Abnormal Left Ventricular Vortex Flow Patterns in Association With Left Ventricular Apical Thrombus Formation in Patients With Anterior Myocardial Infarction

Son, Jang‐Won; Park, Won-Jong; Choi, Jung‐Hyun; Houle, Hélène; Vannan, Mani A.; Hong, Geu‐Ru; Chung, Namsik

doi:10.1253/circj.cj-12-0360

Cited by 49 publications

(48 citation statements)

References 21 publications

(16 reference statements)

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“…20 Recently, a clinical study, performed by echo-PIV, analyzed the risk of thrombus formation in patients with myocardial infarction on the anterior wall. 89 In agreement with previous results, they demonstrated that the vortex remains in a more basal location within the LV, as measured from the steady streaming flow, and this vortex characteristic is strongly associated with LV thrombus formation.…”

Section: Kinematic Aspects: Flow Transitsupporting

confidence: 92%

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Pedrizzetti

Domenichini

2014

Ann Biomed Eng

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Abstract-The flow inside the left ventricle is characterized by the formation of vortices that smoothly accompany blood from the mitral inlet to the aortic outlet. Computational fluid dynamics permitted to shed some light on the fundamental processes involved with vortex motion. More recently, patient-specific numerical simulations are becoming an increasingly feasible tool that can be integrated with the developing imaging technologies. The existing computational methods are reviewed in the perspective of their potential role as a novel aid for advanced clinical analysis. The current results obtained by simulation methods either alone or in combination with medical imaging are summarized. Open problems are highlighted and perspective clinical applications are discussed.

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Section: Kinematic Aspects: Flow Transitsupporting

confidence: 92%

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Pedrizzetti

Domenichini

2014

Ann Biomed Eng

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“…[25][26][27] However, this technique is available only in the 2D mode of TTE, is difficult to use in the evaluation of vortex, and is limited in terms of sub-optical images in patients with obesity or emphysema. 4D-Flow can clearly and non-invasively measure all 3D components of the vectors of blood velocity relative to all 4 spatio-temporal dimensions of the heart and great vessels, which has otherwise been difficult in TTE.…”

Section: Imaging Of the Intra-la Vortex With 4d-flowmentioning

confidence: 99%

Characteristics of Intra-Left Atrial Flow Dynamics and Factors Affecting Formation of the Vortex Flow

Suwa

Saitoh

Takehara

et al. 2014

Circ J

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“…Stratification of patients at risk for LVT formation is currently based primarily on a global assessment of ventricular function and image-based assessment of ventricular wall motion to identify LV regional wall akinesia and dyskinesia. Some previous studies have, however, shown that global parameters, such as EF, SV, and EDV, do not always correlate well with LVT formation (29,40,45), and existing approaches for stratifying LVT risk, therefore, lack sensitivity and specificity (44). The identification of high-risk patients and the pharmacological prevention of LVT formation are the key to preventing embolic events.…”

Section: A Computational Methods That Simultaneously Resolves the Leftmentioning

confidence: 99%

“…However, the correlation between the flow pattern and LVT risk reported in earlier studies is rather descriptive or qualitative. A quantitative metric related to the flow pattern in the LV and its correlation to LVT formation has been suggested (40), but the limitation of this prior study was that the flow patterns in LVT cases were assessed after thrombus formation, making it difficult to determine whether the metric represents conditions conducive to the genesis of LVT or the effect of the LVT on the LV flow.…”

Section: A Computational Methods That Simultaneously Resolves the Leftmentioning

confidence: 99%

“…Current risk stratification methods, therefore, result in the treatment of 10 patients to prevent LVT in 1 patient (22), while the risk of bleeding in the triple therapy era is 1 in 5. Clearly, more effective methods of risk stratification are needed.Several studies have emphasized the importance of LV blood flow patterns on thrombus formation (3,10,23,29,40,45), and it has even been suggested that the direct assessment of LV flow for the identification of abnormal flow patterns (10,29,45), or a metric closely related to the LV flow (40), could be a better marker for LVT formation. However, the correlation between the flow pattern and LVT risk reported in earlier studies is rather descriptive or qualitative.…”

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confidence: 99%

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A coupled chemo-fluidic computational model for thrombogenesis in infarcted left ventricles

Seo

Abd

George

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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Seo JH, Abd T, George RT, Mittal R. A coupled chemo-fluidic computational model for thrombogenesis in infarcted left ventricles. Am J Physiol Heart Circ Physiol 310: H1567-H1582, 2016. First published March 25, 2016; doi:10.1152/ajpheart.00855.2015.-A coupled chemo-fluidic computational model for investigating flowmediated thrombogenesis in infarcted left ventricles (LVs) is proposed. LV thrombus (LVT) formation after the acute myocardial infarction (AMI) may lead to thromboembolic events that are associated with high mortality and morbidity, and reliable stratification of LVT risk is the key to managing the treatment of AMI patients. There have been several studies emphasizing the importance of LV blood flow patterns on thrombus formation; however, given the complex interplay between ventricular flow dynamics and biochemistry of thrombogenesis, current understanding is mostly empirical. In the present model, blood flow in the LV is obtained by solving the incompressible Navier-Stokes equations, and this is coupled to the biochemical modeling of the coagulation cascade, platelet activation, and fibrinogen polymerization. The coupled model is used to examine the effect of ventricular flow patterns on thrombogenesis in modeled ventricles. It is expected that the method developed here will enable in-depth studies of thrombogenesis in patient-derived infarcted LV models. computational hemodynamics; cardiac flow; intraventricular flow; blood clot; coagulation cascade; biochemical reaction NEW & NOTEWORTHY A computational method that simultaneously resolves the left ventricular flow patterns as well as the biochemical coagulation cascade (CC) is proposed. The method enables a clear identification of the effect of flow patterns on left ventricular thrombogenesis and suggests a metric quantitatively correlated to thrombogenic risk.ONE OF THE MOST FEARED COMPLICATIONS for patients with acute myocardial infarction (AMI) is the occurrence of thromboembolic events associated with left ventricular (LV) thrombus (LVT) formation (11) and cardioembolic strokes, which account for 20 -30% of all ischemic strokes (25,27,33). The identification of high-risk patients and the pharmacological prevention of LVT formation are the keys to preventing these embolic events. Thrombus formation results from the combination of disturbed blood flow patterns, endothelial injury, and hypercoagulability of the endothelium. After AMI, LV regional wall akinesia or dyskinesia changes the patterns of blood flow in the LV, and this can result in local stasis of blood flow (3). Prolonged ischemia also leads to subendocardial tissue injury with inflammatory changes and may lead to the development of a LV aneurysm (30, 34), which may cause further abnormalities in LV flow. Furthermore, patients with acute coronary syndrome show a hypercoagulable state with increased concentrations of prothrombin and fibrinopeptide (11). The above prerequisites in the LV with AMI lead to the formation of LVT composed of fibrin, platelets, and red blood cells.Risk factors f...

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Abnormal Left Ventricular Vortex Flow Patterns in Association With Left Ventricular Apical Thrombus Formation in Patients With Anterior Myocardial Infarction

Cited by 49 publications

References 21 publications

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Characteristics of Intra-Left Atrial Flow Dynamics and Factors Affecting Formation of the Vortex Flow

A coupled chemo-fluidic computational model for thrombogenesis in infarcted left ventricles

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