1
|
Uwase E, Caru M, Curnier D, Abasq M, Andelfinger G, Krajinovic M, Laverdière C, Sinnett D, Périé D. Relationship between cardiac mechanical properties and cardiac magnetic resonance imaging at rest in childhood acute lymphoblastic leukemia survivors. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2589-2598. [PMID: 37728802 DOI: 10.1007/s10554-023-02953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
The characterization of cardiac mechanical properties may contribute to better understanding of doxorubicin-induced cardiotoxicity. Our study aims to investigate the relationship between cardiac mechanical properties, T1 and T2 relaxation times and partition coefficient. Fifty childhood acute lymphoblastic leukemia survivors underwent a cardiac magnetic resonance (CMR) at rest on a 3T MRI system and included a standard ECG-gated 3(3)3(3)5 MOLLI sequence for T1 mapping and an ECG-gated T2-prepared TrueFISP sequence for T2 mapping. Partition coefficient, ejection fraction, end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated. CircAdapt model was used to study cardiac mechanical performance (left ventricle stiffness (LVS), contractility (LVC) and pressure (Pmin and Pmax), cardiac work efficiency (CWE) and ventricular arterial coupling). In the whole cohort, our results showed that LVC (R2 = 69.2%, r = 0.83), Pmin (R2 = 62.9%, r = 0.79) and Pmax can be predicted by significant CMR parameters, while T1 (R2 = 23.2%, r = 0.48) and partition coefficient (R2 = 13.8%, r = 0.37) can be predicted by significant cardiac mechanical properties. In SR group LVS (R2 = 94.8%, r = 0.97), LVC (R2 = 93.7%, r = 0.96) and Pmin (R2 = 90.6%, r = 0.95) can be predicted by significant cardiac mechanical properties, while in HR + DEX group CWE (R2 = 49.8%, r = 0.70) can be predicted by significant cardiac mechanical properties. Partition coefficient (R2 = 72.6%, r = 0.85) can be predicted by significant CMR parameters in SR group. Early characterization of cardiac mechanical properties from CMR parameters has the potential to early detect doxorubicin-induced cardiotoxicity.
Collapse
Affiliation(s)
- Egidie Uwase
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
| | - Daniel Curnier
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxence Abasq
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada
| | - Gregor Andelfinger
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Maja Krajinovic
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Caroline Laverdière
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Daniel Sinnett
- Research Center, Sainte-Justine University Health Center, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Montreal, Québec, H3C 3A7, Canada.
- Research Center, Sainte-Justine University Health Center, Montreal, Canada.
| |
Collapse
|
2
|
Uwase E, Caru M, Curnier D, Abasq Meng M, Andelfinger G, Krajinovic M, Laverdière C, Sinnett D, Périé D. Cardiac Mechanical Performance Assessment at Different Levels of Exercise in Childhood Acute Lymphoblastic Leukemia Survivors. J Pediatr Hematol Oncol 2023; 45:247-255. [PMID: 37278566 DOI: 10.1097/mph.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/31/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a shortage of relevant studies interested in cardiac mechanical performance. Thus, it is clinically relevant to study the impact of cancer treatments on survivors' cardiac mechanical performance to improve our knowledge. The first objective of this study is to assess survivors' cardiac mechanical performance during a cardiopulmonary exercise test (CPET) using both ventricular-arterial coupling (VAC) and cardiac work efficiency (CWE) from cardiac magnetic resonance (CMR) acquisitions. The second objective is to assess the impact of doxorubicin and dexrazoxane (DEX) treatments. METHODS A total of 63 childhood acute lymphoblastic leukemia survivors underwent a CMR at rest on a 3T magnetic resonance imaging system, followed by a CPET on ergocycle. The CircAdapt model was used to study cardiac mechanical performance. At different levels of exercise, arterial elastance, end-systolic elastance, VAC, and CWE were estimated. RESULTS We observed significant differences between the different levels of exercise for both VAC ( P <0.0001) and CWE parameters ( P =0.001). No significant differences were reported between prognostic risk groups at rest and during the CPET. Nevertheless, we observed that survivors in the SR group had a VAC value slightly lower than heart rate (HR)+DEX and HR groups throughout the CPET. Moreover, survivors in the SR group had a CWE parameter slightly higher than HR+DEX and HR groups throughout the CPET. CONCLUSIONS This study reveals that the combination of CPET, CMR acquisitions and CircAdapt model was sensitive enough to observe slight changes in the assessment of VAC and CWE parameters. Our study contributes to improving survivors' follow-up and detection of cardiac problems induced by doxorubicin-related cardiotoxicity.
Collapse
Affiliation(s)
- Egidie Uwase
- Department of Mechanical Engineering, Polytechnique
| | - Maxime Caru
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
| | - Daniel Curnier
- Sainte-Justine University Health Center, Research Center
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center
- Department of Pediatrics, University of Montreal
| | - Delphine Périé
- Department of Mechanical Engineering, Polytechnique
- Sainte-Justine University Health Center, Research Center
| |
Collapse
|
3
|
Artz T, Caru M, Curnier D, Abasq M, Krajinovic M, Laverdière C, Sinnett D, Périé D. Modelling cardiac mechanics in doxorubicin-induced cardiotoxicity following childhood acute lymphoblastic leukemia using a combination of cardiac magnetic resonance imaging, cardiopulmonary exercise testing and the CircAdapt model. J Biomech 2023; 154:111616. [PMID: 37207545 DOI: 10.1016/j.jbiomech.2023.111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
Children with acute lymphoblastic leukemia (ALL) are treated with doxorubicin-based chemotherapy that can lead to cardiotoxicity which is a well-known cause of mortality. This study aims to characterize myocardial subtle changes induced by doxorubicin-related cardiotoxicity. We used the combination of cardiac magnetic resonance (CMR) imaging, cardiopulmonary exercise testing and the CircAdapt model to explore hemodynamics and intraventricular mechanisms at rest and during exercise in 53 childhood ALL survivors. A sensitivity analysis of the CircAdapt model identified the most influencing parameters on the left ventricle volume. ANOVA were performed to explore significant differences between left ventricle stiffness, contractility, and arteriovenous pressure drop, as well as survivors' prognostic risk groups. No significant differences were observed between prognostic risk groups. The left ventricle stiffness and left ventricle contractility were non-significantly higher in survivors receiving cardioprotective agents (94.3 %), compared to those at standard and high prognostic risk (77 % and 86 %, respectively). In both left ventricle stiffness and left ventricle contractility, we observed that survivors receiving cardioprotective agents were close to the nominal value of CircAdapt (healthy reference group value is 100 %). This study allowed to improve our knowledge of potential subtle myocardial changes induced by doxorubicin-related cardiotoxicity in childhood ALL survivors. This study confirms that survivors exposed to a high cumulative dose of doxorubicin during treatments are at potential risk of myocardial changes many years after the end of their cancer, while cardio-protective agents may prevent changes in cardiac mechanical properties.
Collapse
Affiliation(s)
- Tanguy Artz
- Department of Mechanical Engineering, Ecole Polytechnique, Montreal, Canada
| | - Maxime Caru
- Department of Mechanical Engineering, Ecole Polytechnique, Montreal, Canada; Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Sainte-Justine University Health Center, Research Center, Montreal, Canada; School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxence Abasq
- Department of Mechanical Engineering, Ecole Polytechnique, Montreal, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center, Montreal, Canada; Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center, Research Center, Montreal, Canada; Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center, Montreal, Canada; Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Delphine Périé
- Department of Mechanical Engineering, Ecole Polytechnique, Montreal, Canada; Sainte-Justine University Health Center, Research Center, Montreal, Canada.
| |
Collapse
|
4
|
De Lazzari B, Badagliacca R, Filomena D, Papa S, Vizza CD, Capoccia M, De Lazzari C. CARDIOSIM©: The First Italian Software Platform for Simulation of the Cardiovascular System and Mechanical Circulatory and Ventilatory Support. Bioengineering (Basel) 2022; 9:bioengineering9080383. [PMID: 36004908 PMCID: PMC9404951 DOI: 10.3390/bioengineering9080383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
This review is devoted to presenting the history of the CARDIOSIM© software simulator platform, which was developed in Italy to simulate the human cardiovascular and respiratory systems. The first version of CARDIOSIM© was developed at the Institute of Biomedical Technologies of the National Research Council in Rome. The first platform version published in 1991 ran on a PC with a disk operating system (MS-DOS) and was developed using the Turbo Basic language. The latest version runs on PC with Microsoft Windows 10 operating system; it is implemented in Visual Basic and C++ languages. The platform has a modular structure consisting of seven different general sections, which can be assembled to reproduce the most important pathophysiological conditions. One or more zero-dimensional (0-D) modules have been implemented in the platform for each section. The different modules can be assembled to reproduce part or the whole circulation according to Starling’s law of the heart. Different mechanical ventilatory and circulatory devices have been implemented in the platform, including thoracic artificial lungs, ECMO, IABPs, pulsatile and continuous right and left ventricular assist devices, biventricular pacemakers and biventricular assist devices. CARDIOSIM© is used in clinical and educational environments.
Collapse
Affiliation(s)
- Beatrice De Lazzari
- Department of Human Movement and Sport Sciences, “Foro Italico” 4th University of Rome, 00135 Rome, Italy
- Correspondence:
| | - Roberto Badagliacca
- Department of Clinical, Internal Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Domenico Filomena
- Department of Clinical, Internal Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Silvia Papa
- Department of Clinical, Internal Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal Anesthesiology and Cardiovascular Sciences, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Massimo Capoccia
- Department of Cardiac Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NW, UK
| | - Claudio De Lazzari
- National Research Council, Institute of Clinical Physiology (IFC-CNR), 00185 Rome, Italy
- Faculty of Medicine, Teaching University Geomedi, Tbilisi 0114, Georgia
| |
Collapse
|
5
|
Cardiovascular fetal-to-neonatal transition: an in silico model. Pediatr Res 2022; 91:116-128. [PMID: 33731808 DOI: 10.1038/s41390-021-01401-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous models describing the fetal-to-neonatal transition often lack oxygen saturation levels, homeostatic control mechanisms, phasic hemodynamic signals, or describe the heart with a time-varying elastance model. METHODS We incorporated these elements in the adapted CircAdapt model with the one-fiber model for myocardial contraction, to simulate the hemodynamics of the healthy term human fetal circulation and its transition during the first 24 h after birth. The fetal-to-neonatal model was controlled by a time- and event-based script of changes occurring at birth, such as lung aeration and umbilical cord clamping. Model parameters were based on and validated with human and animal data. RESULTS The fetal circulation showed low pulmonary blood flow, right ventricular dominance, and inverted mitral and tricuspid flow velocity patterns, as well as high mean ductus venosus flow velocity. The neonatal circulation showed oxygen saturation levels to gradually increase to 98% in the first 15 min after birth as well as temporary left ventricular volume overload. CONCLUSIONS Hemodynamics of the term fetus and 24-h-old neonate, as well as the events occurring directly after birth and the transition during the first 24 h after birth, were realistically represented, allowing the model to be used for educational purposes and future research. IMPACT With the addition of oxygen saturation levels, homeostatic pressure-flow control mechanisms, and the one-fiber model for myocardial contraction, a new closed-loop cardiovascular model was constructed to give more insight into the healthy term human fetal circulation and its cardiovascular transition during the first 24 h after birth. Extensive validation confirmed that the hemodynamics of the term fetus and the fetal-to-neonatal transition were realistically represented with the model. This well-validated and versatile model can serve as an education as well as a research platform for in silico investigation of fetal-to-neonatal hemodynamic changes under a wide range of physiological and pathophysiological conditions.
Collapse
|
6
|
Prediction of Ventricular Mechanics After Pulmonary Valve Replacement in Tetralogy of Fallot by Biomechanical Modeling: A Step Towards Precision Healthcare. Ann Biomed Eng 2021; 49:3339-3348. [PMID: 34853921 DOI: 10.1007/s10439-021-02895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Clinical indicators of heart function are often limited in their ability to accurately evaluate the current mechanical state of the myocardium. Biomechanical modeling has been shown to be a promising tool in addition to clinical indicators. By providing a patient-specific measure of myocardial active stress (contractility), biomechanical modeling can enhance the precision of the description of patient's pathophysiology at any given point in time. In this work we aim to explore the ability of biomechanical modeling to predict the response of ventricular mechanics to the progressively decreasing afterload in repaired tetralogy of Fallot (rTOF) patients undergoing pulmonary valve replacement (PVR) for significant residual right ventricular outflow tract obstruction (RVOTO). We used 19 patient-specific models of patients with rTOF prior to pulmonary valve replacement (PVR), denoted as PSMpre, and patient-specific models of the same patients created post-PVR (PSMpost)-both created in our previous published work. Using the PSMpre and assuming cessation of the pulmonary regurgitation and a progressive decrease of RVOT resistance, we built relationships between the contractility and RVOT resistance post-PVR. The predictive value of such in silico obtained relationships were tested against the PSMpost, i.e. the models created from the actual post-PVR datasets. Our results show a linear 1-dimensional relationship between the in silico predicted contractility post-PVR and the RVOT resistance. The predicted contractility was close to the contractility in the PSMpost model with a mean (± SD) difference of 6.5 (± 3.0)%. The relationships between the contractility predicted by in silico PVR vs. RVOT resistance have a potential to inform clinicians about hypothetical mechanical response of the ventricle based on the degree of pre-operative RVOTO.
Collapse
|
7
|
Sousa RDD, Regis CDM, Silva IDS, Szewierenko P, Hortegal RDA, Abensur H. Software for Post-Processing Analysis of Strain Curves: The D-Station. Arq Bras Cardiol 2020; 114:496-506. [PMID: 32267321 PMCID: PMC7792733 DOI: 10.36660/abc.20180403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/15/2019] [Indexed: 11/18/2022] Open
Abstract
Fundamento O emprego de Speckle Tracking para estudo da função cardíaca tem grande aplicabilidade em diversos cenários. A expansão do uso deste método requer ferramentas que permitam a extração de dados relevantes das curvas de deformação cardíaca e que sejam adicionais aos parâmetros habitualmente utilizados. Objetivos O presente trabalho visa apresentar e validar um software de uso livre, denominado D-station, para análise das curvas de deformação cardíaca. Métodos A partir de arquivos raw data, o D-Station realiza a separação das fases do ciclo cardíaco, exibe simultaneamente curvas de Strain e Strain Rate de diferentes câmaras cardíacas. Para validação do software utilizamos o parâmetro Global Longitudinal Strain (GLS) avaliando-o: 1) Graficamente, a partir da comparação das Medidas emparelhadas de GLS no EchoPAC e D-Station frente à linha de igualdade; 2) pelo Coeficiente de Correlação dessas medidas; 3) pelo Teste de Hipóteses (p > 0,05); e 4) pelo Método Gráfico de Bland-Altman. Resultados O Coeficiente rho de Spearman apontou forte correlação entre as medidas, o Teste de Hipóteses retornou um p-value = 0.6798 >> 0,05, que também indicou a equivalência entre elas; o Método gráfico de Bland-Altman mostrou um viés ≤ 1% e dispersão ≤ 2% entre as medidas. Os testes mostraram que para valores de GLS inferiores à 10% há a tendência de aumento das diferenças percentuais, mas seus valores absolutos ainda são baixos. Conclusão O D-Station foi validado como uma aplicação suplementar ao EchoPAC que utiliza o raw data das curvas de Strain e Strain Rate obtidos por software proprietário. (Arq Bras Cardiol. 2020; 114(3):496-506)
Collapse
Affiliation(s)
| | | | | | - Paulo Szewierenko
- Instituto Dante Pazzanese de Cardiologia - Consultor Estatístico,São Paulo, SP - Brasil
| | - Renato de Aguiar Hortegal
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil.,Hospital Beneficência Portuguesa de São Paulo - Departamento de Ecocardiografia, São Paulo, SP - Brasil
| | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo - Departamento de Ecocardiografia, São Paulo, SP - Brasil
| |
Collapse
|
8
|
Di Achille P, Parikh J, Khamzin S, Solovyova O, Kozloski J, Gurev V. Model order reduction for left ventricular mechanics via congruency training. PLoS One 2020; 15:e0219876. [PMID: 31905197 PMCID: PMC6944464 DOI: 10.1371/journal.pone.0219876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/10/2019] [Indexed: 12/20/2022] Open
Abstract
Computational models of the cardiovascular system and specifically heart function are currently being investigated as analytic tools to assist medical practice and clinical trials. To achieve clinical utility, models should be able to assimilate the diagnostic multi-modality data available for each patient and generate consistent representations of the underlying cardiovascular physiology. While finite element models of the heart can naturally account for patient-specific anatomies reconstructed from medical images, optimizing the many other parameters driving simulated cardiac functions is challenging due to computational complexity. With the goal of streamlining parameter adaptation, in this paper we present a novel, multifidelity strategy for model order reduction of 3-D finite element models of ventricular mechanics. Our approach is centered around well established findings on the similarity between contraction of an isolated muscle and the whole ventricle. Specifically, we demonstrate that simple linear transformations between sarcomere strain (tension) and ventricular volume (pressure) are sufficient to reproduce global pressure-volume outputs of 3-D finite element models even by a reduced model with just a single myocyte unit. We further develop a procedure for congruency training of a surrogate low-order model from multi-scale finite elements, and we construct an example of parameter optimization based on medical images. We discuss how the presented approach might be employed to process large datasets of medical images as well as databases of echocardiographic reports, paving the way towards application of heart mechanics models in the clinical practice.
Collapse
Affiliation(s)
- Paolo Di Achille
- Healthcare and Life Sciences Research, IBM T.J. Watson Research Center, Yorktown Heights, NY, United States of America
| | - Jaimit Parikh
- Healthcare and Life Sciences Research, IBM T.J. Watson Research Center, Yorktown Heights, NY, United States of America
| | - Svyatoslav Khamzin
- Ural Federal University, Yekaterinburg, Russia
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences (UB RAS), Yekaterinburg, Russia
| | - Olga Solovyova
- Ural Federal University, Yekaterinburg, Russia
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences (UB RAS), Yekaterinburg, Russia
| | - James Kozloski
- Healthcare and Life Sciences Research, IBM T.J. Watson Research Center, Yorktown Heights, NY, United States of America
| | - Viatcheslav Gurev
- Healthcare and Life Sciences Research, IBM T.J. Watson Research Center, Yorktown Heights, NY, United States of America
| |
Collapse
|
9
|
Lumens J, Fan CPS, Walmsley J, Yim D, Manlhiot C, Dragulescu A, Grosse-Wortmann L, Mertens L, Prinzen FW, Delhaas T, Friedberg MK. Relative Impact of Right Ventricular Electromechanical Dyssynchrony Versus Pulmonary Regurgitation on Right Ventricular Dysfunction and Exercise Intolerance in Patients After Repair of Tetralogy of Fallot. J Am Heart Assoc 2020; 8:e010903. [PMID: 30651018 PMCID: PMC6497336 DOI: 10.1161/jaha.118.010903] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The relative impact of right ventricular ( RV ) electromechanical dyssynchrony versus pulmonary regurgitation ( PR ) on exercise capacity and RV function after tetralogy of Fallot repair is unknown. We aimed to delineate the relative effects of these factors on RV function and exercise capacity. Methods and Results We retrospectively analyzed 81 children with tetralogy of Fallot repair using multivariable regression. Predictor parameters were electrocardiographic QRS duration reflecting electromechanical dyssynchrony and PR severity by cardiac magnetic resonance. The outcome parameters were exercise capacity (percentage predicted peak oxygen consumption) and cardiac magnetic resonance ejection fraction (RV ejection fraction). To understand the relative effects of RV dyssynchrony versus PR on exercise capacity and RV function, virtual patient simulations were performed using a closed-loop cardiovascular system model (CircAdapt), covering a wide spectrum of disease severity. Eighty-one patients with tetralogy of Fallot repair (median [interquartile range { IQR} ] age, 14.48 [11.55-15.91] years) were analyzed. All had prolonged QRS duration (median [IQR], 144 [123-152] ms), at least moderate PR (median [IQR], 40% [29%-48%]), reduced exercise capacity (median [IQR], 79% [68%-92%] predicted peak oxygen consumption), and reduced RV ejection fraction (median [IQR], 48% [44%-52%]). Longer QRS duration, more than PR , was associated with lower oxygen consumption and lower RV ejection fraction. In a multivariable regression analysis, oxygen consumption decreased with both increasing QRS duration and PR severity. CircAdapt modeling showed that RV dyssynchrony exerts a stronger limiting effect on exercise capacity and on RV ejection fraction than does PR , regardless of contractile function. Conclusions In both patient data and computer simulations, RV dyssynchrony, more than PR , appears to be associated with reduced exercise capacity and RV systolic dysfunction in patients after TOF repair.
Collapse
Affiliation(s)
- Joost Lumens
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands.,3 IHU LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Pessac France
| | - Chun-Po Steve Fan
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - John Walmsley
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Deane Yim
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Cedric Manlhiot
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Andreea Dragulescu
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Lars Grosse-Wortmann
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Luc Mertens
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Frits W Prinzen
- 4 Department of Physiology Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Tammo Delhaas
- 2 Department of Biomedical Engineering Cardiovascular Research Institute Maastricht Maastricht University Maastricht the Netherlands
| | - Mark K Friedberg
- 1 Division of Cardiology Labatt Family Heart Centre and Department of Paediatrics Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| |
Collapse
|
10
|
Altamirano-Diaz L, Kassay AD, Serajelahi B, McIntyre CW, Filler G, Kharche SR. Arterial Hypertension and Unusual Ascending Aortic Dilatation in a Neonate With Acute Kidney Injury: Mechanistic Computer Modeling. Front Physiol 2019; 10:1391. [PMID: 31780955 PMCID: PMC6856675 DOI: 10.3389/fphys.2019.01391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 10/25/2019] [Indexed: 01/23/2023] Open
Abstract
Background Neonatal asphyxia caused kidney injury and severe hypertension in a newborn. An unusually dilatated ascending aorta developed. Dialysis and pharmacological treatment led to partial recovery of the ascending aortic diameters. It was hypothesized that the aortic dilatation may be associated with aortic stiffening, peripheral resistance, and cardiovascular changes. Mathematical modeling was used to better understand the potential causes of the hypertension, and to confirm our clinical treatment within the confines of the model's capabilities. Methods The patient's systolic arterial blood pressure showed hypertension. Echocardiographic exams showed ascending aorta dilatation during hypertension, which partially normalized upon antihypertensive treatment. To explore the underlying mechanisms of the aortic dilatation and hypertension, an existing lumped parameter hemodynamics model was deployed. Hypertension was simulated using realistic literature informed parameter values. It was also simulated using large parameter perturbations to demonstrate effects. Simulations were designed to permit examination of causal mechanisms. The hypertension inducing effects of aortic stiffnesses, vascular resistances, and cardiac hypertrophy on blood flow and pressure were simulated. Sensitivity analysis was used to stratify causes. Results In agreement with our clinical diagnosis, the model showed that an increase of aortic stiffness followed by augmentation of peripheral resistance are the prime causes of realistic hypertension. Increased left ventricular elastance may also cause hypertension. Ascending aortic pressure and flow increased in the simultaneous presence of left ventricle hypertrophy and augmented small vessel resistance, which indicate a plausible condition for ascending aorta dilatation. In case of realistic hypertension, sensitivity analysis showed that the treatment of both the large vessel stiffness and small vessel resistance are more important in comparison to cardiac hypertrophy. Conclusion and Discussion Large vessel stiffness was found to be the prime factor in arterial hypertension, which confirmed the clinical treatment. Treatment of cardiac hypertrophy appears to provide significant benefit but may be secondary to treatment of large vessel stiffness. The quantitative grading of pathophysiological mechanisms provided by the modeling may contribute to treatment recommendations. The model was limited due to a lack of data suitable to permit model identification.
Collapse
Affiliation(s)
- Luis Altamirano-Diaz
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Paediatric Cardiopulmonary Research Laboratory, LHSC, London, ON, Canada
| | | | - Baran Serajelahi
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher W McIntyre
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Guido Filler
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Sanjay R Kharche
- Lawson Health Research Institute, London, ON, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| |
Collapse
|
11
|
Marino PN, Degiovanni A, Zanaboni J. Complex interaction between the atrium and the ventricular filling process: the role of conduit. Open Heart 2019; 6:e001042. [PMID: 31673383 PMCID: PMC6802994 DOI: 10.1136/openhrt-2019-001042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Paolo N Marino
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Anna Degiovanni
- Cardiac-thoracic-vascular Department, Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Italy
| | - Jacopo Zanaboni
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| |
Collapse
|
12
|
|
13
|
Capoccia M, Marconi S, Singh SA, Pisanelli DM, De Lazzari C. Simulation as a preoperative planning approach in advanced heart failure patients. A retrospective clinical analysis. Biomed Eng Online 2018; 17:52. [PMID: 29720187 PMCID: PMC5930731 DOI: 10.1186/s12938-018-0491-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modelling and simulation may become clinically applicable tools for detailed evaluation of the cardiovascular system and clinical decision-making to guide therapeutic intervention. Models based on pressure-volume relationship and zero-dimensional representation of the cardiovascular system may be a suitable choice given their simplicity and versatility. This approach has great potential for application in heart failure where the impact of left ventricular assist devices has played a significant role as a bridge to transplant and more recently as a long-term solution for non eligible candidates. RESULTS We sought to investigate the value of simulation in the context of three heart failure patients with a view to predict or guide further management. CARDIOSIM© was the software used for this purpose. The study was based on retrospective analysis of haemodynamic data previously discussed at a multidisciplinary meeting. The outcome of the simulations addressed the value of a more quantitative approach in the clinical decision process. CONCLUSIONS Although previous experience, co-morbidities and the risk of potentially fatal complications play a role in clinical decision-making, patient-specific modelling may become a daily approach for selection and optimisation of device-based treatment for heart failure patients. Willingness to adopt this integrated approach may be the key to further progress.
Collapse
Affiliation(s)
- Massimo Capoccia
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Silvia Marconi
- National Research Council, Institute of Clinical Physiology, Rome, Italy
| | | | - Domenico M Pisanelli
- National Research Council, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Claudio De Lazzari
- National Research Council, Institute of Clinical Physiology, Rome, Italy. .,National Institute for Cardiovascular Research (I.N.R.C.), Bologna, Italy.
| |
Collapse
|
14
|
Scardulla F, Agnese V, Romano G, Di Gesaro G, Sciacca S, Bellavia D, Clemenza F, Pilato M, Pasta S. Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device: A Biventricular Finite-Element and Lumped-Parameter Analysis. Cardiovasc Eng Technol 2018; 9:427-437. [PMID: 29700783 DOI: 10.1007/s13239-018-0358-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/21/2018] [Indexed: 01/13/2023]
Abstract
The risk of right ventricle (RV) failure remains a major contraindication for continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with heart failure. It is therefore critical to identify the patients who will benefit from early intervention to avoid adverse outcomes. We sought to advance the computational modeling description of the mechanisms underlying RV failure in LVAD-supported patients. RV failure was studied by computational modeling of hemodynamic and cardiac mechanics using lumped-parameter and biventricular finite element (FE) analysis. Findings were validated by comparison of bi-dimensional speckle-tracking echocardiographic strain assessment of the RV free wall vs. patient-specific computational strain estimations, and by non-invasive lumped-based hemodynamic predictions vs. invasive right heart catheterization data. Correlation analysis revealed that lumped-derived RV cardiac output (R = 0.94) and RV stroke work index (R = 0.85) were in good agreement with catheterization data collected from 7 patients with CF-LVAD. Biventricular FE analysis showed abnormal motion of the interventricular septum towards the left ventricular free wall, suggesting impaired right heart mechanics. Good agreement between computationally predicted and echocardiographic measured longitudinal strains was found at basal (- 19.1 ± 3.0% for ECHO, and - 16.4 ± 3.2% for FEM), apical (- 20.0 ± 3.7% for ECHO, and - 17.4 ± 2.7% for FEM), and mid-level of the RV free wall (- 20.1 ± 5.9% for echo, and - 18.0 ± 5.4% for FEM). Simulation approach here presented could serve as a tool for less invasive and early diagnosis of the severity of RV failure in patients with LVAD, although future studies are needed to validate our findings against clinical outcomes.
Collapse
Affiliation(s)
- Francesco Scardulla
- Dipartimento dell'Innovazione Industriale e Digitale (DIID), Universita' di Palermo, Viale delle Scienze, Palermo, Italy
| | - Valentina Agnese
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Giuseppe Romano
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gabriele Di Gesaro
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Sergio Sciacca
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Salvatore Pasta
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy. .,Fondazione Ri.MED, Palermo, Italy.
| |
Collapse
|
15
|
Baličević V, Kalinić H, Lončarić S, Čikeš M, Bijnens B. A computational model-based approach for atlas construction of aortic Doppler velocity profiles for segmentation purposes. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Palau-Caballero G, Walmsley J, Van Empel V, Lumens J, Delhaas T. Why septal motion is a marker of right ventricular failure in pulmonary arterial hypertension: mechanistic analysis using a computer model. Am J Physiol Heart Circ Physiol 2016; 312:H691-H700. [PMID: 28039201 DOI: 10.1152/ajpheart.00596.2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/22/2022]
Abstract
Rapid leftward septal motion (RLSM) during early left ventricular (LV) diastole is observed in patients with pulmonary arterial hypertension (PAH). RLSM exacerbates right ventricular (RV) systolic dysfunction and impairs LV filling. Increased RV wall tension caused by increased RV afterload has been suggested to cause interventricular relaxation dyssynchrony and RLSM in PAH. Simulations using the CircAdapt computational model were used to unravel the mechanism underlying RLSM by mechanistically linking myocardial tissue and pump function. Simulations of healthy circulation and mild, moderate, and severe PAH were performed. We also assessed the effects on RLSM when PAH coexists with RV or LV contractile dysfunction. Our results showed prolonged RV shortening in PAH causing interventricular relaxation dyssynchrony and RLSM. RLSM was observed in both moderate and severe PAH. A negative transseptal pressure gradient only occurred in severe PAH, demonstrating that negative pressure gradient does not entirely explain septal motion abnormalities. PAH coexisting with RV contractile dysfunction exacerbated both interventricular relaxation dyssynchrony and RLSM. LV contractile dysfunction reduced both interventricular relaxation dyssynchrony and RLSM. In conclusion, dyssynchrony in ventricular relaxation causes RLSM in PAH. Onset of RLSM in patients with PAH appears to indicate a worsening in RV function and hence can be used as a sign of RV failure. However, altered RLSM does not necessarily imply an altered RV afterload, but it can also indicate altered interplay of RV and LV contractile function. Reduction of RLSM can result from either improved RV function or a deterioration of LV function.NEW & NOTEWORTHY A novel approach describes the mechanism underlying abnormal septal dynamics in pulmonary arterial hypertension. Change in motion is not uniquely induced by altered right ventricular afterload, but also by altered ventricular relaxation dyssynchrony. Extension or change in motion is a marker reflecting interplay between right and left ventricular contractility.
Collapse
Affiliation(s)
- Georgina Palau-Caballero
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - John Walmsley
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - Vanessa Van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; and
| |
Collapse
|
17
|
Nestler F, Bradley AP, Wilson SJ, Timms DL, Frazier OH, Cohn WE. A hybrid mock circulation loop for a total artificial heart. Artif Organs 2015; 38:775-82. [PMID: 25234760 DOI: 10.1111/aor.12380] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rotary blood pumps are emerging as a viable technology for total artificial hearts, and the development of physiological control algorithms is accelerated with new evaluation environments. In this article, we present a novel hybrid mock circulation loop (HMCL) designed specifically for evaluation of rotary total artificial hearts (rTAH). The rTAH is operated in the physical domain while all vasculature elements are embedded in the numerical domain, thus combining the strengths of both approaches: fast and easy exchange of the vasculature model together with improved controllability of the pump. Parameters, such as vascular resistance, compliance, and blood volume, can be varied dynamically in silico during operation. A hydraulic-numeric interface creates a real-time feedback loop between the physical and numerical domains. The HMCL uses computer-controlled resistance valves as actuators, thereby reducing the size and number of hydraulic elements. Experimental results demonstrate a stable interaction over a wide operational range and a high degree of flexibility. Therefore, we demonstrate that the newly created design environment can play an integral part in the hydraulic design, control development, and durability testing of rTAHs.
Collapse
Affiliation(s)
- Frank Nestler
- School of Information Technology and Electrical Engineering, The University of Queensland, St. Lucia; ICET Lab, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; The Texas Heart Institute, Houston, TX, USA
| | | | | | | | | | | |
Collapse
|
18
|
Liu Y, Sanchez PG, Wei X, Li T, Watkins AC, Li SY, Griffith BP, Wu ZJ. Right ventricular unloading and respiratory support with a wearable artificial pump-lung in an ovine model. J Heart Lung Transplant 2014; 33:857-63. [PMID: 24746636 DOI: 10.1016/j.healun.2014.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Device availability of mechanical circulatory or respiratory support to the right heart has been limited. The purpose of this study was to investigate the effect of right heart unloading and respiratory support with a wearable integrated artificial pump-lung (APL). METHODS The APL device was placed surgically between the right atrium and pulmonary artery in 7 sheep. Anti-coagulation was performed with heparin infusion. The device's ability to unload the right ventricle (RV) was investigated by echocardiograms and right heart catheterization at different bypass flow rates. Hemodynamics and echocardiographic data were evaluated. APL flow and gas transfer rates were also measured at different device speeds. RESULTS Hemodynamics remained stable during APL support. There was no significant change in systemic blood pressure and cardiac index. Central venous pressure, RV pressure, RV end-diastolic dimension and RV ejection fraction were significantly decreased when APL device flow rate approached 2 liters/min. Linear regression showed significant correlative trends between the hemodynamic and cardiac indices and device speed. The oxygen transfer rate increased with device speed. The oxygen saturation from the APL outlet was fully saturated (>95%) during support. The impact of APL support on blood elements (plasma free hemoglobin and platelet activation) was minimal. CONCLUSIONS APL device support significantly unloaded the RV with increasing device speed. The device also provided stable hemodynamics and respiratory support in terms of blood flow and oxygen transfer. The right heart unloading performance of this wearable device needs to be evaluated further in an animal model of right heart failure with long-term support.
Collapse
Affiliation(s)
- Yang Liu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Pablo G Sanchez
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xufeng Wei
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tieluo Li
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amelia C Watkins
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shu-ying Li
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bartley P Griffith
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zhongjun J Wu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| |
Collapse
|
19
|
Vonk-Noordegraaf A, Haddad F, Chin KM, Forfia PR, Kawut SM, Lumens J, Naeije R, Newman J, Oudiz RJ, Provencher S, Torbicki A, Voelkel NF, Hassoun PM. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology. J Am Coll Cardiol 2014; 62:D22-33. [PMID: 24355638 DOI: 10.1016/j.jacc.2013.10.027] [Citation(s) in RCA: 674] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 12/22/2022]
Abstract
Survival in patients with pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Although pulmonary load is an important determinant of RV systolic function in PAH, there remains a significant variability in RV adaptation to pulmonary hypertension. In this report, the authors discuss the emerging concepts of right heart pathobiology in PAH. More specifically, the discussion focuses on the following questions. 1) How is right heart failure syndrome best defined? 2) What are the underlying molecular mechanisms of the failing right ventricle in PAH? 3) How are RV contractility and function and their prognostic implications best assessed? 4) What is the role of targeted RV therapy? Throughout the report, the authors highlight differences between right and left heart failure and outline key areas of future investigation.
Collapse
Affiliation(s)
| | - François Haddad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Kelly M Chin
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paul R Forfia
- Pulmonary Hypertension and Right Heart Failure Program, Temple University Hospital, Philadelphia, Pennsylvania
| | - Steven M Kawut
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Robert Naeije
- Department of Pathophysiology, Faculty of Medicine, Free University of Brussels, Brussels, Belgium
| | - John Newman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ronald J Oudiz
- The David Geffen School of Medicine at UCLA, Liu Center for Pulmonary Hypertension, Division of Cardiology, Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Steve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Chemin Sainte-Foy, Québec, Canada
| | - Adam Torbicki
- Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, ECZ, Otwock, Poland
| | - Norbert F Voelkel
- Division of Pulmonary and Critical Care Medicine and Victoria Johnson Lab for Lung Research, Virginia Commonwealth University, Richmond, Virginia; Johns Hopkins University, Baltimore, Maryland
| | - Paul M Hassoun
- Department of Internal Medicine, Pulmonary Division, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
20
|
|
21
|
Abstract
The meeting of the Advisory Board of Experts in Pulmonary Hypertension (ABEPH) in 2011 discussed the potential development of a prognostic score for pulmonary arterial hypertension (PAH) based on parameters associated with right ventricular function. During the discussion, a shortlist of parameters derived from hemodynamic, echocardiography, magnetic resonance imaging, and biomarker analysis was developed. This shortlist is the starting point for developing a score that reflects heart function; such a score could have potential in the future clinical management of patients with PAH.
Collapse
|