Cardiac fluid dynamics anticipates heart adaptation

Pedrizzetti, Gianni; Martiniello, Alfonso R.; Bianchi, Valter; D’Onofrio, Antonio; Caso, Pio; Tonti, Giovanni

doi:10.1016/j.jbiomech.2014.11.049

Cited by 49 publications

(50 citation statements)

References 20 publications

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“…Correct vortex formation allows the smooth redirection of blood flow toward the outflow tract during systole, thus facilitating systolic blood ejection; it can also prevent excessive impacts on the LV wall. Meanwhile, maladaptive fluid mechanics contribute to cardiac inefficiency . With LV dilation and abnormal myocardial contraction in DCM, maladaptive fluid mechanics (many vortices with different directions of rotation) appear in the left ventricle, which causes the flow to be disorderly, and this redirects the blood flow from the LV base toward the LV posterior wall, the LV apex, and the LVOT.…”

Section: Discussionmentioning

confidence: 99%

Analysis of left ventricular fluid dynamics in dilated cardiomyopathy by echocardiographic particle image velocimetry

et al. 2017

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Objective:The aim was to analyze left ventricular (LV) fluid dynamics in dilated cardiomyopathy (DCM) by using echocardiographic particle image velocimetry (E-PIV).Methods: Twenty patients with DCM and twenty healthy volunteers were examined.LV ultrasound contrast was administered by intravenous bolus injection. At least three dynamic contrast-enhanced echocardiographic images of cardiac cycles from apical three-chamber view and four-chamber view were obtained. The acquired echocardiographic image loops were processed off line by HyperFlow. Results:In healthy hearts, the filling flow in the left ventricle finally comes to be a single large clockwise vortex, which smoothly redirects the blood to the outflow tract.

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Section: Discussionmentioning

confidence: 99%

Analysis of left ventricular fluid dynamics in dilated cardiomyopathy by echocardiographic particle image velocimetry

et al. 2017

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“…Pedrizzetti et al, using the same echo‐PIV technique, studied the LV hemodynamic forces in CRT responders and nonresponders. In CRT responders presenting a longitudinal alignment of the LV hemodynamic forces, pacing switch‐off determined loss of alignment of intraventricular forces and development of transversal components, despite cardiac contractility and synchrony parameters did not show measurable changes (Figure ).…”

Section: Effect Of Crt On Intracardiac Flow Dynamicsmentioning

confidence: 99%

“…Interestingly, measures of intracardiac flow dynamics were apparently more sensitive than those of cardiac contractility and synchrony, at least in the studied populations. The reason is not perfectly understood, and however, global flow modifications are presumably due to minor changes in the synchrony of tissue motion, like local and short‐lasting accelerations, which are difficult to detect directly but reflect on the overall dynamic balance of the incompressible fluid within the LV …”

Section: Effect Of Crt On Intracardiac Flow Dynamicsmentioning

confidence: 99%

Intracardiac flow analysis in cardiac resynchronization therapy: A new challenge?

et al. 2019

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In the past years, assessment of cardiac function has become possible through the analysis of intracardiac flow dynamics, performed noninvasively using phase‐contrast cardiac magnetic resonance and contrast and noncontrast ultrasound techniques. From 2013 to 2019, 9 echocardiographic investigations have considered 215 patients with cardiac resynchronization therapy (CRT) as a model for assessing flow dynamics within the left ventricle. Preliminary results have been reported about the acute hemodynamic effects of CRT and programming of the CRT device, showing the potential of an approach based on analysis of intracardiac flows. At present, there are only scarce data on the capability of intracardiac flow dynamics to predict LV remodeling after CRT and no information on clinical outcome prediction. Future investigations should be aimed at clarifying the mechanisms and impact of maladaptive intracardiac vortex dynamics on progressive LV remodeling as well as the prognostic meaning of implanted CRT device based on cardiac flow analysis.

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“…strain imaging) provide fundamental information on the kinematics and contractility of the heart. The analysis of intraventricular flow, on the other hand, may be an even more powerful indicator of abnormal cardiac phenomena, as changes in the blood flow can precede the development of noticeable structural modifications (Pedrizzetti et al, 2015(1)). Therefore, a reliable and quantitative evaluation of cardiac flow may result not only in a diagnosis of an existing status, but in its prediction, based on an abnormal or sub-optimal cardiac performance (Pedrizzetti et al, 2015 (1-2)).…”

Section: Introductionmentioning

confidence: 99%

Patient-specific CFD models for intraventricular flow analysis from 3D ultrasound imaging: Comparison of three clinical cases

Bavo

Pouch

Degroote

et al. 2017

Journal of Biomechanics

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Background As the intracardiac flow field is affected by changes in shape and motility of the heart, intraventricular flow features can provide diagnostic indications. Ventricular flow patterns differ depending on the cardiac condition and the exploration of different clinical cases can provide insights into how flow fields alter in different pathologies. Methods In this study, we applied a patient-specific computational fluid dynamics model of the left ventricle and mitral valve, with prescribed moving boundaries based on transesophageal ultrasound images for three cardiac pathologies, to verify the abnormal flow patterns in impaired hearts. One case (P1) had normal ejection fraction but low stroke volume and cardiac output, P2 showed low stroke volume and reduced ejection fraction, P3 had a dilated ventricle and reduced ejection fraction. Results The shape of the ventricle and mitral valve, together with the pathology influence the flow field in the left ventricle, leading to distinct flow features. Of particular interest is the pattern of the vortex formation and evolution, influenced by the valvular orifice and the ventricular shape. The base-to-apex pressure difference of maximum 2 mmHg is consistent with reported data. Conclusion We used a CFD model with prescribed boundary motion to describe the intraventricular flow field in three patients with impaired diastolic function. The calculated intraventricular flow dynamics are consistent with the diagnostic patient records and highlight the differences between the different cases. The integration of clinical images and computational techniques, therefore, allows for a deeper investigation intraventricular hemodynamics in patho-physiology.

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Cardiac fluid dynamics anticipates heart adaptation

Cited by 49 publications

References 20 publications

Analysis of left ventricular fluid dynamics in dilated cardiomyopathy by echocardiographic particle image velocimetry

Analysis of left ventricular fluid dynamics in dilated cardiomyopathy by echocardiographic particle image velocimetry

Intracardiac flow analysis in cardiac resynchronization therapy: A new challenge?

Patient-specific CFD models for intraventricular flow analysis from 3D ultrasound imaging: Comparison of three clinical cases

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