1
|
Šeman M, Stephens AF, Walton A, Duffy SJ, McGiffin D, Nanayakkara S, Kaye DM, Gregory SD, Stub D. Impact of Concomitant Mitral Regurgitation on the Hemodynamic Indicators of Aortic Stenosis. J Am Heart Assoc 2023; 12:e025648. [PMID: 36789874 PMCID: PMC10111497 DOI: 10.1161/jaha.122.025648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Background In patients with aortic stenosis (AS), the presence of mitral regurgitation (MR) can lead to underestimation of AS severity and worse clinical outcomes. The objective of this study was to characterize the magnitude of the effects of concomitant MR on hemodynamic indicators of AS severity using clinical data and a computational cardiovascular simulation. Methods and Results Echocardiographic data from 1427 patients with severe AS were used to inform a computational cardiovascular system model, and varying degrees of MR and AS were simulated. Hemodynamic data, including left ventricular and aortic pressure waveforms, were generated for all simulations. Simulated reduction in mean transaortic pressure gradient (MPG) associated with MR was then used to calculate the adjusted MPG in the clinical cohort. MR was present in 861 (60%) patients. Compared with patients without MR, patients with MR had a lower aortic-valve area (0.83±0.2 cm2 versus 0.75±0.2; P<0.001) and were more likely to have a low-gradient pattern (MPG <40 mm Hg) (45% versus 54%; P<0.001). Simulations showed that the presence of concomitant mild, moderate, and severe MR with AS was accompanied by a mean reduction in MPG of 10%, 29%, and 40%, respectively. For patients with MR, their calculated adjusted MPG was on average 24% higher than their MPG (52±22 versus 42±16 mm Hg). Of the 467 patients with low-gradient AS and MR, 240 (51%) would reclassify as high gradient based on their adjusted MPG. Conclusions Concomitant MR results in lower MPG and reduced forward flow compared with isolated AS. Careful quantitation of MR should be factored into the assessment of AS severity to mitigate for potential underestimation.
Collapse
Affiliation(s)
- Michael Šeman
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology - Alfred Health Melbourne Australia
| | - Andrew F Stephens
- Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,Department of Mechanical and Aerospace Engineering Monash University Melbourne Australia
| | - Antony Walton
- Department of Cardiology - Alfred Health Melbourne Australia.,Baker IDI Heart and Diabetes Institute and Alfred Hospital Melbourne Australia.,School of Medicine, Monash University Melbourne Australia
| | - Stephen J Duffy
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Department of Cardiology - Alfred Health Melbourne Australia.,Baker IDI Heart and Diabetes Institute and Alfred Hospital Melbourne Australia
| | - David McGiffin
- Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,School of Medicine, Monash University Melbourne Australia.,Department of Cardiothoracic Surgery - Alfred Health Melbourne Australia
| | - Shane Nanayakkara
- Department of Cardiology - Alfred Health Melbourne Australia.,Baker IDI Heart and Diabetes Institute and Alfred Hospital Melbourne Australia.,School of Medicine, Monash University Melbourne Australia
| | - David M Kaye
- Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology - Alfred Health Melbourne Australia.,Baker IDI Heart and Diabetes Institute and Alfred Hospital Melbourne Australia.,School of Medicine, Monash University Melbourne Australia
| | - Shaun D Gregory
- Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,Department of Mechanical and Aerospace Engineering Monash University Melbourne Australia
| | - Dion Stub
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Cardio-Respiratory Engineering and Technology Laboratory Baker Heart and Diabetes Institute Melbourne Australia.,Department of Cardiology - Alfred Health Melbourne Australia.,Baker IDI Heart and Diabetes Institute and Alfred Hospital Melbourne Australia
| |
Collapse
|
2
|
Scarsoglio S, Saglietto A, Tripoli F, Zwanenburg JJM, Biessels GJ, De Ferrari GM, Anselmino M, Ridolfi L. Cerebral hemodynamics during atrial fibrillation: Computational fluid dynamics analysis of lenticulostriate arteries using 7 T high-resolution magnetic resonance imaging. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2022; 34:121909. [PMID: 36776539 PMCID: PMC9907777 DOI: 10.1063/5.0129899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/26/2022] [Indexed: 06/18/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, inducing irregular and faster heart beating. Aside from disabling symptoms-such as palpitations, chest discomfort, and reduced exercise capacity-there is growing evidence that AF increases the risk of dementia and cognitive decline, even in the absence of clinical strokes. Among the possible mechanisms, the alteration of deep cerebral hemodynamics during AF is one of the most fascinating and least investigated hypotheses. Lenticulostriate arteries (LSAs)-small perforating arteries perpendicularly departing from the anterior and middle cerebral arteries and supplying blood flow to basal ganglia-are especially involved in silent strokes and cerebral small vessel diseases, which are considered among the main vascular drivers of dementia. We propose for the first time a computational fluid dynamics analysis to investigate the AF effects on the LSAs hemodynamics by using 7 T high-resolution magnetic resonance imaging (MRI). We explored different heart rates (HRs)-from 50 to 130 bpm-in sinus rhythm and AF, exploiting MRI data from a healthy young male and internal carotid artery data from validated 0D cardiovascular-cerebral modeling as inflow condition. Our results reveal that AF induces a marked reduction of wall shear stress and flow velocity fields. This study suggests that AF at higher HR leads to a more hazardous hemodynamic scenario by increasing the atheromatosis and thrombogenesis risks in the LSAs region.
Collapse
Affiliation(s)
- S. Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - A. Saglietto
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Università di Torino, Torino, Italy
| | - F. Tripoli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - J. J. M. Zwanenburg
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G. J. Biessels
- Department of Neurology UMC Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G. M. De Ferrari
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Università di Torino, Torino, Italy
| | - M. Anselmino
- Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Università di Torino, Torino, Italy
| | - L. Ridolfi
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| |
Collapse
|
3
|
Anselmino M, Scarsoglio S, Ridolfi L, De Ferrari GM, Saglietto A. Insights from computational modeling on the potential hemodynamic effects of sinus rhythm versus atrial fibrillation. Front Cardiovasc Med 2022; 9:844275. [PMID: 36187015 PMCID: PMC9515395 DOI: 10.3389/fcvm.2022.844275] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is the most common clinical tachyarrhythmia, posing a significant burden to patients, physicians, and healthcare systems worldwide. With the advent of more effective rhythm control strategies, such as AF catheter ablation, an early rhythm control strategy is progressively demonstrating its superiority not only in symptoms control but also in prognostic terms, over a standard strategy (rate control, with rhythm control reserved only to patients with refractory symptoms). This review summarizes the different impacts exerted by AF on heart mechanics and systemic circulation, as well as on cerebral and coronary vascular beds, providing computational modeling-based hemodynamic insights in favor of pursuing sinus rhythm maintenance in AF patients.
Collapse
Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
- *Correspondence: Matteo Anselmino,
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land, and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy
| |
Collapse
|
4
|
Mazumder O, Gupta S, Roy D, Sinha A. Computational Fluid Dynamic Model of Left Atrium to Analyze Hemodynamic Manifestation during Atrial Fibrillation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3967-3971. [PMID: 36086394 DOI: 10.1109/embc48229.2022.9871139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this paper, we present a computational fluid dynamic (CFD) model of left atrium (LA) to analyze the manifestation and progression of atrial fibrillation (AF) in terms of hemodynamic metrics. We propose a coupled lumped-CFD (0d-3d) pipeline to model and predict the pulsatile flow and pressure fields of three-dimensional cardiac chamber under the influence of sinus rhythm, high frequency AF (HF-AF) and LA remodeled AF, considering the interactions between the heart and the arterial system through a separately modeled 0d lumped hemodynamic cardiac model. A novel rhythm generator is modeled to generate modulated cardiac chamber compliance and decoupled auricular and ventricular contraction rate to synthesize variation in sinus rhythm and subsequent AF generation. CFD simulation were solved using subject specific CT scan. Systemic and pulmonary flow and pressure along with metrics related to wall shear stress in LA were derived. Left ventricular (LV) hemodynamic parameters associated with global cardio vascular evaluation like ejection fraction, stroke volume, cardiac output, etc. were also generated for all the rhythmic disturbance under consideration. The proposed 0d-3d coupled hemodynamic model of the LA can provide useful insights on the dynamics of AF manifestation and predict vulnerable regions in the cardiac chambers as well as arterial vasculature for probable thrombogenic plaque formation that leads to stroke and infraction, leading to heart failure.
Collapse
|
5
|
Scarsoglio S, Ridolfi L. Different Impact of Heart Rate Variability in the Deep Cerebral and Central Hemodynamics at Rest: An in silico Investigation. Front Neurosci 2021; 15:600574. [PMID: 34079433 PMCID: PMC8165247 DOI: 10.3389/fnins.2021.600574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Heart rate variability (HRV), defined as the variability between consecutive heartbeats, is a surrogate measure of cardiac vagal tone. It is widely accepted that a decreased HRV is associated to several risk factors and cardiovascular diseases. However, a possible association between HRV and altered cerebral hemodynamics is still debated, suffering from HRV short-term measures and the paucity of high-resolution deep cerebral data. We propose a computational approach to evaluate the deep cerebral and central hemodynamics subject to physiological alterations of HRV in an ideal young healthy patient at rest. Methods: The cardiovascular-cerebral model is composed by electrical components able to reproduce the response of the different cardiovascular regions and their features. The model was validated over more than thirty studies and recently exploited to understand the hemodynamic mechanisms between cardiac arrythmia and cognitive deficit. Three configurations (baseline, increased HRV, and decreased HRV) are built based on the standard deviation (SDNN) of RR beats. For each configuration, 5,000 RR beats are simulated to investigate the occurrence of extreme values, alteration of the regular hemodynamics pattern, and variation of mean perfusion/pressure levels. Results: In the cerebral circulation, our results show that HRV has overall a stronger impact on pressure than flow rate mean values but similarly alters pressure and flow rate in terms of extreme events. By comparing reduced and increased HRV, this latter induces a higher probability of altered mean and extreme values, and is therefore more detrimental at distal cerebral level. On the contrary, at central level a decreased HRV induces a higher cardiac effort without improving the mechano-contractile performance, thus overall reducing the heart efficiency. Conclusions: Present results suggest that: (i) the increase of HRV per se does not seem to be sufficient to trigger a better cerebral hemodynamic response; (ii) by accounting for both central and cerebral circulations, the optimal HRV configuration is found at baseline. Given the relation inversely linking HRV and HR, the presence of this optimal condition can contribute to explain why the mean HR of the general population settles around the baseline value (70 bpm).
Collapse
Affiliation(s)
- Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| |
Collapse
|
6
|
Effects of Ageing on Aortic Circulation During Atrial Fibrillation; a Numerical Study on Different Aortic Morphologies. Ann Biomed Eng 2021; 49:2196-2213. [PMID: 33655419 PMCID: PMC8455405 DOI: 10.1007/s10439-021-02744-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/01/2021] [Indexed: 01/21/2023]
Abstract
Atrial fibrillation (AF) can alter intra-cardiac flow and cardiac output that subsequently affects aortic flow circulation. These changes may become more significant where they occur concomitantly with ageing. Aortic ageing is accompanied with morphological changes such as dilation, lengthening, and arch unfolding. While the recognition of AF mechanism has been the subject of numerous studies, less focus has been devoted to the aortic circulation during the AF and there is a lack of such investigation at different ages. The current work aims to address the present gap. First, we analyse aortic flow distribution in three configurations, which attribute to young, middle and old people, using geometries constructed via clinical data. We then introduce two transient inlet flow conditions representative of key AF-associated defects. Results demonstrate that both AF and ageing negatively affect flow circulation. The main consequence of concomitant occurrence is enhancement of endothelial cell activation potential (ECAP) throughout the vascular domain, mainly at aortic arch and descending thoracic aorta, which is consistent with some clinical observations. The outcome of the current study suggests that AF exacerbates the vascular defects occurred due to the ageing, which increases the possibility of cardiovascular diseases per se.
Collapse
|
7
|
Deyranlou A, Naish JH, Miller CA, Revell A, Keshmiri A. Numerical Study of Atrial Fibrillation Effects on Flow Distribution in Aortic Circulation. Ann Biomed Eng 2020; 48:1291-1308. [PMID: 31938982 PMCID: PMC7089914 DOI: 10.1007/s10439-020-02448-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common type of arrhythmia, which undermines cardiac function. Atrial fibrillation is a multi-facet malady and it may occur as a result of other diseases or it may trigger other problems. One of the main complications of AF is stroke due to the possibility of clot formation inside the atrium. However, the possibility of stroke occurrence due to the AF and the location from which an embolus dispatches are subject of debate. Another hypothesis about the embolus formation during AF is thrombus formation in aorta and carotid arteries, embolus detachment and its movement. To investigate the possibility of the latter postulation, the current work suggests a parametric study to quantify the sensitivity of aortic flow to four common AF traits including lack of atrial kick, atrial remodelling, left ventricle systolic dysfunction, and high frequency fibrillation. The simulation was carried out by coupling several in-house codes and ANSYS-CFX module. The results reveal that AF traits lower flow rate at left ventricular outflow tract, which in general lowers blood perfusion to systemic, cerebral and coronary circulations. Consequently, it leads to endothelial cell activation potential (ECAP) increase and variation of flow structure that both suggest predisposed areas to atherogenesis and thrombus formation in different regions in ascending aorta, aortic arch and descending thoracic aorta.
Collapse
Affiliation(s)
- Amin Deyranlou
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, M13 9PL, UK
| | - Josephine H Naish
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Southmoor Road, Wythenshawe, Manchester, M13 9PL, UK.,Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK
| | - Alistair Revell
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, M13 9PL, UK
| | - Amir Keshmiri
- Department of Mechanical, Aerospace and Civil Engineering (MACE), The University of Manchester, Manchester, M13 9PL, UK.
| |
Collapse
|
8
|
Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications. MEDICINA-LITHUANIA 2019; 55:medicina55100709. [PMID: 31640260 PMCID: PMC6843475 DOI: 10.3390/medicina55100709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.
Collapse
|
9
|
Li XH, Hu YM, Yin GL, Wu P. Correlation between HCN4 gene polymorphisms and lone atrial fibrillation risk. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:2989-2993. [PMID: 31315459 DOI: 10.1080/21691401.2019.1637885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and objective: Atrial electrical remodelling (AER) was significantly associated with atrial fibrillation (AF) development. Polymorphisms in hyperpolarization activated cyclic nucleotide gated potassium channel 4 (HCN4) gene might be correlated with AER. In the present study, we explored the association of HCN4 polymorphisms (rs498005 and rs7164883) with lone AF risk in a Chinese Han population. Methods: In this case-control study, the Sanger sequencing method was utilized to genotype the HCN4 polymorphisms. Relative risk of AF was assessed by the χ2 test, and presented by odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Logistic regression analysis was performed for multivariate analysis. The effects of HCN4 polymorphisms on AF clinical features were analyzed by the Mann-Whitney U test and adjusted by the Bonferroni method. Results: C allele of rs498005 was significantly correlated with increased risk of AF (OR = 1.412, 95%CI = 1.012-1.970), and the association still exited after adjustment by age, gender, the status of smoking and drinking, histories of diabetes, hyperlipidaemia and myocardial infarction (adjusted OR = 1.473, 95%CI = 1.043-2.081). G allele of rs7164883 SNP was marginally associated with enhanced AF risk after adjustment by the above clinical parameters (adjusted OR = 1.742, 95%CI = 1.019-2.980). Atrial late potential (ALP), including TP (P wave duration after filtering) and LP20 (the amplitude of superimposed potential in the final 20 ms of P wave) were significantly associated with rs498005 genotype (p < .001). Conclusion: HCN4 rs498005 and rs7164883 polymorphisms are significantly associated with AF risk.
Collapse
Affiliation(s)
- Xiao-Hong Li
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| | - Ya-Min Hu
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| | - Guang-Li Yin
- b Department of Cardiology, Hebei Provincial Hospital of Integrative Chinese and Western Medicine , Cangzhou , China
| | - Ping Wu
- a Department of Cardiology, Cangzhou City Central Hospital , Cangzhou , China
| |
Collapse
|
10
|
Higher ventricular rate during atrial fibrillation relates to increased cerebral hypoperfusions and hypertensive events. Sci Rep 2019; 9:3779. [PMID: 30846776 PMCID: PMC6405756 DOI: 10.1038/s41598-019-40445-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/14/2019] [Indexed: 12/03/2022] Open
Abstract
Atrial fibrillation (AF) is associated with cognitive impairment/dementia, independently of clinical cerebrovascular events (stroke/TIA). One of the plausible mechanisms is the occurrence of AF-induced transient critical hemodynamic events; however, it is presently unknown, if ventricular response rate during AF may impact on cerebral hemodynamics. AF was simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) by two coupled lumped parameter validated models (systemic and cerebral circulation), and compared to corresponding control normal sinus rhythm simulations (NSR). Hemodynamic outcomes and occurrence of critical events (hypoperfusions and hypertensive events) were assessed along the internal carotid artery-middle cerebral artery pathway up to the capillary-venous bed. At the distal cerebral circle level (downstream middle cerebral artery), increasing ventricular rates lead to a reduced heart rate-related dampening of hemodynamic signals compared to NSR (p = 0.003 and 0.002 for flow rate and pressure, respectively). This response causes a significant progressive increase in critical events in the distal cerebral circle (p < 0.001) as ventricular rate increases during AF. On the other side, at the lowest ventricular response rates (HR 50 bpm), at the systemic-proximal cerebral circle level (up to middle cerebral artery) hypoperfusions (p < 0.001) occur more commonly, compared to faster AF simulations. This computational study suggests that higher ventricular rates relate to a progressive increase in critical cerebral hemodynamic events (hypoperfusions and hypertensive events) at the distal cerebral circle. Thus, a rate control strategy aiming to around 60 bpm could be beneficial in terms on cognitive outcomes in patients with permanent AF.
Collapse
|
11
|
Scarsoglio S, Saglietto A, Anselmino M, Gaita F, Ridolfi L. Alteration of cerebrovascular haemodynamic patterns due to atrial fibrillation: an in silico investigation. J R Soc Interface 2018; 14:rsif.2017.0180. [PMID: 28446702 DOI: 10.1098/rsif.2017.0180] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/29/2017] [Indexed: 01/01/2023] Open
Abstract
There has recently been growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, is independently associated with the risk of dementia. This represents a very recent frontier with high social impact for the number of individuals involved and for the expected increase in AF incidence in the next 40 years. Although a number of potential haemodynamic processes, such as microembolisms, altered cerebral blood flow, hypoperfusion and microbleeds, arise as connecting links between the two pathologies, the causal mechanisms are far from clear. An in silico approach is proposed that combines in sequence two lumped-parameter schemes, for the cardiovascular system and the cerebral circulation. The systemic arterial pressure is obtained from the cardiovascular system and used as the input for the cerebral circulation, with the aim of studying the role of AF on the cerebral haemodynamics with respect to normal sinus rhythm (NSR), over a 5000 beat recording. In particular, the alteration of the haemodynamic (pressure and flow rate) patterns in the microcirculation during AF is analysed by means of different statistical tools, from correlation coefficients to autocorrelation functions, crossing times, extreme values analysis and multivariate linear regression models. A remarkable signal alteration, such as a reduction in signal correlation (NSR, about 3 s; AF, less than 1 s) and increased probability (up to three to four times higher in AF than in NSR) of extreme value events, emerges for the peripheral brain circulation. The described scenario offers a number of plausible cause-effect mechanisms that might explain the occurrence of critical events and the haemodynamic links relating to AF and dementia.
Collapse
Affiliation(s)
- S Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - A Saglietto
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Torino, Italy
| | - M Anselmino
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Torino, Italy
| | - F Gaita
- Division of Cardiology, Department of Medical Sciences, 'Città della Salute e della Scienza' Hospital, University of Turin, Torino, Italy
| | - L Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| |
Collapse
|
12
|
Scarsoglio S, Cazzato F, Ridolfi L. From time-series to complex networks: Application to the cerebrovascular flow patterns in atrial fibrillation. CHAOS (WOODBURY, N.Y.) 2017; 27:093107. [PMID: 28964131 DOI: 10.1063/1.5003791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A network-based approach is presented to investigate the cerebrovascular flow patterns during atrial fibrillation (AF) with respect to normal sinus rhythm (NSR). AF, the most common cardiac arrhythmia with faster and irregular beating, has been recently and independently associated with the increased risk of dementia. However, the underlying hemodynamic mechanisms relating the two pathologies remain mainly undetermined so far; thus, the contribution of modeling and refined statistical tools is valuable. Pressure and flow rate temporal series in NSR and AF are here evaluated along representative cerebral sites (from carotid arteries to capillary brain circulation), exploiting reliable artificially built signals recently obtained from an in silico approach. The complex network analysis evidences, in a synthetic and original way, a dramatic signal variation towards the distal/capillary cerebral regions during AF, which has no counterpart in NSR conditions. At the large artery level, networks obtained from both AF and NSR hemodynamic signals exhibit elongated and chained features, which are typical of pseudo-periodic series. These aspects are almost completely lost towards the microcirculation during AF, where the networks are topologically more circular and present random-like characteristics. As a consequence, all the physiological phenomena at the microcerebral level ruled by periodicity-such as regular perfusion, mean pressure per beat, and average nutrient supply at the cellular level-can be strongly compromised, since the AF hemodynamic signals assume irregular behaviour and random-like features. Through a powerful approach which is complementary to the classical statistical tools, the present findings further strengthen the potential link between AF hemodynamic and cognitive decline.
Collapse
Affiliation(s)
- Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Fabio Cazzato
- Medacta International SA, Castel San Pietro, Switzerland
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
| |
Collapse
|
13
|
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn). METHODS Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 x MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn-SR Cn)/AF Cn] x 100. The percentage gradient (mean or maximal) difference between AF and SR was calculated as follows: [AF gradient (mean or maximal) - SR gradient (mean or maximal)]/[AF gradient (mean or maximal)] x 100. RESULTS The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, maximal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and maximal) (Cn difference-mean gradient difference; r=0.46; p=0.05; Cn difference-maximal gradient difference; r=0.72; p=0.001). CONCLUSION Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.
Collapse
|
14
|
A Computational Study on the Relation between Resting Heart Rate and Atrial Fibrillation Hemodynamics under Exercise. PLoS One 2017; 12:e0169967. [PMID: 28076389 PMCID: PMC5226796 DOI: 10.1371/journal.pone.0169967] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/26/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS Clinical data indicating a heart rate (HR) target during rate control therapy for permanent atrial fibrillation (AF) and assessing its eventual relationship with reduced exercise tolerance are lacking. The present study aims at investigating the impact of resting HR on the hemodynamic response to exercise in permanent AF patients by means of a computational cardiovascular model. METHODS The AF lumped-parameter model was run to simulate resting (1 Metabolic Equivalent of Task-MET) and various exercise conditions (4 METs: brisk walking; 6 METs: skiing; 8 METs: running), considering different resting HR (70 bpm for the slower resting HR-SHR-simulations, and 100 bpm for the higher resting HR-HHR-simulations). To compare relative variations of cardiovascular variables upon exertion, the variation comparative index (VCI)-the absolute variation between the exercise and the resting values in SHR simulations referred to the absolute variation in HHR simulations-was calculated at each exercise grade (VCI4, VCI6 and VCI8). RESULTS Pulmonary venous pressure underwent a greater increase in HHR compared to SHR simulations (VCI4 = 0.71, VCI6 = 0.73 and VCI8 = 0.77), while for systemic arterial pressure the opposite is true (VCI4 = 1.15, VCI6 = 1.36, VCI8 = 1.56). CONCLUSIONS The computational findings suggest that a slower, with respect to a higher resting HR, might be preferable in permanent AF patients, since during exercise pulmonary venous pressure undergoes a slighter increase and systemic blood pressure reveals a more appropriate increase.
Collapse
|