Demonstration of Patient-Specific Simulations To Assess Left Atrial Appendage Thrombogenesis Risk

García-Villalba, Manuel; Rossini, Lorenzo; Gonzalo, Alejandro; Vigneault, Davis M.; Martínez‐Legazpi, Pablo; Flores, Oscar; Bermejo, Javier; McVeigh, Elliot R.; Kahn, Andrew; Álamo, Juan C. del

doi:10.1101/2020.05.07.083220

Cited by 5 publications

(3 citation statements)

References 32 publications

(56 reference statements)

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“…By employing rigid RA walls, and having into account the mass conservation balance, all flow entering this chamber must be equal to the flow exiting the TV, which is not physiologically accurate. Moreover, fixed-wall simulations oversimplify inflow-outflow boundary conditions and ignore atrial-ventricular interactions; they have been shown to yield different flow fields and stasis maps [ 71 ] and overestimate instantaneous quantities (e.g. flow velocity; WSS) when compared to moving wall simulations [ 72 ]; however, time-averaged quantities have been shown not to greatly vary [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters

Oliveira

Owen

Qian³

et al. 2021

PLoS ONE

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Central venous catheters are widely used in haemodialysis therapy, having to respect design requirements for appropriate performance. These are placed within the right atrium (RA); however, there is no prior computational study assessing different catheter designs while mimicking their native environment. Here, a computational fluid dynamics model of the RA, based on realistic geometry and transient physiological boundary conditions, was developed and validated. Symmetric, split and step catheter designs were virtually placed in the RA and their performance was evaluated by: assessing their interaction with the RA haemodynamic environment through prediction of flow vorticity and wall shear stress (WSS) magnitudes (1); and quantifying recirculation and tip shear stress (2). Haemodynamic predictions from our RA model showed good agreement with the literature. Catheter placement in the RA increased average vorticity, which could indicate alterations of normal blood flow, and altered WSS magnitudes and distribution, which could indicate changes in tissue mechanical properties. All designs had recirculation and elevated shear stress values, which can induce platelet activation and subsequently thrombosis. The symmetric design, however, had the lowest associated values (best performance), while step design catheters working in reverse mode were associated with worsened performance. Different tip placements also impacted on catheter performance. Our findings suggest that using a realistically anatomical RA model to study catheter performance and interaction with the haemodynamic environment is crucial, and that care needs to be given to correct tip placement within the RA for improved recirculation percentages and diminished shear stress values.

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Section: Discussionmentioning

confidence: 99%

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters

Oliveira

Owen

Qian³

et al. 2021

PLoS ONE

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“…Corresponding to the blood flow velocity, the time when the blood stays in the LAA and blood flow energy-related indicators are also ideal tools. If the average residence time in LAA is more than 2 s, a thrombus can be formed (54). These parameters all have the potential to be used in clinical practice; for example, the high sensitivity of LAD (96.7%) exhibits its potential to be used for the accurate prediction of patients' relatively high risk when doctors are in doubt.…”

Section: Hemodynamic Indexes and Their Predictive Value For Thrombosi...mentioning

confidence: 99%

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

Sun

Chen

et al. 2023

Front. Cardiovasc. Med.

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Patients with atrial fibrillation (AF) suffer from a high risk of thrombosis. Currently, the CHA2DS2-VASc score is the most widely used tool for risk stratification in patients with AF, but it has disappointing accuracy and limited predictive value, especially in those with low scores. Thrombi in patients with AF mostly grow in their left atrial appendages (LAA), which is directly related to the abnormal morphology of the LAA or the left atrium and the unusual hemodynamic state around LAA, which may sensitively evaluate the risk of thrombosis complications in patients with AF and bring bases to clinical plans of medication and operation. Therefore, we investigated the research progress of hemodynamic and morphological studies about the predictive value of thrombosis risk in patients with AF, intending to discuss the prediction potential of morphological and hemodynamic indexes when compared with the presently used CHA2DS2-VASc system and how to build a more precise thromboembolic event prediction model for patients with AF.

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“…Studies have shown that fixed wall simulation can be reflect the flow patterns of LA and LAA well in dysfunctional atrium. In sinus rhythm, the risk of thrombosis can still be assessed, although with some limitations (38). Therefore, the heart wall in this paper was set up as a rigid noslip wall.…”

Section: Solving Processmentioning

confidence: 99%

Numerical study of the risk of thrombosis in the left atrial appendage of chicken wing shape in atrial fibrillation

Yang

Song

Ding

et al. 2022

Front. Cardiovasc. Med.

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Atrial fibrillation (AF) is a common and life-threatening disease. For the patients with AF, more than 90% of the thrombi are formed in the left atrial appendage (LAA), thrombus dislodgement can cause vascular embolism, making them is becoming a high-risk group for stroke. Therefore, identifying the patients with high risk of thrombosis is crucial for advanced stroke warning. To better investigate the mechanism behind thrombus formation in the LAA, this study reconstructed the 3-D Left Atrium (LA) models of six AF volunteer patients by corresponding Computed Tomography (CT) images. Combine the advantages of Computational Fluid Dynamics (CFD), the blood flow field in LA both in AF and sinus heart rate states were studied. The risk of thrombus was evaluated based on the blood viscosity, shear rate thrombus prediction model and Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT) values. The results showed that the left atrium had lower blood flow velocity and TAWSS values at the LAA in both AF and sinus rhythm, thus the LAA is the most thrombogenic region in the LA. Besides, the RRT value of LAA was generally higher in AF than in sinus rhythm. Therefore, AF carries a higher risk of thrombosis.

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Demonstration of Patient-Specific Simulations To Assess Left Atrial Appendage Thrombogenesis Risk

Cited by 5 publications

References 32 publications

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters

Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

Numerical study of the risk of thrombosis in the left atrial appendage of chicken wing shape in atrial fibrillation

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