The vortex—an early predictor of cardiovascular outcome?

Pedrizzetti, Gianni; Canna, Giovanni La; Alfieri, Ottavio; Tonti, Giovanni

doi:10.1038/nrcardio.2014.75

Cited by 206 publications

(203 citation statements)

References 72 publications

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“…This demonstrated that LV flow is extremely sensible to minor changes in cardiac function, therefore it may represent a natural early indicator of sub-clinical physiological changes and a predictor of cardiovascular diseases. 75 …”

Section: Intraventricular Pressure Gradientsmentioning

confidence: 99%

“…In other words, an abnormal, sub-optimal LV function is expected to be associated with a cardiac suffering that may give rise to feedback mechanisms that participate in adaptation and LV remodeling. 9,72,75 A reduction in energetic efficiency was documented by CMR and numerical methods in patients with DCM. 10,28,62 However, numerous clinical indicators are available for this disease and the incremental contribution of fluid dynamics is not decisive for this specific application.…”

Section: Dynamic Aspects: Energy and Momentum Balancementioning

confidence: 99%

“…More about how the presence of a sub-optimal function may anticipate the progression of pathology than on the diagnosis of the pathology itself; fluid mechanics moves the focus from the diagnosis of an overt disease to the prediction of its development. 75 In this context, unveiling the significance of LV fluid dynamics for clinical applications requires a preliminary understanding of its fundamental theoretical aspects and then the construction of firm interpretative schemes to be transferred into the clinical arena.…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Pedrizzetti

Domenichini

2014

Ann Biomed Eng

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Abstract-The flow inside the left ventricle is characterized by the formation of vortices that smoothly accompany blood from the mitral inlet to the aortic outlet. Computational fluid dynamics permitted to shed some light on the fundamental processes involved with vortex motion. More recently, patient-specific numerical simulations are becoming an increasingly feasible tool that can be integrated with the developing imaging technologies. The existing computational methods are reviewed in the perspective of their potential role as a novel aid for advanced clinical analysis. The current results obtained by simulation methods either alone or in combination with medical imaging are summarized. Open problems are highlighted and perspective clinical applications are discussed.

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Section: Intraventricular Pressure Gradientsmentioning

confidence: 99%

Section: Dynamic Aspects: Energy and Momentum Balancementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Pedrizzetti

Domenichini

2014

Ann Biomed Eng

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“…141,142 In the context of global or regional LV systolic dysfunction, abnormality of the flow pattern within the LV is associated with progressive remodeling of the ventricle, worsening of HF symptoms, and an increased risk of intracardiac clot formation. [141][142][143][144][145] Additionally, the breakdown of normal vortical flow pattern in the LV also adversely influences its diastolic function and increases the risk of LA dilatation/dysfunction. 143,[146][147][148] In patients with hypertrophic cardiomyopathy, abnormal flow vortices may contribute to the development of systolic anterior motion of the mitral leaflet and the LV outflow tract obstruction.…”

Section: New Software and Computational Approachesmentioning

confidence: 99%

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

Omar

Bansal

Sengupta

2016

Circulation Research

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Echocardiography, given its safety, easy availability, and the ability to permit a comprehensive assessment of cardiac structure and function, is an indispensable tool in the evaluation and management of patients with heart failure (HF). From initial phenotyping and risk stratification to providing vital data for guiding therapeutic decision-making and monitoring, echocardiography plays a pivotal role in the care of HF patients. The recent advent of multiparametric approaches for myocardial deformation imaging has provided valuable insights in the pathogenesis of HF, elucidating distinct patterns of myocardial dysfunction and events that are associated with progression from subclinical stage to overt HF. At the same time, miniaturization of echocardiography has further expanded clinical application of echocardiography, with the use of pocket cardiac ultrasound as an adjunct to physical examination demonstrated to improve diagnostic accuracy and risk stratification. Furthermore, ongoing advances in the field of big data analytics promise to create an exciting opportunity to operationalize precision medicine as the new approach to healthcare delivery that aims to individualize patient care by integrating data extracted from clinical, laboratory, echocardiographic, and genetic assessments. evidence supporting the diagnosis of HF. Echocardiography is the most commonly used modality for this purpose because of its ease of application, noninvasive nature, safety, and ability to provide a vast amount of information about cardiac structure and function. Additionally, echocardiography also plays an important role in guiding therapeutic decision-making and in monitoring response to therapy. Over the past 3 decades, numerous advancements have occurred in the field of echocardiography that have helped improve our understanding of the morpho-functional aberrations occurring in HF. This review summarizes the recent advances in echocardiography as applicable to the evaluation and management of HF. Classification of Heart FailureTo facilitate clinical management, several attempts have been made to divide HF patients into categories that unify them according to their dominant clinical presentations. Thus, HF has often been described as low output failure or high output failure; forward failure or backward failure; systolic HF or diastolic HF; HFrEF or HF with preserved ejection fraction (HFpEF); and so on. More recently, HF has also been classified according to alterations in the mechanical function of the left ventricle (LV; Table 1). 6The classification of HF into systolic or diastolic HF appeared to be intuitive, categorizing patients based on the primary pathogenic abnormality, that is, impairment of cardiac contractility or impairment of filling. However, this description has now been abandoned with the recognition that these 2 entities are not mutually exclusive and have considerable overlap. Significant LV diastolic dysfunction is a ubiquitous occurrence in patients with systolic HF, whereas systolic dysfunction...

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“…This physiological flow pattern minimizes kinetic energy loss due to turbulent fluctuation, conserving the energy provided by the incoming jet at peak flow [8]. Furthermore, it has been established that vortex formation in the left ventricle is an indicator of cardiac health [10,11], therefore abnormal or disturbed flow patterns might predict impending cardiac diseases before any overt manifestation of symptoms [12,13].…”

Section: Introductionmentioning

confidence: 99%

A D-Shaped Bileaflet Bioprosthesis Which Replicates Physiological Left Ventricular Flow Patterns1

Tan

Leo

2016

Journal of Medical Devices

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Prior studies have shown that in a healthy heart, there exist a large asymmetric vortex structure that aids in establishing a steady flow field in the left ventricle. However, the implantation of existing artificial heart valves at the mitral position is found to have a negative effect on this physiological flow pattern. In light of this, a novel D-shaped bileaflet porcine bioprosthesis (GD valve) has been designed based on the native geometry mitral valve, with the hypothesis that biomimicry in valve design can restore physiological left ventricle flow patterns after valve implantation. An in-vitro experiment using two dimensional particle velocimetry imaging was carried out to determine the hemodynamic performance of the new bileaflet design and then compared to that of the well-established St. Jude Epic valve which functioned as a control in the experiment. Although both valves were found to have similar Reynolds shear stress and Turbulent Kinetic Energy levels, the novel D-shape valve was found to have lower turbulence intensity and greater mean kinetic energy conservation.

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The vortex—an early predictor of cardiovascular outcome?

Cited by 206 publications

References 72 publications

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Left Ventricular Fluid Mechanics: The Long Way from Theoretical Models to Clinical Applications

Advances in Echocardiographic Imaging in Heart Failure With Reduced and Preserved Ejection Fraction

A D-Shaped Bileaflet Bioprosthesis Which Replicates Physiological Left Ventricular Flow Patterns1

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