Topology of Blood Transport in the Human Left Ventricle by Novel Processing of Doppler Echocardiography

Hendabadi, Sahar; Bermejo, Javier; Benito, Yolanda; Yotti, Raquel; Fernández-Avilés, Francisco; Álamo, Juan C. del; Shadden, Shawn C.

doi:10.1007/s10439-013-0853-z

Cited by 83 publications

(101 citation statements)

References 40 publications

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“…Based on calculations of OSI in the apex and measurements of blood residence time by others,10 the apex represents a potentially prothrombotic environment. Healthy persons, however, do not typically form thrombi in the apex, an outcome that may be attributable in part to regional expression of anticoagulation genes.…”

Section: Resultsmentioning

confidence: 99%

“…The relative contribution of this indirect mechanism to flow‐mediated endothelial signaling and whether it could influence steady‐state cell phenotype in the apex is unknown. The retention of blood in the apex for a longer period10 likely leads to quite different average transport kinetics at the apical EEC surface that may influence cell phenotype.…”

Section: Discussionmentioning

confidence: 99%

“…The development of 4‐dimensional (4D) flow magnetic resonance imaging (MRI), which relies on 3‐dimensional (3D) velocity encoding concurrent with ECG gating, provides accurate spatial and temporal information about in vivo blood velocity throughout the cardiovascular system 9. Intracardiac studies by Doppler imaging and 4D flow MRI demonstrate regional differences in both velocity and blood residence time within the LV 10, 11. Notably, slower velocities and longer residence time toward the apex of the heart suggest significant regional differences that we hypothesized would influence the WSS‐induced endothelial phenotype, as reflected in the steady‐state transcriptome profiles of regional EECs.…”

Section: Introductionmentioning

confidence: 99%

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Integrated Regional Cardiac Hemodynamic Imaging and RNA Sequencing Reveal Corresponding Heterogeneity of Ventricular Wall Shear Stress and Endocardial Transcriptome

McCormick

Manduchi

Witschey

et al. 2016

JAHA

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BackgroundUnlike arteries, in which regionally distinct hemodynamics are associated with phenotypic heterogeneity, the relationships between endocardial endothelial cell phenotype and intraventricular flow remain largely unexplored. We investigated regional differences in left ventricular wall shear stress and their association with endocardial endothelial cell gene expression.Methods and ResultsLocal wall shear stress was calculated from 4‐dimensional flow magnetic resonance imaging in 3 distinct regions of human (n=8) and pig (n=5) left ventricle: base, adjacent to the outflow tract; midventricle; and apex. In both species, wall shear stress values were significantly lower in the apex and midventricle relative to the base; oscillatory shear index was elevated in the apex. RNA sequencing of the endocardial endothelial cell transcriptome in pig left ventricle (n=8) at a false discovery rate ≤10% identified 1051 genes differentially expressed between the base and the apex and 327 between the base and the midventricle; no differentially expressed genes were detected at this false discovery rate between the apex and the midventricle. Enrichment analyses identified apical upregulation of genes associated with translation initiation including mammalian target of rapamycin, and eukaryotic initiation factor 2 signaling. Genes of mitochondrial dysfunction and oxidative phosphorylation were also consistently upregulated in the left ventricular apex, as were tissue factor pathway inhibitor (mean 50‐fold) and prostacyclin synthase (5‐fold)—genes prominently associated with antithrombotic protection.ConclusionsWe report the first spatiotemporal measurements of wall shear stress within the left ventricle and linked regional hemodynamics to heterogeneity in ventricular endothelial gene expression, most notably to translation initiation and anticoagulation properties in the left ventricular apex, in which oscillatory shear index is increased and wall shear stress is decreased.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Integrated Regional Cardiac Hemodynamic Imaging and RNA Sequencing Reveal Corresponding Heterogeneity of Ventricular Wall Shear Stress and Endocardial Transcriptome

McCormick

Manduchi

Witschey

et al. 2016

JAHA

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“…Assessment of LV stagnation regions in vivo was also performed on trajectory-based computation of Lagrangian coherent structures from CMR data, 93 and on velocity fields reconstructed by the colorDoppler approach. 40 It was demonstrated how these methods are capable of revealing the underlying topological structure of blood mixing and providing qualitative and quantitative assessments of blood transport patterns.…”

Section: Kinematic Aspects: Flow Transitmentioning

confidence: 99%

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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“…But probably most important, the analysis approach used in this thesis is less prone to errors. Hendabadi et al (44) applied our definition of the four flow components to the LV using bi-directional velocity field maps acquired using US combined with trajectorybased computation of lagrangian coherent structures. Their study resulted in a slightly higher relative Direct Flow than in the healthy subjects and patients in our studies, but there is fairly good agreement; the ratio of total inflow that Direct Inflow constitutes agreed fairly well as well.…”

Section: Flow Component Studies Using Other Approachesmentioning

confidence: 99%

Quantification of 4D Left Ventricular Blood Flow in Health and Disease

Eriksson¹

2013

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The main function of the heart is to pump blood throughout the cardiovascular system by generating pressure differences created through volume changes. Although the main purpose of the heart and vessels is to lead the flowing blood throughout the body, clinical assessments of cardiac function are usually based on morphology, approximating the flow features by viewing the motion of the myocardium and vessels. Measurement of three-directional, three-dimensional and time-resolved velocity (4D Flow) data is feasible using magnetic resonance (MR). The focus of this thesis is the development and application of methods that facilitate the analysis of larger groups of data in order to increase our understanding of intracardiac flow patterns and take the 4D flow technique closer to the clinical setting.In the first studies underlying this thesis, a pathline based method for analysis of intra ventricular blood flow patterns has been implemented and applied. A pathline is integrated from the velocity data and shows the path an imaginary massless particle would take through the data volume. This method separates the end-diastolic volume (EDV) into four functional components, based on the position for each individual pathline at end-diastole (ED) and end-systole (ES). This approach enables tracking of the full EDV over one cardiac cycle and facilitates calculation of parameters such as e.g. volumes and kinetic energy (KE). Besides blood flow, pressure plays an important role in the cardiac dynamics. In order to study this parameter in the left ventricle, the relative pressure field was computed using the pressure Poisson equation. A comprehensive presentation of the pressure data was obtained dividing the LV blood pool into 17 pie-shaped segments based on a modification of the standard seventeen segment model. Further insight into intracardiac blood flow dynamics was obtained by studying the turbulent kinetic energy (TKE) in the LV. The methods were applied to data from a group of healthy subjects and patients with dilated cardiomyopathy (DCM). DCM is a pathological state where the cardiac function is impaired and the left ventricle or both ventricles are dilated.The validation study of the flow analysis method showed that a reliable user friendly tool for intra ventricular blood flow analysis was obtained. The application of this tool also showed that roughly one third of the blood that enters the LV, directly leaves the LV again in the same heart beat. The distribution of the four LV EDV components was altered in the DCM group as compared to the healthy group; the component that enters and leaves the LV during one cardiac cycle (Direct Flow) was significantly larger in the healthy subjects. Furthermore, when the kinetic energy was normalized by the volume for each component, at time of ED, the Direct Flow had the highest values in the healthy subjects. In the DCM group, however, the Retained Inflow and Delayed Ejection Flow had higher values. The relative pressure field showed to be highly heterogeneous, in the hea...

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Topology of Blood Transport in the Human Left Ventricle by Novel Processing of Doppler Echocardiography

Cited by 83 publications

References 40 publications

Integrated Regional Cardiac Hemodynamic Imaging and RNA Sequencing Reveal Corresponding Heterogeneity of Ventricular Wall Shear Stress and Endocardial Transcriptome

Integrated Regional Cardiac Hemodynamic Imaging and RNA Sequencing Reveal Corresponding Heterogeneity of Ventricular Wall Shear Stress and Endocardial Transcriptome

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

Quantification of 4D Left Ventricular Blood Flow in Health and Disease

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