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Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy

  • Advances in Biomechanics: from foundations to applications
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Abstract

In the healthy heart, left ventricular (LV) filling generates different flow patterns which have been proposed to optimize blood transport by coupling diastole and systole. This work presents a novel image-based method to assess how different flow patterns influence LV blood transport in patients undergoing cardiac resynchronization therapy (CRT). Our approach is based on solving the advection equation for a passive scalar field from time-resolved blood velocity fields. Imposing time-varying inflow boundary conditions for the scalar field provides a straightforward method to distinctly track the transport of blood entering the LV in the different filling waves of a given cardiac cycle, as well as the transport barriers which couple filling and ejection. We applied this method to analyze flow transport in a group of patients with implanted CRT devices and a group of healthy volunteers. Velocity fields were obtained using echocardiographic color Doppler velocimetry, which provides two-dimensional time-resolved flow maps in the apical long axis three-chamber view of the LV. In the patients under CRT, the device programming was varied to analyze flow transport under different values of the atrioventricular conduction delay, and to model tachycardia (100 bpm). Using this method, we show how CRT influences the transit of blood inside the left ventricle, contributes to conserving kinetic energy, and favors the generation of hemodynamic forces that accelerate blood in the direction of the LV outflow tract. These novel aspects of ventricular function are clinically accessible by quantitative analysis of color-Doppler echocardiograms.

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Acknowledgments

This study was supported by grants, PI12/02885, PIS09/02603, RD12/0042 (Red de Investigación Cardiovascular), and CM12/00273 (to CPV) from the Instituto de Salud Carlos III –Ministerio de Economía y Competitividad, Spain, and NIH grant 1R21 HL108268-01 (to JCA and AMK).

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Authors and Affiliations

  1. Mechanical and Aerospace Engineering Department, University of California San Diego, Mail Code 0411 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Lorenzo Rossini, Pablo Martinez-Legazpi, María-Guadalupe Borja & Juan C. del Álamo

  2. Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007, Madrid, Spain

    Pablo Martinez-Legazpi, Yolanda Benito, Candelas Pérez del Villar, Ana Gonzalez-Mansilla, Alicia Barrio, Raquel Yotti, Francisco Fernández-Avilés & Javier Bermejo

  3. Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Andrew M. Kahn

  4. Mechanical Engineering Department, University of California Berkeley, Berkeley, CA, USA

    Shawn C. Shadden

  5. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

    Francisco Fernández-Avilés & Javier Bermejo

  6. Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA, USA

    Juan C. del Álamo

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  1. Lorenzo Rossini
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  2. Pablo Martinez-Legazpi
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  3. Yolanda Benito
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Correspondence to Javier Bermejo or Juan C. del Álamo.

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Rossini, L., Martinez-Legazpi, P., Benito, Y. et al. Clinical assessment of intraventricular blood transport in patients undergoing cardiac resynchronization therapy. Meccanica 52, 563–576 (2017). https://doi.org/10.1007/s11012-015-0322-x

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