Compensatory Effect between Aortic Stiffening and Remodelling during Ageing

Guala, Andrea; Camporeale, Carlo Vincenzo; Ridolfi, Luca

doi:10.1371/journal.pone.0139211

Cited by 26 publications

(22 citation statements)

References 45 publications

(84 reference statements)

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“…Forward pressure waves generated by systolic contraction propagate through the arterial tree, and they are partially reflected at every impedance mismatch generating backward propagating pressure waves. These backward propagating waves are further reflected at upstream bifurcation, creating a complex pattern rapidly smoothed out by blood and vessel wall viscosity [ 12 ]. Therefore, arterial pressure in a given measurement location results from the sum of the location-specific forward and backward components.…”

Section: Discussionmentioning

confidence: 99%

“…The mathematical model used for central pressure appraisal has been previously presented and described [ 9 , 12 , 13 ]. Blood flow/pressure dynamics in the large artery network are described by one-dimensional modeling, which includes the non-linear viscoelasticity of the arterial walls, while left ventricle, its valves and distal microcirculation are described by lumped models.…”

Section: Methodsmentioning

confidence: 99%

“…In particular, multi-scale models—most of them relying on a one-dimensional description of the wave propagation through the large arteries and on a simpler zero-dimensional characterization of the left ventricle, aortic valve and microcirculation—are now being used in a number studies. E.g., to analyze the pressure waveforms [ 9 , 12 ], the coronary function [ 9 , 13 ], and the effect of the aortic shape [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Tosello¹,

Guala

Leone³

et al. 2016

PLoS ONE

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IntroductionCurrent evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice.AimThe aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics.MethodsA total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study.ResultsModel-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed.ConclusionIn conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Tosello¹,

Guala

Leone³

et al. 2016

PLoS ONE

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“…The present study relies on the multiscale model proposed by Guala et al [23], which combines the 0D-1D modelling of the left heart and arterial tree [24,25,8] together with the coronary circulation model as introduced by Mynard et al [26,27]. The geometrical domain includes the arterial tree, the left heart, with mitral and aortic valves, and the left coronary circulation.…”

Section: Mathematical Modellingmentioning

confidence: 99%

Impaired coronary blood flow at higher heart rates during atrial fibrillation: Investigation via multiscale modelling

Scarsoglio

Gallo

Saglietto

et al. 2019

Computer Methods and Programs in Biomedicine

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Background. Different mechanisms have been proposed to relate atrial fibrillation (AF) and coronary flow impairment, even in absence of relevant coronary artery disease (CAD). However, the underlying hemodynamics remains unclear. Aim of the present work is to computationally explore whether and to what extent ventricular rate during AF affects the coronary perfusion. Methods. AF is simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) through a 0D-1D multiscale validated model, which combines the left heart-arterial tree together with the coronary circulation. Artificially-built RR stochastic extraction mimics the in vivo beating features. All the hemodynamic parameters computed are based on the left anterior descending (LAD) artery and account for the waveform, amplitude and perfusion of the coronary blood flow. Results. Alterations of the coronary hemodynamics are found to be associated either to the heart rate increase, which strongly modifies waveform and amplitude of the LAD flow rate, and to the beat-to-beat variability. The latter is overall amplified in the coronary circulation as HR grows, even though the input RR variability is kept constant at all HRs. Conclusions. Higher ventricular rate during AF exerts an overall coronary blood flow impairment and imbalance of the myocardial oxygen supply-demand ratio. The combined increase of heart rate and higher AF-induced hemodynamic variability lead to a coronary perfusion impairment exceeding 90-110 bpm in AF. Moreover, it is found that coronary perfusion pressure (CPP) is no longer a good measure of the myocardial perfusion for HR higher than 90 bpm.

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“…In the present work, we adopt the multiscale model proposed and validated by Guala and coauthors [15,16,17], which includes a lumped parameterization of the cardiac and distal circulation together with one-dimensional modelling of large-tomedium systemic arteries, to investigate in detail the local effect of AF on the arterial fluid dynamics. AF and normal sinus rhythm (NSR) conditions are simulated extracting 2000 RR heartbeats for each configuration to guarantee the statistical stationarity of the outcomes.…”

Section: Introductionmentioning

confidence: 99%

Effects of atrial fibrillation on the arterial fluid dynamics: a modelling perspective

2018

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Atrial fibrillation (AF) is the most common form of arrhythmia with accelerated and irregular heart rate (HR), leading to both heart failure and stroke and being responsible for an increase in cardiovascular morbidity and mortality. In spite of its importance, the direct effects of AF on the arterial hemodynamic patterns are not completely known to date. Based on a multiscale modelling approach, the proposed work investigates the effects of AF on the local arterial fluid dynamics. AF and normal sinus rhythm (NSR) conditions are simulated extracting 2000 RR heartbeats and comparing the most relevant cardiac and vascular parameters at the same HR (75 bpm). Present outcomes evidence that the arterial system is not able to completely absorb the AF-induced variability, which can be even amplified towards the peripheral circulation. AF is also able to locally alter the wave dynamics, by modifying the interplay between forward and backward signals. The sole heart rhythm variation (i.e., from NSR to AF) promotes an alteration of the regular dynamics at the arterial level which, in terms of pressure and peripheral perfusion, suggests a modification of the physiological phenomena ruled by periodicity (e.g., regular organ perfusion)and a possible vascular dysfunction due to the prolonged exposure to irregular and extreme values. The present study represents a first modeling approach to characterize the variability of arterial hemodynamics in presence of AF, which surely deserves further clinical investigation.

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Compensatory Effect between Aortic Stiffening and Remodelling during Ageing

Cited by 26 publications

References 45 publications

Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Impaired coronary blood flow at higher heart rates during atrial fibrillation: Investigation via multiscale modelling

Effects of atrial fibrillation on the arterial fluid dynamics: a modelling perspective

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