Anticoagulation in Patients with Dilated Cardiomyopathy, Low Ejection Fraction, and Sinus Rhythm: Back to the Drawing Board

Mischie, Alexandru; Chioncel, Valentin; Droc, Ionel; Sinescu, Crina

doi:10.1111/1755-5922.12019

Cited by 12 publications

(14 citation statements)

References 48 publications

(75 reference statements)

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“…While the dilated, low cardiac output condition serves as the baseline for our study, dilated cardiomyopathy has itself been associated with a 1%‐2% stroke rate and 10% intraventricular thrombus incidence . The risk of thromboembolism in cardiomyopathy is increased both with larger LV size and lower ejection fraction, both of which affect the fluid dynamics.…”

Section: Discussionmentioning

confidence: 99%

“…[36][37][38] While the dilated, low cardiac output condition serves as the baseline for our study, dilated cardiomyopathy has itself been associated with a 1%-2% stroke rate and 10% intraventricular thrombus incidence. [39][40][41] The risk of thromboembolism in cardiomyopathy is increased both with larger LV size and lower ejection fraction, both of which affect the fluid dynamics. In patients with severe cardiac dysfunction, the dilated LV geometry and depressed function create shorter, rounder vortex structures that have lower strength and persistence, which are associated with greater energy dissipation and higher residence time (>2 s) than in the normal heart.…”

Section: Discussionmentioning

confidence: 99%

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Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

et al. 2019

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Due to the high stroke rate of left ventricular assist device (LVAD) patients, reduction of thrombus has emerged as an important target for LVAD support. Left ventricular blood flow patterns with areas of flow stasis and recirculation are associated with platelet aggregation, which is worsened by exposure to high shear stress. Previous reports of intraventricular thrombus in LVAD patients have identified the outside of the LVAD inflow cannula as a nidus for LV thrombus formation. Previous studies of LVAD inflow cannula design have shown a region of low blood velocity and pulsatility at the apex, adjacent to the cannula. One unresolved question is whether the standard practice of inserting the LVAD inflow cannula several mm into the LV could be revised to reduce thrombus formation. To address this, a “tipless” inflow cannula was designed for the EVAHEART LVAS, and assessed in a mock circulatory loop of the LVAD‐supported heart. Customized transparent silicone models of a dilated LV were connected to the EVAHEART LVAS at the apex with a clear polycarbonate inflow cannula for flow visualization using particle image velocimetry (PIV). The “tipless” cannula was inserted flush with the endocardial border and did not protrude into the LV. This condition was compared to the standard cannula position with a 1‐cm insertion into the LV. The Pre‐LVAD condition corresponded to a severe heart failure patient (ejection fraction of 24%) with a dilated LV (180 mL). LVAD support was provided at speeds of 1.8 and 2.3 krpm. At the lower LVAD speed, 63% of the flow passed through the LVAD, with the remainder ejecting through the aortic valve. When LVAD speed was increased, nearly all flow (98%) left the LV through the LVAD. Both LVAD speed conditions produced a vortex ring similar to the Pre‐LVAD condition in diastole. However, the protruding inflow cannula interrupted the growth and restricted the movement of the vortex, and produced areas of low velocity and pulsatility adjacent to the cannula. The tipless cannula exhibited an uninterrupted pattern of the mitral jet toward the LV apex, which allowed the diastolic vortex to grow and aid in the washout of this region. In addition, the tipless cannula increased aortic valve flow, which reduces stasis in the left ventricular outflow tract. The EVAHEART LVAS tipless inflow cannula design improved regional velocity, pulsatility, and vortex formation compared to the standard protruding design, which all reduce the risk of thrombus formation. The clinical significance of the differences observed in the flow field will be dependent on other factors such as the cannula material and surface characteristics, as well as the patients' coagulation status.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

et al. 2019

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“…The role of anticoagulation in DCM with sinus rhythm is unclear [80]. The prospective randomized trials were either underpowered or with a too short follow-up.…”

Section: Anticoagulationmentioning

confidence: 99%

Current Pathophysiological and Genetic Aspects of Dilated Cardiomyopathy

Schild¹,

Ricciardi²,

Hellige³

et al. 2019

Visions of Cardiomyocyte - Fundamental Concepts of Heart Life and Disease [Working Title]

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Dilated cardiomyopathy is the most common form of cardiomyopathy and the second leading cause of left ventricular dysfunction with highly variable clinical presentation and prognosis. The clinical courses vary and are strongly heterogeneous, ranging from asymptomatic patients to those suffering from intractable heart failure or sudden cardiac death due to arrhythmias. Previous studies have reported a 10 years cardiovascular mortality up to 40% in developed countries, due to advanced heart failure or sudden cardiac death. However, the prognosis of dilated cardiomyopathy patients is variable and depends on multiple risk factors. This chapter provides a review of dilated cardiomyopathy with specific focus on the pathophysiological aspects and genetic etiology of the disease.

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“…Being associated with progressive hemodynamic deterioration and thromboembolic risk, [1] chronic systolic heart failure is often caused by non-ischemic cardiomyopathy (non-ICMP). [2,3] Among researches addressing how heart failure affects the eyes, [4,5] one reported increased bulbar conjunctival vascular density in mild heart failure, whereas severe heart failure was shown to be characterized by decreased microvascular density.…”

mentioning

confidence: 99%

“…[5] In severe non-ICMP, the heart cannot pump blood well enough to meet the needs of tissue. Following heart failure, tissue hypoxia and peripheral edema, thus, usually develop, [1] along with peripheral vascular alterations such as arterial constriction and venous dilation. [1,4] By contrast, retinal-choroidal vessels may not be affected to as great an extent due to strong ocular hemodynamic and vascular protective mechanisms.…”

mentioning

confidence: 99%

Evaluation of retinal vessel caliber, choroidal thickness, and ocular perfusion pressure in patients with low cardiac ejection fraction

Alur¹

2019

Cardiovasc Surg Int

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This study aims to investigate the retinal vessel caliber, choroidal thickness, and ocular perfusion pressure in patients with low cardiac output. Patients and methods: Between June 2014 and June 2015, a total of 44 patients (34 males, 10 females; mean age 59.3±12.4 years) with low ejection fraction due to dilated cardiomyopathy and 44 healthy, age-and sex-matched individuals (34 males, 10 females; mean age 59.3±8.5 years) were included in this cross-sectional comparative study. All patients in the study group had an ejection fraction less than 40%. Retinal vascular caliber measurements were made using retinal photographs with fluorescein angiography, whereas subfoveal choroidal thickness and foveal thickness were measured using the spectral-domain optical coherence tomography. The ocular perfusion pressure was calculated according to a formula consisting of mean arterial blood pressure and intraocular pressure. Results: There was no statistically significant difference between patients with low cardiac ejection fraction and healthy controls regarding the retinal vascular caliber, subfoveal choroidal thickness, foveal thickness, or ocular perfusion pressure (p>0.05). The mean intraocular pressure was 13.1±2.8 mmHg in the study group and 13.4±2.7 mmHg in the control group (p=0.59). Ejection fraction was not significantly associated with the retinal vascular caliber, subfoveal choroidal thickness, or ocular perfusion pressure (p>0.05). Conclusion: Our findings suggest that reduced cardiac output does not significantly affect the retinal vessel caliber, choroidal thickness, or ocular perfusion pressure in clinical practice.

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Anticoagulation in Patients with Dilated Cardiomyopathy, Low Ejection Fraction, and Sinus Rhythm: Back to the Drawing Board

Cited by 12 publications

References 48 publications

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

Current Pathophysiological and Genetic Aspects of Dilated Cardiomyopathy

Evaluation of retinal vessel caliber, choroidal thickness, and ocular perfusion pressure in patients with low cardiac ejection fraction

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