6533b86dfe1ef96bd12c978e

RESEARCH PRODUCT

Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device: A Biventricular Finite-Element and Lumped-Parameter Analysis

Francesco ScardullaValentina AgneseGiuseppe RomanoGabriele Di GesaroSergio SciaccaDiego BellaviaFrancesco ClemenzaMichele PilatoSalvatore PastaSalvatore Pasta

subject

MaleCardiac CatheterizationCardiac outputVentricular Dysfunction Rightmedicine.medical_treatmentHemodynamicsSpeckle tracking echocardiography02 engineering and technology030204 cardiovascular system & hematologySeverity of Illness IndexRight ventricular failure Left ventricular assist device Speckle-tracking echocardiography Lumped-parameter Finite-element analysis.Ventricular Function LeftVentricular Dysfunction Left0302 clinical medicineRisk FactorsMedicineModels CardiovascularMiddle AgedTreatment Outcomemedicine.anatomical_structureEchocardiographyCardiologyFemaleCardiology and Cardiovascular MedicineAdultmedicine.medical_specialtyFinite Element Analysis0206 medical engineeringBiomedical EngineeringProsthesis DesignProsthesis Implantation03 medical and health sciencesInternal medicineSettore ING-IND/12 - Misure Meccaniche E TermicheHumansComputer SimulationInterventricular septumContraindicationRetrospective StudiesHeart Failurebusiness.industryHemodynamicsmedicine.disease020601 biomedical engineeringVentricleVentricular assist deviceHeart failureVentricular Function RightHeart-Assist Devicesbusiness

description

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.

yearjournalcountryeditionlanguage
2017-12-11Cardiovascular Engineering and Technology
https://doi.org/10.1007/s13239-018-0358-x