Computational Modeling Studies of the Roles of Left Ventricular Geometry, Afterload, and Muscle Contractility on Myocardial Strains in Heart Failure with Preserved Ejection Fraction

Shavik, Sheikh Mohammad; Wall, Samuel; Sundnes, Joakim; Guccione, Julius M.; Sengupta, Partho P.; Solomon, Scott D.; Burkhoff, Daniel; Lee, Lik Chuan

doi:10.1007/s12265-021-10130-y

Cited by 25 publications

(26 citation statements)

References 69 publications

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“…Fifth, the boundary condition in which the base is constrained from moving out of plane is more similar to a Langendorff preparation than it is to a heart in vivo , where the base is moving out of plane and the apex has little motion. These boundary conditions have been applied in previous models ( Guccione et al, 1995 ; Balaban et al, 2018 ; Zhang et al, 2018 , 2021 ; Shavik et al, 2021 ). As mentioned in Guccione et al (2003) , however, stress and strain would still be largely similar because these quantities are independent of rigid body motion.…”

Section: Discussionmentioning

confidence: 99%

“…The computational framework consists of an FE model of the LV and 4 coronary microvascular networks (each consisting of 400 vessels) located at different transmural locations across the LV wall (i.e., endocardium, mid-endocardium, mid-epicardium, and epicardium) that are all connected to a lumped parameter representation of the systemic circulation (Figure 1). We note that the circulatory modeling framework is an extension of a previous study of only LV mechanics (Shavik et al, 2017(Shavik et al, , 2021, in which an additional distal arterial compartment that is parameterized by a resistance R a,d and a compliance C a,d is included here.…”

Section: Systemic Circulation Modelmentioning

confidence: 99%

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Transmural Distribution of Coronary Perfusion and Myocardial Work Density Due to Alterations in Ventricular Loading, Geometry and Contractility

et al. 2021

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Myocardial supply changes to accommodate the variation of myocardial demand across the heart wall to maintain normal cardiac function. A computational framework that couples the systemic circulation of a left ventricular (LV) finite element model and coronary perfusion in a closed loop is developed to investigate the transmural distribution of the myocardial demand (work density) and supply (perfusion) ratio. Calibrated and validated against measurements of LV mechanics and coronary perfusion, the model is applied to investigate changes in the transmural distribution of passive coronary perfusion, myocardial work density, and their ratio in response to changes in LV contractility, preload, afterload, wall thickness, and cavity volume. The model predicts the following: (1) Total passive coronary flow varies from a minimum value at the endocardium to a maximum value at the epicardium transmurally that is consistent with the transmural distribution of IMP; (2) Total passive coronary flow at different transmural locations is increased with an increase in either contractility, afterload, or preload of the LV, whereas is reduced with an increase in wall thickness or cavity volume; (3) Myocardial work density at different transmural locations is increased transmurally with an increase in either contractility, afterload, preload or cavity volume of the LV, but is reduced with an increase in wall thickness; (4) Myocardial work density-perfusion mismatch ratio at different transmural locations is increased with an increase in contractility, preload, wall thickness or cavity volume of the LV, and the ratio is higher at the endocardium than the epicardium. These results suggest that an increase in either contractility, preload, wall thickness, or cavity volume of the LV can increase the vulnerability of the subendocardial region to ischemia.

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Section: Discussionmentioning

confidence: 99%

Section: Systemic Circulation Modelmentioning

confidence: 99%

Transmural Distribution of Coronary Perfusion and Myocardial Work Density Due to Alterations in Ventricular Loading, Geometry and Contractility

et al. 2021

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“…A study by Shavik et al applied computational simulation techniques to replicate the physiology of heart failure with preserved ejection fraction (HFpEF), whereby decreased longitudinal strain exists with a normal ejection fraction ( Shavik et al, 2021 ). Through their framework, the variables of ventricular geometry, chamber size, blood pressure, and ventricular strains were altered based on sets of clinically measured patient-specific data.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricle Biomechanics of Low-Flow, Low-Gradient Aortic Stenosis: A Patient-Specific Computational Model

et al. 2022

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This study aimed to create an imaging-derived patient-specific computational model of low-flow, low-gradient (LFLG) aortic stenosis (AS) to obtain biomechanics data about the left ventricle. LFLG AS is now a commonly recognized sub-type of aortic stenosis. There remains much controversy over its management, and investigation into ventricular biomechanics may elucidate pathophysiology and better identify patients for valve replacement. ECG-gated cardiac computed tomography images from a patient with LFLG AS were obtained to provide patient-specific geometry for the computational model. Surfaces of the left atrium, left ventricle (LV), and outflow track were segmented. A previously validated multi-scale, multi-physics computational human heart model was adapted to the patient-specific geometry, yielding a model consisting of 91,000 solid elements. This model was coupled to a virtual circulatory system and calibrated to clinically measured parameters from echocardiography and cardiac catheterization data. The simulation replicated key physiologic parameters within 10% of their clinically measured values. Global LV systolic myocardial stress was 7.1 ± 1.8 kPa. Mean stress of the basal, middle, and apical segments were 7.7 ± 1.8 kPa, 9.1 ± 3.8 kPa, and 6.4 ± 0.4 kPa, respectively. This is the first patient-specific computational model of LFLG AS based on clinical imaging. Low myocardial stress correlated with low ejection fraction and eccentric LV remodeling. Further studies are needed to understand how alterations in LV biomechanics correlates with clinical outcomes of AS.

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“…While in the past most attention in the field of cardiac modeling had been paid to the simulation of the ventricles, and still is an active field of research [3][4][5][6][7], modeling of the atria has moved into focus in the last years. However, most publications deal with atrial electrophysiology and there are only a few addressing atrial mechanics [8].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Standard Ablation Strategies for Atrial Fibrillation on Cardiovascular Performance in a Four-chamber Heart Model

Gerach¹,

Schuler²,

Wächter³

et al. 2022

Preprint

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Atrial fibrillation is one of the most frequent cardiac arrhythmias in the industrialized world and ablation therapy is the method of choice for many patients. However, ablation scars alter the electrophysiological activation and the mechanical behavior of the affected atria. Different ablation strategies with the aim to terminate atrial fibrillation and prevent its recurrence exist but their impact on the hemodynamic performance of the heart has not been investigated thoroughly. Methods: In this work, we present a simulation study analyzing five commonly used ablation scar patterns and their combinations in the left atrium regarding their impact on the pumping function of the heart using an electromechanical whole-heart model. We analyzed how the altered atrial activation and increased stiffness due to the ablation scar affect atrial as well as ventricular contraction and relaxation. Results: We found that systolic and diastolic function of the left atrium is impaired by ablation scars and that the reduction of atrial stroke volume of up to 11.43% depends linearly on the amount of inactivated tissue. Consequently, the end-diastolic volume of the left ventricle, and thus stroke volume, was reduced by up to 1.4% and 1.8%, respectively. During ventricular systole, left atrial pressure was increased by up to 20% due to changes in the atrial activation sequence and the stiffening of scar tissue. Conclusion:This study provides biomechanical evidence that atrial ablation has acute effects not only on atrial contraction but also on ventricular pumping function. Our results have the potential to help tailoring ablation strategies towards minimal global hemodynamic impairment.

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Computational Modeling Studies of the Roles of Left Ventricular Geometry, Afterload, and Muscle Contractility on Myocardial Strains in Heart Failure with Preserved Ejection Fraction

Cited by 25 publications

References 69 publications

Transmural Distribution of Coronary Perfusion and Myocardial Work Density Due to Alterations in Ventricular Loading, Geometry and Contractility

Transmural Distribution of Coronary Perfusion and Myocardial Work Density Due to Alterations in Ventricular Loading, Geometry and Contractility

Left Ventricle Biomechanics of Low-Flow, Low-Gradient Aortic Stenosis: A Patient-Specific Computational Model

The Impact of Standard Ablation Strategies for Atrial Fibrillation on Cardiovascular Performance in a Four-chamber Heart Model

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