A clinical method for mapping and quantifying blood stasis in the left ventricle

Rossini, Lorenzo; Martínez‐Legazpi, Pablo; Vu, Vi; Fernández‐Friera, Leticia; Villar, Candelas Pérez del; Rodríguez-López, Sara; Benito, Yolanda; Borja, María-Guadalupe; Pastor-Escuredo, David; Yotti, Raquel; Ledesma-Carbayo, María J.; Kahn, Andrew; Ibáñez, Borja; Fernández-Avilés, Francisco; May‐Newman, Karen; Bermejo, Javier; Álamo, Juan C. del

doi:10.1016/j.jbiomech.2015.11.049

Cited by 57 publications

(56 citation statements)

References 39 publications

(56 reference statements)

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“…The inflow waveform across the mitral valve was derived from previously published in vivo measurements in another heart failure patient using echo-Doppler [26, 27]. A smoothed-periodic curve was fitted to the echo-Doppler data in MATLAB R2014a (Mathworks, Natick, MA) (Figure 3, A).…”

Section: Methodsmentioning

confidence: 99%

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

Prisco¹,

Aliseda

Beckman

et al. 2017

ASAIO Journal

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Treatment of end-stage heart failure includes cardiac transplantation or ventricular assist device (VAD) therapy. While increasingly prevalent, current VAD therapy has inherent complications, including thrombosis. Studies have demonstrated that VAD implantation alters intra-cardiac blood flow, creating areas of stagnation that predispose to thrombus formation. Two potential surgical configurations exist for VAD implantation: through the apical or diaphragmatic surfaces of the heart. We hypothesized that diaphragmatic implantation causes more stagnation than apical implantation. We also hypothesized that intermittent aortic valve (AV) opening reduces stagnation of blood inside the left ventricle (LV) when compared to a closed AV. To test these hypotheses, a human left-ventricle geometry was re-created in silico and a VAD inflow cannula was virtually implanted in each configuration. A computational indicator-dilution study was conducted where “virtually-dyed blood” was washed out of the LV by injecting blood with no dye. Simulations demonstrated a substantial reduction in stagnation with intermittent AV opening. In addition, virtual dye was cleared slightly faster in the apical configuration. Simulations from our study demonstrate the clinical importance of VAD management to allow intermittent opening of the AV to prevent subvalvular stagnation, and it also suggests that apical configuration might be more hemodynamically favorable.

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Section: Methodsmentioning

confidence: 99%

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

Prisco¹,

Aliseda

Beckman

et al. 2017

ASAIO Journal

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“…As shown below, combining the results from the forward and backward integrations allows for a straightforward categorization of blood transport templates inside the LV. Equation (1) was numerically integrated using previously described in-house software written in FORTRAN [37]. The equation was discretized on a Cartesian grid by a 2nd-order finite volume method, and a total variation diminishing flux limiting scheme was used to avoid numerical oscillations at the sharp interfaces created between volumes of blood with different inflow tags.…”

Section: D Image Analysis and Intraventricular Flow Processingmentioning

confidence: 99%

Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy

et al. 2016

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In the healthy heart, left ventricular (LV) filling generates different flow patterns which have been proposed to optimize blood transport by coupling diastole and systole. This work presents a novel image-based method to assess how different flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Our approach is based on solving the advection equation for a passive scalar field from time-resolved blood velocity fields. Imposing time-varying inflow boundary conditions for the scalar field provides a straightforward method to distinctly track the transport of blood entering the LV in the different filling waves of a given cardiac cycle, as well as the transport barriers which couple filling and ejection. We applied this method to analyze flow transport in a group of patients with implanted CRT devices and a group of healthy volunteers. Velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular conduction delay, and to model tachycardia (100 bpm). Using this method, we show how CRT influences the transit of blood inside the left ventricle, contributes to conserving kinetic energy, and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract. These novel aspects of ventricular function are clinically accessible by quantitative analysis of color-Doppler echocardiograms.

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“…In these limited human studies, the focus has been on proof-of-concept study designs, with small sample sizes, limited a priori hypotheses, and case studies, rather than group comparisons or interventional designs [10,12,13,39,[57][58][59]. Focused studies on basic science or clinical research questions are the natural next step for the field, in which HiFRUS can be used as a specialized research tool for both simple and complex system cardiovascular measurement.…”

Section: Framework For In Vivo Cardiovascular Studiesmentioning

confidence: 99%

Riding the Plane Wave: Considerations for In Vivo Study Designs Employing High Frame Rate Ultrasound

Hughson

2018

Applied Sciences

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Advancements in diagnostic ultrasound have allowed for a rapid expansion of the quantity and quality of non-invasive information that clinical researchers can acquire from cardiovascular physiology. The recent emergence of high frame rate ultrasound (HiFRUS) is the next step in the quantification of complex blood flow behavior, offering angle-independent, high temporal resolution data in normal physiology and clinical cases. While there are various HiFRUS methods that have been tested and validated in simulations and in complex flow phantoms, there is a need to expand the field into more rigorous in vivo testing for clinical relevance. In this tutorial, we briefly outline the major advances in HiFRUS, and discuss practical considerations of participant preparation, experimental design, and human measurement, while also providing an example of how these frameworks can be immediately applied to in vivo research questions. The considerations put forward in this paper aim to set a realistic framework for research labs which use HiFRUS to commence the collection of human data for basic science, as well as for preliminary clinical research questions.

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A clinical method for mapping and quantifying blood stasis in the left ventricle

Cited by 57 publications

References 39 publications

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

Impact of LVAD Implantation Site on Ventricular Blood Stagnation

Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy

Riding the Plane Wave: Considerations for In Vivo Study Designs Employing High Frame Rate Ultrasound

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