healthy subjects: a meta-analysis",
              "url": "https://publications.ersnet.org/content/erj/64/2/2400967",
              "verification": "primary-source-metadata-checked",
              "year": 2024
            },
            {
              "identifiers": {
                "doi": "10.1183/13993003.00879-2022",
                "pmid": "36028254"
              },
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "title": "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension",
              "url": "https://publications.ersnet.org/lookup/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.",
              "year": 2022
            },
            {
              "identifiers": {
                "doi": "10.1007/s00392-023-02269-2"
              },
              "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",
              "url": "https://link.springer.com/article/10.1007/s00392-023-02269-2",
              "verification": "primary-source-metadata-checked",
              "year": 2023
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2025.03.011"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2025/07/Left-Ventricular-Diastolic-Function.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2025
            },
            {
              "identifiers": {
                "pmid": "602351"
              },
              "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve",
              "title": "Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle",
              "url": "https://pubmed.ncbi.nlm.nih.gov/602351/",
              "verification": "primary-source-metadata-checked",
              "year": 1977
            },
            {
              "identifiers": {
                "doi": "10.1161/01.cir.62.4.756",
                "pmid": "7190882"
              },
              "sourceId": "hirota-1980-lv-relaxation",
              "title": "A clinical study of left ventricular relaxation",
              "url": "https://pubmed.ncbi.nlm.nih.gov/7190882/",
              "verification": "primary-source-metadata-checked",
              "year": 1980
            },
            {
              "identifiers": {
                "doi": "10.1378/chest.78.1.10",
                "pmid": "7471826"
              },
              "sourceId": "stein-1980-rv-pressure-fall",
              "title": "Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle",
              "url": "https://pubmed.ncbi.nlm.nih.gov/7471826/",
              "verification": "primary-source-metadata-checked",
              "year": 1980
            }
          ],
          "supplementalChecks": [
            {
              "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.",
              "checkId": "left-ventricle.relaxation-tau",
              "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.",
              "observationMethodId": "main-wire-lv-relaxation-tau-v1",
              "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.",
              "referenceSourceIds": [
                "nagueh-2025-lv-diastolic-function",
                "hirota-1980-lv-relaxation"
              ],
              "referenceUpperMs": 48,
              "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."
            }
          ]
        },
        "policy": {
          "anatomyRule": "For this sex-unspecified generic baseline only, automatic eligibility requires all six valid anatomical CMR comparisons inside BOTH declared sex strata. Otherwise require demographic/method review, not automatic disease rejection. This conservative design intersection does not assign sex or claim joint population normality; preset/patient fitting must use its own profile.",
          "loadGuardRationale": "Keep a baseline away from low/high systemic load and high native end-filling pressure. Ao bounds are retained design choices, not derived from Herbert. LV native flow cessation may precede the pressure upstroke; <=16 is an approximate end-filling design ceiling, not validated catheter LVEDP equivalence or a lower normal limit.",
          "numericalAndConstructionProvenance": "Inherited numerical/gradient/ringing checks resolve their existing per-check evidence; new rest criteria do not reinterpret the old physiological corridors or clear the old provenance audit.",
          "operating": [
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, CI",
              "lower": 2.5,
              "metricId": "systemic-net-flow.cardiac-index",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 4
            },
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, mean RAP",
              "lower": 2,
              "metricId": "central-venous-pressure.mean",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 6
            },
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, mean PAP",
              "lower": 8,
              "metricId": "pulmonary-artery-pressure.mean",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 20
            },
            {
              "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
              "locator": "Methods, invasive versus cuff-calibrated pressure distinction",
              "lower": 90,
              "metricId": "aortic-pressure.maximum",
              "sourceId": "herbert-2014-central-pressure-reference",
              "upper": 140
            },
            {
              "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
              "locator": "Methods, DBP calibration; no central-DBP reference interval",
              "lower": 60,
              "metricId": "aortic-pressure.minimum",
              "sourceId": "herbert-2014-central-pressure-reference",
              "upper": 90
            },
            {
              "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range",
              "locator": "Section2, Table1 p539 (>16), Figure1 p540",
              "lower": null,
              "metricId": "left-ventricle.native-end-filling-pressure",
              "sourceId": "nagueh-2025-lv-diastolic-function",
              "upper": 16
            }
          ],
          "policyId": "main-wire-prospective-baseline-admission-v1",
          "regression": "__tests__/mainWireProspectiveBaselineAdmissionV1.test.ts",
          "scope": "Resting unassisted nonshunting sinus research construction, BSA1.9, HR60 or70, zero intrathoracic reference. Scientific eligibility for exact-model promotion, not public mint or clinical normality.",
          "warningRule": "Keep strict source comparisons for phasic PAP, ET, anatomy and SVI plus historical timing/E-A/dPdt/roundness context. A warning never excuses missing, nonfinite or invalid observations. Preserve unexplained ringing/closure-rebound construction holds; pressure-peak phase and PV roundness are not universal normality gates."
        }
      },
      "methodId": "main-wire-baseline-observation-v2",
      "reference": {
        "clinicalValidationClaimed": false,
        "evidenceRole": "construction",
        "label": "baseline",
        "referenceId": "baseline",
        "target": {
          "admissionPolicyId": "main-wire-prospective-baseline-admission-v1",
          "comparisonProfileId": "main-wire-resting-reference-profile-v1",
          "evaluationRolePolicyId": "main-wire-standard70-baseline-evaluation-roles-v3",
          "evidenceRegistryId": "main-wire-normal-reference-evidence-v1",
          "kind": "construction-corridors",
          "referenceOutputsAreTargets": false
        }
      }
    }
  },
  {
    "modelId": "circleheart.main-wire-integrated-transaction-v3.static-anatomy.standard-74",
    "numericalSourceSha256": "f92b231c6f11c4746bb9f47e96d89cbe6f17692f57f704cca5ff82eb1ee2b326",
    "resultSha256": "04f0c00b4eee5014418049a4786e385039ade65dda86b731d15b8ee86bd087fc",
    "nominalDtSec": 0.001,
    "initialization": {
      "kind": "cold"
    },
    "cycles": 56,
    "rest": {
      "assessment": {
        "anatomyReviewRequired": false,
        "comparison": {
          "admissionDecision": "not-performed",
          "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.",
          "endTimeSec": 47.86799999999995,
          "entries": [
            {
              "actual": 0.25499999999999545,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.248,
                    "upper": 0.336
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "Copenhagen pooled healthy adults; HR 63 +/- 10"
                }
              ],
              "locator": "Methods, Cardiac time intervals; Table 2, pooled LVET 95% prediction interval",
              "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.",
              "metricId": "aortic-valve.ejection-time",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
              "unit": "s"
            },
            {
              "actual": 0.25800000000000267,
              "comparisons": [],
              "locator": "Abstract: population and recording stations; no numeric adult ET interval verified",
              "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.",
              "metricId": "pulmonary-valve.ejection-time",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "van-oort-1988-pulmonary-doppler",
              "unit": "s"
            },
            {
              "actual": 111.35437809515427,
              "comparisons": [
                {
                  "range": {
                    "lower": 80,
                    "upper": 110
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "outside-source-range",
                  "stratum": "women 20-29"
                },
                {
                  "range": {
                    "lower": 92,
                    "upper": 115
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 20-29"
                },
                {
                  "range": {
                    "lower": 84,
                    "upper": 119
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 30-39"
                },
                {
                  "range": {
                    "lower": 88,
                    "upper": 120
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 30-39"
                },
                {
                  "range": {
                    "lower": 87,
                    "upper": 123
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 40-49"
                },
                {
                  "range": {
                    "lower": 90,
                    "upper": 123
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 40-49"
                },
                {
                  "range": {
                    "lower": 93,
                    "upper": 127
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 50-59"
                },
                {
                  "range": {
                    "lower": 96,
                    "upper": 126
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 50-59"
                },
                {
                  "range": {
                    "lower": 97,
                    "upper": 129
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 60-69"
                },
                {
                  "range": {
                    "lower": 97,
                    "upper": 128
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 60-69"
                },
                {
                  "range": {
                    "lower": 100,
                    "upper": 131
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "women 70+"
                },
                {
                  "range": {
                    "lower": 99,
                    "upper": 130
                  },
                  "statistic": "published-10th-90th-percentiles",
                  "status": "inside-source-range",
                  "stratum": "men 70+"
                }
              ],
              "locator": "Methods, Standardizing methodologies; Table 2, Normal population, all adult age rows",
              "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.",
              "metricId": "aortic-pressure.maximum",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "herbert-2014-central-pressure-reference",
              "unit": "mmHg"
            },
            {
              "actual": 77.54846419227914,
              "comparisons": [],
              "locator": "Methods, Standardizing methodologies; Table 1, brachial DBP summary",
              "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.",
              "metricId": "aortic-pressure.minimum",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "herbert-2014-central-pressure-reference",
              "unit": "mmHg"
            },
            {
              "actual": 3.0758312312680354,
              "comparisons": [
                {
                  "range": {
                    "lower": 2,
                    "upper": 6
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, mean RAP; section 5.1.12.1",
              "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.",
              "metricId": "central-venous-pressure.mean",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 26.166946634024157,
              "comparisons": [
                {
                  "range": {
                    "lower": 15,
                    "upper": 30
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, systolic PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.maximum",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 12.03387992696858,
              "comparisons": [
                {
                  "range": {
                    "lower": 4,
                    "upper": 12
                  },
                  "statistic": "published-reference-interval",
                  "status": "outside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, diastolic PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.minimum",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 17.871712818401345,
              "comparisons": [
                {
                  "range": {
                    "lower": 8,
                    "upper": 20
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "locator": "Table 11, mean PAP; section 5.1.12.1",
              "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.",
              "metricId": "pulmonary-artery-pressure.mean",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 8.377448599630208,
              "comparisons": [
                {
                  "range": {
                    "lower": null,
                    "upper": 15
                  },
                  "statistic": "clinical-upper-limit",
                  "status": "not-above-source-upper-limit",
                  "stratum": "adult RHC PAWP clinical reference"
                }
              ],
              "locator": "Table 11, PAWP; section 5.1.12.1",
              "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.",
              "metricId": "pcwp-surrogate.mean",
              "observationStatus": "observed",
              "role": "method-context",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mmHg"
            },
            {
              "actual": 75.64295371315426,
              "comparisons": [
                {
                  "range": {
                    "lower": 46,
                    "upper": 104
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 46,
                    "upper": 91
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.edv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 33.45028226585985,
              "comparisons": [
                {
                  "range": {
                    "lower": 11,
                    "upper": 41
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 11,
                    "upper": 34
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.esv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 0.5577872012678575,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.53,
                    "upper": 0.79
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 0.55,
                    "upper": 0.8
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 2, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "left-ventricle.ejection-fraction",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "fraction"
            },
            {
              "actual": 74.05801460699432,
              "comparisons": [
                {
                  "range": {
                    "lower": 49,
                    "upper": 117
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 47,
                    "upper": 99
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.edv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 31.86570133636767,
              "comparisons": [
                {
                  "range": {
                    "lower": 12,
                    "upper": 56
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 11,
                    "upper": 43
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.esv-index",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "mL/m2"
            },
            {
              "actual": 0.5697197459927834,
              "comparisons": [
                {
                  "range": {
                    "lower": 0.44,
                    "upper": 0.77
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "men, pooled adult ages"
                },
                {
                  "range": {
                    "lower": 0.49,
                    "upper": 0.77
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "women, pooled adult ages"
                }
              ],
              "locator": "Table 8, anatomical segmentation, sex-specific indexed volume/EF rows",
              "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.",
              "metricId": "right-ventricle.ejection-fraction",
              "observationStatus": "observed",
              "role": "demographic-comparison",
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "unit": "fraction"
            },
            {
              "actual": 2.953486998647304,
              "comparisons": [
                {
                  "range": {
                    "lower": 2.5,
                    "upper": 4
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "historicalCheckId": "systemic-forward-flow.cardiac-index",
              "locator": "Table 11, CI; section 5.1.12.1, direct Fick/thermodilution",
              "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.",
              "metricId": "systemic-net-flow.cardiac-index",
              "observationStatus": "observed",
              "role": "operating-comparison",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "L/min/m2"
            },
            {
              "actual": 42.19267140924705,
              "comparisons": [
                {
                  "range": {
                    "lower": 33,
                    "upper": 47
                  },
                  "statistic": "published-reference-interval",
                  "status": "inside-source-range",
                  "stratum": "resting adult RHC reference"
                }
              ],
              "historicalCheckId": "systemic-forward-flow.stroke-volume-index",
              "locator": "Table 11, SVI; section 5.1.12.1",
              "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.",
              "metricId": "systemic-net-flow.stroke-volume-index",
              "observationStatus": "observed",
              "role": "coupled-flow-context",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "unit": "mL/m2"
            }
          ],
          "flowCoupling": {
            "basis": "signed-native-AoV-net-flow",
            "ciConditionalSviIntervalMlPerM2": {
              "lower": 35.71428571428558,
              "upper": 57.14285714285693
            },
            "ciMinusHrTimesSviOver1000": -4.440892098500626e-16,
            "conditionalIntervalIsPublishedSviReference": false,
            "forwardMinusNetCi": 0,
            "pulmonaryMinusAorticNetFlowLPerMin": -0.00004763389824535835
          },
          "heartRateBpm": 70.00000000000026,
          "nativeLvEndDiastolicPressure": {
            "absolutePressureMmHg": 10.940681487530963,
            "differenceFromMeanLaMmHg": 2.563232887900755,
            "externalPressureMmHg": 0,
            "timeSec": 47.11571428571428,
            "transmuralPressureMmHg": 10.940681487530963
          },
          "observationApplicabilityEstablished": false,
          "physiologicalNormalityClaimed": false,
          "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.",
          "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.",
          "startTimeSec": 47.0108571428571,
          "subject": {
            "age": "unspecified",
            "allowedHeartRatesBpm": [
              60,
              70
            ],
            "bodySurfaceAreaM2": 1.9,
            "ethnicity": "unspecified",
            "sex": "unspecified"
          }
        },
        "historicalWarnings": [
          {
            "actual": 2600.069423820747,
            "checkId": "left-ventricle.maximum-dpdt",
            "maximum": 2500,
            "minimum": 1200,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": -1556.3378582564847,
            "checkId": "left-ventricle.minimum-dpdt",
            "maximum": -700,
            "minimum": -1400,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": 0.0931428571428583,
            "checkId": "timing.ict",
            "maximum": 0.07,
            "minimum": 0.02,
            "status": "failed",
            "unit": "s"
          },
          {
            "actual": 0.7338935574229916,
            "checkId": "timing.tei-index",
            "maximum": 0.65,
            "minimum": 0.29,
            "status": "failed",
            "unit": "ratio"
          }
        ],
        "invalidOrFailedRetained": [],
        "operating": [
          {
            "actual": 2.953486998647304,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, CI",
            "lower": 2.5,
            "metricId": "systemic-net-flow.cardiac-index",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 4
          },
          {
            "actual": 3.0758312312680354,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, mean RAP",
            "lower": 2,
            "metricId": "central-venous-pressure.mean",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 6
          },
          {
            "actual": 17.871712818401345,
            "basis": "source-informed-operating-target",
            "locator": "Table 11, mean PAP",
            "lower": 8,
            "metricId": "pulmonary-artery-pressure.mean",
            "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
            "status": "passed",
            "upper": 20
          },
          {
            "actual": 111.35437809515427,
            "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
            "locator": "Methods, invasive versus cuff-calibrated pressure distinction",
            "lower": 90,
            "metricId": "aortic-pressure.maximum",
            "sourceId": "herbert-2014-central-pressure-reference",
            "status": "passed",
            "upper": 140
          },
          {
            "actual": 77.54846419227914,
            "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
            "locator": "Methods, DBP calibration; no central-DBP reference interval",
            "lower": 60,
            "metricId": "aortic-pressure.minimum",
            "sourceId": "herbert-2014-central-pressure-reference",
            "status": "passed",
            "upper": 90
          },
          {
            "actual": 10.940681487530963,
            "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range",
            "locator": "Section2, Table1 p539 (>16), Figure1 p540",
            "lower": null,
            "metricId": "left-ventricle.native-end-filling-pressure",
            "sourceId": "nagueh-2025-lv-diastolic-function",
            "status": "passed",
            "upper": 16
          }
        ],
        "status": "passed",
        "unavailable": []
      },
      "observation": {
        "checks": [
          {
            "actual": 1,
            "checkId": "settlement.period1",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 1,
            "checkId": "waveform.LVP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 0.2047946870215112,
            "checkId": "waveform.LVP.rounded-not-plateau",
            "maximum": 0.35,
            "minimum": 0.08,
            "status": "passed",
            "unit": "fraction"
          },
          {
            "actual": 1,
            "checkId": "waveform.RVP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "bool"
          },
          {
            "actual": 0.18713168215863774,
            "checkId": "waveform.RVP.rounded-not-plateau",
            "maximum": 0.35,
            "minimum": 0.08,
            "status": "passed",
            "unit": "fraction"
          },
          {
            "actual": 4.2688920544472495,
            "checkId": "aortic-valve.mean-gradient",
            "maximum": 5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 7.856587691589837,
            "checkId": "aortic-valve.peak-gradient",
            "maximum": 10,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 0.25499999999999545,
            "checkId": "aortic-valve.ejection-time",
            "maximum": 0.34,
            "minimum": 0.24,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 2600.069423820747,
            "checkId": "left-ventricle.maximum-dpdt",
            "maximum": 2500,
            "minimum": 1200,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": -1556.3378582564847,
            "checkId": "left-ventricle.minimum-dpdt",
            "maximum": -700,
            "minimum": -1400,
            "status": "failed",
            "unit": "mmHg/s"
          },
          {
            "actual": 0.9290646643310849,
            "checkId": "mitral-flow.peak-e-to-a",
            "maximum": 2,
            "minimum": 0.8,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 0.0931428571428583,
            "checkId": "timing.ict",
            "maximum": 0.07,
            "minimum": 0.02,
            "status": "failed",
            "unit": "s"
          },
          {
            "actual": 0.0940000000000012,
            "checkId": "timing.irt",
            "maximum": 0.134,
            "minimum": 0.059,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 0.7338935574229916,
            "checkId": "timing.tei-index",
            "maximum": 0.65,
            "minimum": 0.29,
            "status": "failed",
            "unit": "ratio"
          },
          {
            "actual": 111.35437809515427,
            "checkId": "aortic-pressure.maximum",
            "maximum": 140,
            "minimum": 90,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 77.54846419227914,
            "checkId": "aortic-pressure.minimum",
            "maximum": 90,
            "minimum": 60,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 26.166946634024157,
            "checkId": "pulmonary-artery-pressure.maximum",
            "maximum": 35,
            "minimum": 15,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 12.03387992696858,
            "checkId": "pulmonary-artery-pressure.minimum",
            "maximum": 15,
            "minimum": 4,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 3.0758312312680354,
            "checkId": "central-venous-pressure.mean",
            "maximum": 8,
            "minimum": 1,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 8.377448599630208,
            "checkId": "pcwp-surrogate.mean",
            "maximum": 13,
            "minimum": 4,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 75.64295371315426,
            "checkId": "left-ventricle.edv-index",
            "maximum": 99,
            "minimum": 34,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 33.45028226585985,
            "checkId": "left-ventricle.esv-index",
            "maximum": 40,
            "minimum": 10,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 0.5577872012678575,
            "checkId": "left-ventricle.ejection-fraction",
            "maximum": 0.74,
            "minimum": 0.52,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 74.05801460699432,
            "checkId": "right-ventricle.edv-index",
            "maximum": 87,
            "minimum": 32,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 31.86570133636767,
            "checkId": "right-ventricle.esv-index",
            "maximum": 44,
            "minimum": 8,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 0.5697197459927834,
            "checkId": "right-ventricle.ejection-fraction",
            "maximum": 0.82,
            "minimum": 0.42,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 2.9534869986473034,
            "checkId": "systemic-forward-flow.cardiac-index",
            "maximum": 4,
            "minimum": 2.5,
            "status": "passed",
            "unit": "L/min/m2"
          },
          {
            "actual": 42.19267140924705,
            "checkId": "systemic-forward-flow.stroke-volume-index",
            "maximum": 65,
            "minimum": 35,
            "status": "passed",
            "unit": "mL/m2"
          },
          {
            "actual": 4.453576925688471,
            "checkId": "pulmonary-valve.mean-gradient",
            "maximum": 5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 7.415462429217236,
            "checkId": "pulmonary-valve.peak-gradient",
            "maximum": 10,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          },
          {
            "actual": 0.25800000000000267,
            "checkId": "pulmonary-valve.ejection-time",
            "maximum": 0.35,
            "minimum": 0.22,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 602.8260931029814,
            "checkId": "right-ventricle.maximum-dpdt",
            "maximum": 1000,
            "minimum": 300,
            "status": "passed",
            "unit": "mmHg/s"
          },
          {
            "actual": -375.68447322572655,
            "checkId": "right-ventricle.minimum-dpdt",
            "maximum": -150,
            "minimum": -700,
            "status": "passed",
            "unit": "mmHg/s"
          },
          {
            "actual": 1.089865656083185,
            "checkId": "tricuspid-flow.peak-e-to-a",
            "maximum": 2,
            "minimum": 0.8,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 0.027999999999998693,
            "checkId": "right-timing.ict",
            "maximum": 0.09,
            "minimum": 0.02,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 0.06400000000000006,
            "checkId": "right-timing.irt",
            "maximum": 0.12,
            "minimum": 0.03,
            "status": "passed",
            "unit": "s"
          },
          {
            "actual": 0.3565891472868132,
            "checkId": "right-timing.tei-index",
            "maximum": 0.65,
            "minimum": 0.25,
            "status": "passed",
            "unit": "ratio"
          },
          {
            "actual": 1,
            "checkId": "waveform.PAP.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 1,
            "checkId": "waveform.PV-flow.single-forward-episode",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 1,
            "checkId": "waveform.PV-flow.single-peak-no-ringing",
            "maximum": 1,
            "minimum": 1,
            "status": "passed",
            "unit": "count"
          },
          {
            "actual": 0,
            "checkId": "waveform.PAP.post-PV-closure-rebound",
            "maximum": 0.5,
            "minimum": 0,
            "status": "passed",
            "unit": "mmHg"
          }
        ],
        "measured": {
          "LVP": {
            "centralRangeFraction": 0.2047946870215112,
            "forwardEpisodeCount": 1,
            "peakPhase01": 0.746031746031746,
            "significantPeakCount": 1,
            "totalVariationRatio": 1.1735192456354728
          },
          "RVP": {
            "centralRangeFraction": 0.18713168215863774,
            "forwardEpisodeCount": 1,
            "peakPhase01": 0.6745098039215687,
            "significantPeakCount": 1,
            "totalVariationRatio": 1.2871731286441173
          },
          "aorticValve": {
            "ejectionTimeSec": 0.25499999999999545,
            "meanGradientMmHg": 4.2688920544472495,
            "peakGradientMmHg": 7.856587691589837
          },
          "cardiacSizeAndFunction": {
            "bodySurfaceAreaM2": 1.9,
            "leftVentricle": {
              "ejectionFraction01": 0.5577872012678575,
              "endDiastolicVolumeIndexMlPerM2": 75.64295371315426,
              "endDiastolicVolumeMl": 143.72161205499307,
              "endSystolicVolumeIndexMlPerM2": 33.45028226585985,
              "endSystolicVolumeMl": 63.555536305133714
            },
            "rightVentricle": {
              "ejectionFraction01": 0.5697197459927834,
              "endDiastolicVolumeIndexMlPerM2": 74.05801460699432,
              "endDiastolicVolumeMl": 140.7102277532892,
              "endSystolicVolumeIndexMlPerM2": 31.86570133636767,
              "endSystolicVolumeMl": 60.54483253909857
            },
            "systemicForwardFlow": {
              "cardiacIndexLPerMinPerM2": 2.9534869986473034,
              "cardiacOutputLPerMin": 5.611625297429876,
              "strokeVolumeIndexMlPerM2": 42.19267140924705,
              "strokeVolumeMl": 80.16607567756938
            }
          },
          "hemodynamicPressure": {
            "aortic": {
              "maximumMmHg": 111.35437809515427,
              "minimumMmHg": 77.54846419227914
            },
            "centralVenousMeanMmHg": 3.0758312312680354,
            "pcwpSurrogateMeanMmHg": 8.377448599630208,
            "pulmonaryArtery": {
              "maximumMmHg": 26.166946634024157,
              "minimumMmHg": 12.03387992696858
            }
          },
          "leftVentricle": {
            "maximumDpDtMmHgPerSec": 2600.069423820747,
            "minimumDpDtMmHgPerSec": -1556.3378582564847
          },
          "mitralFlow": {
            "peakAMlPerSec": 425.6736983557625,
            "peakEMlPerSec": 395.478391677468,
            "peakEToA": 0.9290646643310849
          },
          "pulmonaryRootMorphology": {
            "maximumPostClosurePapReboundMmHg": 0,
            "papSignificantPeakCount": 1,
            "pvFlowSignificantPeakCount": 1,
            "pvForwardEpisodeCount": 1
          },
          "pulmonaryValve": {
            "ejectionTimeSec": 0.25800000000000267,
            "meanGradientMmHg": 4.453576925688471,
            "peakGradientMmHg": 7.415462429217236
          },
          "rightTiming": {
            "ictSec": 0.027999999999998693,
            "irtSec": 0.06400000000000006,
            "teiIndex": 0.3565891472868132
          },
          "rightVentricle": {
            "maximumDpDtMmHgPerSec": 602.8260931029814,
            "minimumDpDtMmHgPerSec": -375.68447322572655
          },
          "timing": {
            "ictSec": 0.0931428571428583,
            "irtSec": 0.0940000000000012,
            "teiIndex": 0.7338935574229916
          },
          "tricuspidFlow": {
            "peakAMlPerSec": 328.9148690433511,
            "peakEMlPerSec": 358.4730195454467,
            "peakEToA": 1.089865656083185
          }
        }
      },
      "referenceId": "baseline",
      "status": "passed"
    },
    "referenceContext": {
      "assessmentPolicy": {
        "evidence": {
          "checkGroups": [
            {
              "analysisPartition": "objective",
              "changeReason": "Fail closed before interpreting any derived baseline measurement.",
              "checkIds": [
                "settlement.period1"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "numerical-quality",
              "evidenceGap": "No clinical population interval applies to an exact periodic-classifier contract.",
              "evidenceRole": "construction",
              "groupId": "settlement",
              "measurementMeaning": "Whether the exact periodic classifier established the required period-one terminal state.",
              "observationLimitations": "Period-one settlement is numerical admissibility, not physiological normality or independent model validation.",
              "sourceComparisons": [],
              "thresholdBasis": "exact-contract"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "waveform.LVP.single-peak-no-ringing",
                "waveform.RVP.single-peak-no-ringing"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "ventricular-pressure-morphology",
              "measurementMeaning": "Algorithmic peak count, total variation and episode count of pressure during the associated semilunar-valve forward-flow episode.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "waveform.LVP.rounded-not-plateau",
                "waveform.RVP.rounded-not-plateau"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "ventricular-pressure-contour-reference",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Author-institution abstract; ascending aortic pressure waveform groups",
                  "observationMeaning": "Simultaneous ascending aortic pressure and flow; early versus late systolic pressure, not the model's ventricular central-range or peak-index fractions.",
                  "sourceId": "murgo-1980-human-aortic-waveforms",
                  "sourceRange": "Late greater than early in 7, nearly equal in 7, early greater than late in 4.",
                  "targetPopulation": "18 elective catheterization patients in whom no heart disease was found; not a population reference sample."
                },
                {
                  "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.",
                  "locator": "Methods; Tables 1 and 4; Figures 4-5, PDF pp. 6-7",
                  "observationMeaning": "Simultaneous Millar conductance-catheter LV pressure/volume sampled at 250 Hz; observed inter- and intra-subject PV contours.",
                  "sourceId": "kohli-2017-normalized-human-pv-loops",
                  "sourceRange": null,
                  "targetPopulation": "13 catheterization subjects selected for normal LV function, sinus rhythm and valves; 9 had hypertension. This is not a strictly healthy normative cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Constrain the non-stenotic baseline while retaining the model's explicit pressure-station limitation.",
              "checkIds": [
                "aortic-valve.mean-gradient",
                "aortic-valve.peak-gradient"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "aortic-valve-gradient",
              "measurementMeaning": "Time-weighted mean and maximum raw LV-minus-Ao node pressure difference during native aortic forward flow.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Prevent a gradient reduction obtained by implausibly shortening or prolonging ejection.",
              "checkIds": [
                "aortic-valve.ejection-time"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "evidenceGap": "The frozen construction interval is provisional. Similarity to the retrospective Copenhagen interval does not establish its historical derivation or cross-method validity.",
              "evidenceRole": "construction",
              "groupId": "aortic-ejection-time",
              "measurementMeaning": "Native AoV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen interval is slightly broader at both endpoints; no observer-specific calibration has established equivalence.",
                  "locator": "Table 2; Methods, Cardiac time intervals",
                  "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.",
                  "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
                  "sourceRange": "LVET 248-336 ms.",
                  "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."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Retain plausible contraction and relaxation rates while adjusting aortic ejection morphology.",
              "checkIds": [
                "left-ventricle.maximum-dpdt",
                "left-ventricle.minimum-dpdt"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-pressure-rate",
              "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary LV pressure over the completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The positive mean lies within the frozen corridor; the signed negative mean does not. Exercise values cannot justify a resting cutoff.",
                  "locator": "Abstract; resting values before ergometer exercise",
                  "observationMeaning": "Invasive maximal LV pressure rise and pressure-fall magnitude; the accessible abstract does not fully establish acquisition bandwidth.",
                  "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve",
                  "sourceRange": "Resting maximum +1721 +/- 378 mmHg/s; negative magnitude 1862 +/- 343 mmHg/s (mean +/- SD).",
                  "targetPopulation": "13 patients described as having a normal LV; not a population-based, sex/age-stratified healthy sample."
                },
                {
                  "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.",
                  "locator": "Methods p. 757; normal-control table p. 759; abstract",
                  "observationMeaning": "Millar LV micromanometer and continuous differentiator; average of five sinus beats, after premedication.",
                  "sourceId": "hirota-1980-lv-relaxation",
                  "sourceRange": "Maximum +1674 +/- 421 mmHg/s; negative magnitude 1864 +/- 390 mmHg/s (observed negative-magnitude range 1275-2772).",
                  "targetPopulation": "18 normal controls including patients investigated for chest pain, murmurs or other indications; not a healthy population reference sample."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "mitral-flow.peak-e-to-a"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "mitral-e-to-a",
              "measurementMeaning": "Ratio of peak native mitral forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen bounds truncate some healthy age-specific ranges and admit values outside others; numerical overlap cannot validate a native volume-flow ratio.",
                  "locator": "Tables 3 and 5 (p. 551)",
                  "observationMeaning": "PW Doppler mitral leaflet-tip E and A velocities, identified relative to ECG T and P waves; estimated fifth-to-95th percentiles.",
                  "sourceId": "nagueh-2025-lv-diastolic-function",
                  "sourceRange": "E/A: ages 20-39, 0.88-2.73; ages 40-60, 0.69-2.07; ages 60-80, 0.50-1.40.",
                  "targetPopulation": "Healthy reference data grouped by age; guideline echocardiographic assessment in adults, with age- and sex-aware supplementary data."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "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.",
              "checkIds": [
                "timing.ict",
                "timing.irt",
                "timing.tei-index"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "evidenceGap": "The intervals remain provisional hydraulic timing targets. Matching some published endpoints does not establish a measurement-equivalence study or historical source derivation.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-timing",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Table 2; Methods, Cardiac time intervals",
                  "observationMeaning": "Color-TDI M-mode mitral-leaflet event timing; pooled 95% prediction intervals, not interchangeable with other Doppler or hydraulic event methods.",
                  "sourceId": "alhakak-2023-copenhagen-cardiac-time-intervals",
                  "sourceRange": "IVCT 20-59 ms; IVRT 59-134 ms; MPI 0.29-0.65.",
                  "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."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Maintain broad resting systemic-pressure compatibility as a construction safety envelope.",
              "checkIds": [
                "aortic-pressure.maximum",
                "aortic-pressure.minimum",
                "central-venous-pressure.mean"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "systemic-pressure",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen RA corridor is wider. A single illustrative arterial pressure cannot substantiate either Ao endpoint.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "Mean RAP 2-6 mmHg; systemic systolic/diastolic pressure is illustrated as 120/80 mmHg, not a reference interval.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Use broad resting pressure context as a sentinel while withholding a pulmonary-waveform validation claim.",
              "checkIds": [
                "pulmonary-artery-pressure.maximum",
                "pulmonary-artery-pressure.minimum"
              ],
              "contextEvidenceIds": [
                "mukherjee-ase-right-heart-2025"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-artery-pressure",
              "measurementMeaning": "Extrema of absolute model PA root-node pressure over the exact completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen lower bounds match; the upper bounds are deliberately wider and are not the guideline's normal interval.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "PAP systolic 15-30 mmHg; diastolic 4-12 mmHg.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                },
                {
                  "comparisonToChosenBounds": "These distributions provide context but do not establish the chosen wider systolic and diastolic corridors.",
                  "locator": "Table 1; healthy resting supine catheterization data",
                  "observationMeaning": "Invasive resting supine PAP pooled across cohorts; mean +/- SD rather than a joint systolic/diastolic normal region.",
                  "sourceId": "kovacs-2009-healthy-pap-review",
                  "sourceRange": "Systolic 20.8 +/- 4.4 mmHg (upper limit 29.6); diastolic 8.8 +/- 3.0 mmHg.",
                  "targetPopulation": "47 studies, 1,187 healthy participants overall; resting supine systolic PAP available in 625, with heterogeneous age and sex representation."
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Bound left-sided filling pressure while preserving the explicit station and measurement mismatch.",
              "checkIds": [
                "pcwp-surrogate.mean"
              ],
              "contextEvidenceIds": [
                "kovacs-pawp-healthy-meta-2024"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pcwp-surrogate",
              "measurementMeaning": "Time-weighted completed-beat mean absolute LA pressure, exposed only as a labelled PCWP surrogate.",
              "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.",
              "sourceComparisons": [
                {
                  "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.",
                  "locator": "Main results; individual-data and zero-reference subgroup analyses",
                  "observationMeaning": "Resting supine catheter PAWP, with heterogeneous zero references and respiratory conventions; significant sex differences.",
                  "sourceId": "zeder-2024-healthy-pawp-meta-analysis",
                  "sourceRange": "Pooled PAWP 9.4 +/- 1.82 mmHg; upper limit 13 mmHg (mid-thoracic-zero subgroup 12.2 mmHg).",
                  "targetPopulation": "960 mainly nonobese healthy participants from 49 studies; individual-data subset n=159, median age 26 (IQR 23-53), 67% men."
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Create a deliberately broad cross-modality construction corridor rather than a joint population-normal claim.",
              "checkIds": [
                "left-ventricle.edv-index",
                "left-ventricle.esv-index",
                "left-ventricle.ejection-fraction"
              ],
              "contextEvidenceIds": [
                "lang-ase-eacvi-2015",
                "kou-norre-2014",
                "cmr-consolidated-normal-reference-2016"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "left-ventricular-indexed-size-function",
              "measurementMeaning": "Valve-event-defined 0D LV volumes indexed to the reference BSA and their event-defined ejection fraction.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Chosen EF is the sex-union; the volume corridor is not the sex-union and admits larger volumes.",
                  "locator": "Table 2 (p. 7); ED/ES definition (p. 6)",
                  "observationMeaning": "2D biplane LV volumes indexed to BSA; ED/ES may use valve events or cavity extrema; normal ranges based on mean +/- 2 SD.",
                  "sourceId": "lang-2015-chamber-quantification",
                  "sourceRange": "Men: EDVi 34-74, ESVi 11-31 mL/m2, EF 52-72%; women: 29-61, 8-24, 54-74%.",
                  "targetPopulation": "Adult sex-specific echocardiographic reference data."
                },
                {
                  "comparisonToChosenBounds": "The chosen volume and EF bounds are broader than these sex-specific intervals; the source does not support their exact endpoints.",
                  "locator": "Table 2, pp. 684-685",
                  "observationMeaning": "Biplane Simpson 2D echo, excluding papillary muscles and trabeculae from the cavity; BSA indexing does not remove age/sex effects.",
                  "sourceId": "kou-2014-norre-chamber-reference",
                  "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%.",
                  "targetPopulation": "734 healthy adults (320 men, 414 women), age 45.8 +/- 13.3 years, predominantly white Europeans from 22 institutions."
                },
                {
                  "comparisonToChosenBounds": "The chosen corridor is not a CMR normal interval and can exclude source-normal EDVi or EF while admitting much lower volumes.",
                  "locator": "Table 2 (p. 2)",
                  "observationMeaning": "1.5 T SSFP CMR with LV papillary muscles included in mass; mean +/- 2 SD.",
                  "sourceId": "kawel-boehm-2015-cmr-normal-values",
                  "sourceRange": "Men: EDVi 57-105, ESVi 14-38 mL/m2, EF 57-77%; women: 56-96, 14-34, 57-77%.",
                  "targetPopulation": "Pooled adult European cohorts, ages 20-80 years; sex-specific results."
                },
                {
                  "comparisonToChosenBounds": "An updated, method-declared comparison, not support for the retained cross-modality endpoints or a demographic assignment to the synthetic model.",
                  "locator": "Sections 2-3; Table 2 (papillary muscles/trabeculations in mass)",
                  "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.",
                  "sourceId": "kawel-boehm-2025-scmr-reference-values",
                  "sourceRange": "Men: EDVi 46-104, ESVi 11-41 mL/m2, EF 53-79%; women: 46-91, 11-34, 55-80%.",
                  "targetPopulation": "Pooled healthy adult CMR cohorts, sex-specific and mixed ages; not an age-40-49 or single joint population interval.",
                  "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.",
                  "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, LV rows",
                  "observationMeaning": "CMR anatomical segmentation, BSA-indexed volumes and EF; both ventricles can be compared in the same stratum without joining different modalities.",
                  "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
                  "sourceRange": "Men: EDVi 51-102, ESVi 13-40 mL/m2, EF 53-77%; women: 49-88, 13-33, 56-78%.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Retain broad RV size/function safety bounds without extending the current systemic and left-heart claim.",
              "checkIds": [
                "right-ventricle.edv-index",
                "right-ventricle.esv-index",
                "right-ventricle.ejection-fraction"
              ],
              "contextEvidenceIds": [
                "lang-ase-eacvi-2015-3de-rv"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-indexed-size-function",
              "measurementMeaning": "Valve-event-defined 0D RV volumes indexed to the reference BSA and their event-defined ejection fraction.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Volume bounds reproduce the sex-union. EF bounds span subgroup extremes, not a universal normal range.",
                  "locator": "Table 8 (p. 20); Supplemental Table 8 (p. 39.e13)",
                  "observationMeaning": "3D-echo RV volume segmentation and BSA indexing; subgroup EF limits are fifth/95th percentiles.",
                  "sourceId": "lang-2015-chamber-quantification",
                  "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.",
                  "targetPopulation": "Adult sex-specific 3D-echo data; supplemental RV EF limits further stratified by age."
                },
                {
                  "comparisonToChosenBounds": "Chosen volume bounds exclude substantial CMR-normal values; the 3D-echo corridor cannot be called a broad cross-modality RV normal interval.",
                  "locator": "Table 6 (p. 7)",
                  "observationMeaning": "1.5 T SSFP CMR with RV trabeculations and papillary muscles in the cavity; mean +/- 2 SD.",
                  "sourceId": "kawel-boehm-2015-cmr-normal-values",
                  "sourceRange": "Men: EDVi 61-121, ESVi 19-59 mL/m2, EF 52-72%; women: 48-112, 12-52, 51-71%.",
                  "targetPopulation": "Healthy adult cohorts aged 20-68 years, sex-specific results; indexed RV ESV uses the Hudsmith cohort."
                },
                {
                  "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.",
                  "locator": "Sections 2 and 4; Table 8 (papillary muscles/trabeculations in mass), not smooth-segmentation Table 9",
                  "observationMeaning": "Short-axis bSSFP anatomical RV cavity volume with myocardial tissue excluded from blood volume; event, geometric and segmentation correspondence to 0D remains approximate.",
                  "sourceId": "kawel-boehm-2025-scmr-reference-values",
                  "sourceRange": "Men: EDVi 49-117, ESVi 12-56 mL/m2, EF 44-77%; women: 47-99, 11-43, 49-77%.",
                  "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.",
                  "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.",
                  "locator": "Author website Table 37 (men) and Table 7 (women), 40-49-year column, RV rows",
                  "observationMeaning": "CMR anatomical segmentation and BSA indexation, same subject strata and measurement convention as the LV comparison.",
                  "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
                  "sourceRange": "Men: EDVi 61-118, ESVi 21-55 mL/m2, EF 44-71%; women: 53-97, 17-42, 49-73%.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "objective",
              "changeReason": "Maintain broad resting forward-flow compatibility across the admitted HR values.",
              "checkIds": [
                "systemic-forward-flow.cardiac-index",
                "systemic-forward-flow.stroke-volume-index"
              ],
              "contextEvidenceIds": [
                "cardiac-index-clinical-reference",
                "resting-indexed-flow-reference"
              ],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "indexed-systemic-forward-flow",
              "measurementMeaning": "Positive-only native AoV flow integrated for stroke volume and converted to cardiac output over the completed beat, both indexed to reference BSA.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "CI endpoints match exactly; SVI endpoints do not. Fick/thermodilution output is not necessarily the model's positive-only valve-flow output.",
                  "locator": "Table 11; section 5.1.12.1",
                  "observationMeaning": "Supine catheter pressure, mid-thoracic zero and end-expiratory reading; output by direct Fick or thermodilution.",
                  "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
                  "sourceRange": "CI 2.5-4.0 L/min/m2; SVI 33-47 mL/m2.",
                  "targetPopulation": "Adult resting right-heart catheterization reference values summarized by the guideline, not a new sex-, age-, or BSA-stratified healthy cohort."
                },
                {
                  "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.",
                  "coveredCheckIds": [
                    "systemic-forward-flow.cardiac-index",
                    "systemic-forward-flow.stroke-volume-index"
                  ],
                  "locator": "Methods; healthy-group results and age analysis",
                  "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.",
                  "sourceId": "carlsson-2012-cmr-cardiac-output",
                  "sourceRange": "CI 3.2 +/- 0.5 L/min/m2; SVI 51 +/- 7 mL/m2 (mean +/- SD).",
                  "targetPopulation": "144 healthy nonathletic adults, 68 women, ages 21-81 (mean 39 +/- 16) years; BMI <=30, no cardiovascular disease or medication.",
                  "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.",
                  "thresholdVerification": "context-only"
                }
              ],
              "thresholdBasis": "literature-context-plus-engineering-envelope"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record the existing Standard70 right-heart gradient sentinels without promoting them to left-objective groups or changing their numerical limits.",
              "checkIds": [
                "pulmonary-valve.mean-gradient",
                "pulmonary-valve.peak-gradient"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-valve-gradient",
              "measurementMeaning": "Time-weighted mean and maximum raw RV-minus-PA node pressure difference while native PV flow is positive over the completed beat.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record the existing Standard70 pulmonary ejection-time corridor with its missing method-matched normative evidence.",
              "checkIds": [
                "pulmonary-valve.ejection-time"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "physiological-target",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-ejection-time",
              "measurementMeaning": "Native PV zero-flow opening to exact completed-beat closure; the observer requires agreement with the completed beat's accumulated positive-flow duration.",
              "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.",
              "sourceComparisons": [],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Reclassify the existing Standard70 RV derivative corridors as reference warnings without altering the recorded numerical bounds.",
              "checkIds": [
                "right-ventricle.maximum-dpdt",
                "right-ventricle.minimum-dpdt"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-pressure-rate",
              "measurementMeaning": "Maximum and minimum accepted-step finite-difference derivative of absolute intracavitary RV pressure over the completed beat.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "This is not the maximum native intracavitary derivative and does not establish either chosen endpoint or a normal upper limit.",
                  "locator": "RV dP/dt section, pp. 158-159",
                  "observationMeaning": "TR Doppler 1-to-2 m/s upslope converted to a 12 mmHg pressure-gradient rise divided by time.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "RV dP/dt below 400 mmHg/s is abnormal for this Doppler method.",
                  "targetPopulation": "Adult right-heart echocardiography; normal-reference data are limited."
                },
                {
                  "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.",
                  "locator": "Abstract; normal-PAP and pulmonary-hypertension groups",
                  "observationMeaning": "Maximal invasive RV pressure-fall magnitude; strong pressure-load dependence, with acquisition detail incompletely resolved by the abstract.",
                  "sourceId": "stein-1980-rv-pressure-fall",
                  "sourceRange": "Normal-PAP group 170 +/- 20 mmHg/s; pulmonary-hypertension groups 670 +/- 60 mmHg/s, with or without RV failure.",
                  "targetPopulation": "34 patients: eight with normal PAP, 17 with pulmonary hypertension, nine with pulmonary hypertension and RV failure; not a general healthy reference cohort."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "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.",
              "checkIds": [
                "tricuspid-flow.peak-e-to-a"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "tricuspid-e-to-a",
              "measurementMeaning": "Ratio of peak native tricuspid forward volume flow in early and atrial filling windows anchored to the observed atrial-capture event.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen numeric endpoints match, but flow-versus-velocity and respiratory averaging differ; this is not method-matched validation.",
                  "locator": "Table 1; RV diastolic function, pp. 168-169",
                  "observationMeaning": "PW tricuspid inflow E/A velocities; end-expiratory averaging over at least five beats.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "Tricuspid E/A >=0.8 and <2.0.",
                  "targetPopulation": "Adult echocardiographic reference context."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "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.",
              "checkIds": [
                "right-timing.ict",
                "right-timing.irt",
                "right-timing.tei-index"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "reference-warning",
              "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.",
              "evidenceRole": "construction",
              "groupId": "right-ventricular-timing",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "The chosen upper IRT and Tei bounds are wider, and no chosen lower bound or ICT interval follows from these thresholds.",
                  "locator": "RV MPI, pp. 158-159; IVRT, pp. 168-169",
                  "observationMeaning": "PW-Doppler or tissue-Doppler MPI and tissue-Doppler IVRT, not native valve-flow events.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": "MPI <0.40 by PW Doppler or <0.55 by TDI; IVRT <=73 ms by TDI.",
                  "targetPopulation": "Adult right-heart echocardiography."
                }
              ],
              "thresholdBasis": "engineering-guess"
            },
            {
              "analysisPartition": "right-heart-sentinel",
              "changeReason": "Record Standard70 pulmonary ringing and re-ejection guards as construction-only waveform criteria.",
              "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"
              ],
              "contextEvidenceIds": [],
              "evaluationRole": "construction-guard",
              "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.",
              "evidenceRole": "construction",
              "groupId": "pulmonary-root-morphology",
              "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.",
              "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.",
              "sourceComparisons": [
                {
                  "comparisonToChosenBounds": "Qualitative flow context only; it establishes no peak-prominence, PAP peak-count or post-PV-closure rebound cutoff.",
                  "locator": "RVOT Doppler flow, p. 158",
                  "observationMeaning": "Qualitative RVOT Doppler velocity waveform: parabolic with a midsystolic peak.",
                  "sourceId": "mukherjee-2025-right-heart-guideline",
                  "sourceRange": null,
                  "targetPopulation": "Adult resting right-heart echocardiography."
                }
              ],
              "thresholdBasis": "engineering-guess"
            }
          ],
          "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."
          },
          "evaluationPolicyId": "main-wire-standard70-baseline-evaluation-roles-v3",
          "evidenceBindings": [
            {
              "canonicalSourceIds": [
                "lang-2015-chamber-quantification"
              ],
              "evidenceId": "lang-ase-eacvi-2015",
              "limitations": "Modality-, sex-, age-, and body-size-dependent reference context; it does not directly define this model's joint admissible interval.",
              "measurementMeaning": "Adult echocardiographic LV chamber volumes and systolic function.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "kou-2014-norre-chamber-reference"
              ],
              "evidenceId": "kou-norre-2014",
              "limitations": "The cohort and measurement method do not identify a unique 0D-model parameter vector or a joint multivariate normal region.",
              "measurementMeaning": "Two-dimensional echocardiographic adult chamber-size reference ranges.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "kawel-boehm-2015-cmr-normal-values"
              ],
              "evidenceId": "cmr-consolidated-normal-reference-2016",
              "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.",
              "measurementMeaning": "CMR chamber-volume and function reference context across published cohorts.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "lang-2015-chamber-quantification"
              ],
              "evidenceId": "lang-ase-eacvi-2015-3de-rv",
              "limitations": "A 0D chamber volume is compared only as broad construction context; acquisition and segmentation conventions remain different.",
              "measurementMeaning": "Adult three-dimensional echocardiographic RV volumes and ejection fraction.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "carlsson-2012-cmr-cardiac-output",
                "barratt-boyes-wood-1958-healthy-hemodynamics"
              ],
              "evidenceId": "cardiac-index-clinical-reference",
              "limitations": "The model interval is an engineering synthesis across methods and cohorts, not a verbatim interval from either source.",
              "measurementMeaning": "Resting forward cardiac output indexed to body surface area.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "carlsson-2012-cmr-cardiac-output",
                "barratt-boyes-wood-1958-healthy-hemodynamics"
              ],
              "evidenceId": "resting-indexed-flow-reference",
              "limitations": "Stroke-volume index depends on heart rate, body-size convention, cohort, and acquisition method; the gate is a broad engineering envelope.",
              "measurementMeaning": "Resting systemic forward stroke volume indexed to body surface area.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "mukherjee-2025-right-heart-guideline",
                "kovacs-2009-healthy-pap-review"
              ],
              "evidenceId": "mukherjee-ase-right-heart-2025",
              "limitations": "This does not directly support the exact 10-35 mmHg model interval or validate the current pulmonary waveform shape.",
              "measurementMeaning": "Right-heart echocardiographic assessment and healthy pulmonary arterial pressure context.",
              "useRole": "construction-context"
            },
            {
              "canonicalSourceIds": [
                "zeder-2024-healthy-pawp-meta-analysis"
              ],
              "evidenceId": "kovacs-pawp-healthy-meta-2024",
              "limitations": "The retained legacy evidence ID uses the last author's name; the model reports mean LA pressure, not a simulated wedged-catheter measurement.",
              "measurementMeaning": "Supine resting pulmonary arterial wedge pressure in healthy subjects.",
              "useRole": "construction-context"
            }
          ],
          "observationMethodId": "main-wire-baseline-observation-v2",
          "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.",
          "policyRevisions": [
            {
              "changeReason": "Capture the current Standard68 mint policy and healthy-reference context after retrospective provenance repair.",
              "evidenceRole": "construction",
              "policySha256": "74f5b1ca712b56f304fee1ccf20da3e9dee8c7102213a2cb60dc2e7701cf3356",
              "revisionId": "main-wire-standard68-baseline-policy-r1"
            }
          ],
          "preloadReservePolicyRevisions": [
            {
              "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.",
              "decisionTiming": "post-hoc-after-exploratory-candidate-inspection",
              "evidenceRole": "construction",
              "policySha256": "dec7d6cdf587522c67892f0f94c910a2a8871a1aada6620c1a8778869109f4d5",
              "revisionId": "main-wire-standard69-preload-reserve-policy-r1"
            }
          ],
          "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.",
          "registryId": "main-wire-normal-reference-evidence-v1",
          "schemaVersion": 1,
          "sourceComparisonTiming": "retrospective-provenance-audit-not-original-cutoff-derivation",
          "sources": [
            {
              "identifiers": {
                "doi": "10.1093/eurheartj/ehu293"
              },
              "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",
              "url": "https://academic.oup.com/eurheartj/article/35/44/3122/2293191",
              "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.",
              "year": 2014
            },
            {
              "identifiers": {
                "doi": "10.1093/oxfordjournals.eurheartj.a062515",
                "pmid": "3383877"
              },
              "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",
              "url": "https://pubmed.ncbi.nlm.nih.gov/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.",
              "year": 1988
            },
            {
              "identifiers": {
                "doi": "10.1161/01.CIR.62.1.105",
                "pmid": "7379273"
              },
              "sourceId": "murgo-1980-human-aortic-waveforms",
              "title": "Aortic input impedance in normal man: relationship to pressure wave forms",
              "url": "https://scholars.uthscsa.edu/es/publications/aortic-input-impedance-in-normal-man-relationship-to-pressure-wav/",
              "verification": "author-institution-abstract-checked-not-full-text",
              "year": 1980
            },
            {
              "identifiers": {
                "doi": "10.14814/phy2.13160",
                "pmid": "28351966"
              },
              "sourceId": "kohli-2017-normalized-human-pv-loops",
              "title": "The quest for load-independent left ventricular chamber properties: exploring the normalized pressure-volume loop",
              "url": "https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.13160",
              "verification": "primary-full-text-methods-and-figures-4-5-checked",
              "year": 2017
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2014.10.003",
                "pmid": "25559473"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2016/02/2015_ChamberQuantificationREV.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2015
            },
            {
              "identifiers": {
                "doi": "10.1093/ehjci/jet284",
                "pmid": "24451180"
              },
              "sourceId": "kou-2014-norre-chamber-reference",
              "title": "Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study",
              "url": "https://orbi.uliege.be/bitstream/2268/169431/1/Eur%20Heart%20J%20Cardiovasc%20Imaging-2014-Kou-680-90.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2014
            },
            {
              "identifiers": {
                "doi": "10.1186/s12968-015-0111-7",
                "pmid": "25928314"
              },
              "sourceId": "kawel-boehm-2015-cmr-normal-values",
              "title": "Normal values for cardiovascular magnetic resonance in adults and children",
              "url": "https://link.springer.com/content/pdf/10.1186/s12968-015-0111-7.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2015
            },
            {
              "identifiers": {
                "doi": "10.1186/1532-429X-14-51",
                "pmid": "22839436"
              },
              "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",
              "url": "https://link.springer.com/article/10.1186/1532-429X-14-51",
              "verification": "primary-full-text-methods-and-results-checked",
              "year": 2012
            },
            {
              "identifiers": {
                "doi": "10.1016/j.jocmr.2025.101853",
                "pmcid": "PMC12159681"
              },
              "sourceId": "kawel-boehm-2025-scmr-reference-values",
              "title": "Society for Cardiovascular Magnetic Resonance reference values (normal values) in cardiovascular magnetic resonance: 2025 update",
              "url": "https://pmc.ncbi.nlm.nih.gov/articles/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.",
              "year": 2025
            },
            {
              "identifiers": {
                "doi": "10.1016/j.jcmg.2024.01.009",
                "pmid": "38613554"
              },
              "sourceId": "raisi-estabragh-2024-hhc-anatomical-tables",
              "title": "Cardiovascular Magnetic Resonance Reference Ranges From the Healthy Hearts Consortium: author-published anatomical segmentation tables",
              "url": "https://healthy-hearts.org.uk/tables/",
              "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.",
              "year": 2024
            },
            {
              "identifiers": {
                "pmid": "13514210"
              },
              "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",
              "url": "https://pubmed.ncbi.nlm.nih.gov/13514210/",
              "verification": "primary-source-metadata-checked",
              "year": 1958
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2025.01.006",
                "pmid": "40044341"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2025/03/PIIS0894731725000379.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2025
            },
            {
              "identifiers": {
                "doi": "10.1183/09031936.00145608"
              },
              "sourceId": "kovacs-2009-healthy-pap-review",
              "title": "Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review",
              "url": "https://publications.ersnet.org/highwire_display/entity_view/node/476971/full",
              "verification": "primary-source-metadata-checked",
              "year": 2009
            },
            {
              "identifiers": {
                "doi": "10.1183/13993003.00967-2024",
                "pmid": "38964777"
              },
              "sourceId": "zeder-2024-healthy-pawp-meta-analysis",
              "title": "Pulmonary arterial wedge pressure in healthy subjects: a meta-analysis",
              "url": "https://publications.ersnet.org/content/erj/64/2/2400967",
              "verification": "primary-source-metadata-checked",
              "year": 2024
            },
            {
              "identifiers": {
                "doi": "10.1183/13993003.00879-2022",
                "pmid": "36028254"
              },
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "title": "2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension",
              "url": "https://publications.ersnet.org/lookup/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.",
              "year": 2022
            },
            {
              "identifiers": {
                "doi": "10.1007/s00392-023-02269-2"
              },
              "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",
              "url": "https://link.springer.com/article/10.1007/s00392-023-02269-2",
              "verification": "primary-source-metadata-checked",
              "year": 2023
            },
            {
              "identifiers": {
                "doi": "10.1016/j.echo.2025.03.011"
              },
              "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",
              "url": "https://www.asecho.org/wp-content/uploads/2025/07/Left-Ventricular-Diastolic-Function.pdf",
              "verification": "primary-source-metadata-checked",
              "year": 2025
            },
            {
              "identifiers": {
                "pmid": "602351"
              },
              "sourceId": "bussmann-1977-normal-lv-contractile-relaxation-reserve",
              "title": "Contractile and relaxation reserve of the left ventricle. I. Normal left ventricle",
              "url": "https://pubmed.ncbi.nlm.nih.gov/602351/",
              "verification": "primary-source-metadata-checked",
              "year": 1977
            },
            {
              "identifiers": {
                "doi": "10.1161/01.cir.62.4.756",
                "pmid": "7190882"
              },
              "sourceId": "hirota-1980-lv-relaxation",
              "title": "A clinical study of left ventricular relaxation",
              "url": "https://pubmed.ncbi.nlm.nih.gov/7190882/",
              "verification": "primary-source-metadata-checked",
              "year": 1980
            },
            {
              "identifiers": {
                "doi": "10.1378/chest.78.1.10",
                "pmid": "7471826"
              },
              "sourceId": "stein-1980-rv-pressure-fall",
              "title": "Effect of chronic pressure overload on the maximal rate of pressure fall of the right ventricle",
              "url": "https://pubmed.ncbi.nlm.nih.gov/7471826/",
              "verification": "primary-source-metadata-checked",
              "year": 1980
            }
          ],
          "supplementalChecks": [
            {
              "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.",
              "checkId": "left-ventricle.relaxation-tau",
              "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.",
              "observationMethodId": "main-wire-lv-relaxation-tau-v1",
              "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.",
              "referenceSourceIds": [
                "nagueh-2025-lv-diastolic-function",
                "hirota-1980-lv-relaxation"
              ],
              "referenceUpperMs": 48,
              "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."
            }
          ]
        },
        "policy": {
          "anatomyRule": "For this sex-unspecified generic baseline only, automatic eligibility requires all six valid anatomical CMR comparisons inside BOTH declared sex strata. Otherwise require demographic/method review, not automatic disease rejection. This conservative design intersection does not assign sex or claim joint population normality; preset/patient fitting must use its own profile.",
          "loadGuardRationale": "Keep a baseline away from low/high systemic load and high native end-filling pressure. Ao bounds are retained design choices, not derived from Herbert. LV native flow cessation may precede the pressure upstroke; <=16 is an approximate end-filling design ceiling, not validated catheter LVEDP equivalence or a lower normal limit.",
          "numericalAndConstructionProvenance": "Inherited numerical/gradient/ringing checks resolve their existing per-check evidence; new rest criteria do not reinterpret the old physiological corridors or clear the old provenance audit.",
          "operating": [
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, CI",
              "lower": 2.5,
              "metricId": "systemic-net-flow.cardiac-index",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 4
            },
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, mean RAP",
              "lower": 2,
              "metricId": "central-venous-pressure.mean",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 6
            },
            {
              "basis": "source-informed-operating-target",
              "locator": "Table 11, mean PAP",
              "lower": 8,
              "metricId": "pulmonary-artery-pressure.mean",
              "sourceId": "humbert-2022-esc-ers-pulmonary-hypertension",
              "upper": 20
            },
            {
              "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
              "locator": "Methods, invasive versus cuff-calibrated pressure distinction",
              "lower": 90,
              "metricId": "aortic-pressure.maximum",
              "sourceId": "herbert-2014-central-pressure-reference",
              "upper": 140
            },
            {
              "basis": "retained-engineering-load-guard-NOT-source-derived-normal-range",
              "locator": "Methods, DBP calibration; no central-DBP reference interval",
              "lower": 60,
              "metricId": "aortic-pressure.minimum",
              "sourceId": "herbert-2014-central-pressure-reference",
              "upper": 90
            },
            {
              "basis": "source-informed-engineering-load-guard-NOT-method-matched-normal-range",
              "locator": "Section2, Table1 p539 (>16), Figure1 p540",
              "lower": null,
              "metricId": "left-ventricle.native-end-filling-pressure",
              "sourceId": "nagueh-2025-lv-diastolic-function",
              "upper": 16
            }
          ],
          "policyId": "main-wire-prospective-baseline-admission-v1",
          "regression": "__tests__/mainWireProspectiveBaselineAdmissionV1.test.ts",
          "scope": "Resting unassisted nonshunting sinus research construction, BSA1.9, HR60 or70, zero intrathoracic reference. Scientific eligibility for exact-model promotion, not public mint or clinical normality.",
          "warningRule": "Keep strict source comparisons for phasic PAP, ET, anatomy and SVI plus historical timing/E-A/dPdt/roundness context. A warning never excuses missing, nonfinite or invalid observations. Preserve unexplained ringing/closure-rebound construction holds; pressure-peak phase and PV roundness are not universal normality gates."
        }
      },
      "methodId": "main-wire-baseline-observation-v2",
      "reference": {
        "clinicalValidationClaimed": false,
        "evidenceRole": "construction",
        "label": "baseline",
        "referenceId": "baseline",
        "target": {
          "admissionPolicyId": "main-wire-prospective-baseline-admission-v1",
          "comparisonProfileId": "main-wire-resting-reference-profile-v1",
          "evaluationRolePolicyId": "main-wire-standard70-baseline-evaluation-roles-v3",
          "evidenceRegistryId": "main-wire-normal-reference-evidence-v1",
          "kind": "construction-corridors",
          "referenceOutputsAreTargets": false
        }
      }
    }
  }
]

全入力と起動checkpointの出自

{
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    "mechanismResearchInputs": {
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        },
        "calciumDecayTimeScaleByWall": {
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        },
        "inputId": "main-wire-five-wall-mechanics-research-input-v1",
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      },
      "coronaryDisease": {
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        },
        "inputId": "main-wire-coronary-disease-research-inputs-v2",
        "structuralR1ResistanceScaleByTerritoryLayer": {
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          },
          "LCx": {
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            "subepicardial": 1
          },
          "RCA": {
            "subendocardial": 1,
            "subepicardial": 1
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        },
        "structuralRmResistanceScaleByTerritoryLayer": {
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            "subepicardial": 1
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      },
      "inputId": "main-wire-integrated-model-mechanism-research-inputs-v3",
      "oxygenTransport": {
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        "barometricPressureMmHg": 760,
        "hemoglobinGPerDl": 15,
        "inputId": "whole-body-beat-mean-oxygen-transport-input-v1",
        "inspiredOxygenFraction01": 0.21,
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        "targetOxygenConsumptionMlPerMin": 250,
        "trueShuntFraction01": 0.02
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        "inputId": "main-wire-common-pericardium-research-inputs-v1",
        "prescribedFluidVolumeMl": 0,
        "pressureScale": 1,
        "referenceCapacityScale": 1
      },
      "valveAreas": {
        "AoV": {
          "closedReverseEroaCm2": 0,
          "maximumForwardEoaCm2": 3.5
        },
        "MV": {
          "closedReverseEroaCm2": 0,
          "maximumForwardEoaCm2": 5.5
        },
        "PV": {
          "closedReverseEroaCm2": 0,
          "maximumForwardEoaCm2": 4
        },
        "TV": {
          "closedReverseEroaCm2": 0,
          "maximumForwardEoaCm2": 8
        }
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    },
    "ventricularContractilityScale": 1
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  "inputBinding": {
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          "inputId": "main-wire-five-wall-mechanics-research-input-v1",
          "passiveStiffnessScaleByWall": {
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        },
        "coronaryDisease": {
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          "inputId": "main-wire-coronary-disease-research-inputs-v2",
          "structuralR1ResistanceScaleByTerritoryLayer": {
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              "subendocardial": 1,
              "subepicardial": 1
            },
            "LCx": {
              "subendocardial": 1,
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            },
            "RCA": {
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            }
          },
          "structuralRmResistanceScaleByTerritoryLayer": {
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              "subepicardial": 1
            },
            "LCx": {
              "subendocardial": 1,
              "subepicardial": 1
            },
            "RCA": {
              "subendocardial": 1,
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            }
          }
        },
        "inputId": "main-wire-integrated-model-mechanism-research-inputs-v3",
        "oxygenTransport": {
          "arterialCarbonDioxidePressureMmHg": 40,
          "barometricPressureMmHg": 760,
          "hemoglobinGPerDl": 15,
          "inputId": "whole-body-beat-mean-oxygen-transport-input-v1",
          "inspiredOxygenFraction01": 0.21,
          "respiratoryExchangeRatio": 0.8,
          "targetOxygenConsumptionMlPerMin": 250,
          "trueShuntFraction01": 0.02
        },
        "pericardium": {
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          "inputId": "main-wire-common-pericardium-research-inputs-v1",
          "prescribedFluidVolumeMl": 0,
          "pressureScale": 1,
          "referenceCapacityScale": 1
        },
        "valveAreas": {
          "AoV": {
            "closedReverseEroaCm2": 0,
            "maximumForwardEoaCm2": 3.5
          },
          "MV": {
            "closedReverseEroaCm2": 0,
            "maximumForwardEoaCm2": 5.5
          },
          "PV": {
            "closedReverseEroaCm2": 0,
            "maximumForwardEoaCm2": 4
          },
          "TV": {
            "closedReverseEroaCm2": 0,
            "maximumForwardEoaCm2": 8
          }
        }
      },
      "ventricularContractilityScale": 1
    },
    "changes": [],
    "initialization": "cold",
    "interpretation": "Unchanged input meanings in the same exact model; independent cold reconstruction.",
    "priorCheckpointImported": false,
    "publicPromotionAuthorized": false,
    "recordSha256": "c0eefe1a8b57e2dafd86f61ac48ee2b06e91e3a557153de326b9ecf86ed533b3",
    "referenceId": "baseline",
    "sourceModelId": "circleheart.main-wire-integrated-transaction-v3.static-anatomy.standard-74",
    "targetModelId": "circleheart.main-wire-integrated-transaction-v3.static-anatomy.standard-74"
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  "launchBinding": {
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    "qualifiedCheckpointSha256": "816ca45e592525aca9501a70a88ac20186f7fc1ee559166b4b325c8a02ea6f79",
    "launchCheckpointSha256": "4b881697899904e7a66fa5095db92208270942ef5734d0cbd2d9b964717ea4bf",
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  },
  "continuation": {
    "presetId": "standard74-baseline-v1",
    "steps": 1000,
    "completeFramesAndTerminalCaptureEqual": true
  }
}

この文書は保存された症例評価と測定時のSurfaceを示します。新しいSurfaceによるESPVR・EDPVR・PVAや表示方法の検証とは区別します。過去の受動力学試験を今回の成功例として読み替えていません。