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Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation

Background: Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy...

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Autores principales: Scarsoglio, Stefania, Saglietto, Andrea, Gaita, Fiorenzo, Ridolfi, Luca, Anselmino, Matteo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: PeerJ Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974931/
https://www.ncbi.nlm.nih.gov/pubmed/27547548
http://dx.doi.org/10.7717/peerj.2240
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author Scarsoglio, Stefania
Saglietto, Andrea
Gaita, Fiorenzo
Ridolfi, Luca
Anselmino, Matteo
author_facet Scarsoglio, Stefania
Saglietto, Andrea
Gaita, Fiorenzo
Ridolfi, Luca
Anselmino, Matteo
author_sort Scarsoglio, Stefania
collection PubMed
description Background: Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. Methods: We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i) irregular, uncorrelated and faster heart rate; (ii) atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation), by varying–through the valve opening angle–the valve area. Results: Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. Discussion: The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive treatment of AF. Present findings, if clinically confirmed, hold the potential to impact AF management (e.g., adoption of a rhythm control strategy) in specific valvular diseases.
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spelling pubmed-49749312016-08-19 Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation Scarsoglio, Stefania Saglietto, Andrea Gaita, Fiorenzo Ridolfi, Luca Anselmino, Matteo PeerJ Bioengineering Background: Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. Methods: We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i) irregular, uncorrelated and faster heart rate; (ii) atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation), by varying–through the valve opening angle–the valve area. Results: Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. Discussion: The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive treatment of AF. Present findings, if clinically confirmed, hold the potential to impact AF management (e.g., adoption of a rhythm control strategy) in specific valvular diseases. PeerJ Inc. 2016-07-26 /pmc/articles/PMC4974931/ /pubmed/27547548 http://dx.doi.org/10.7717/peerj.2240 Text en © 2016 Scarsoglio et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.
spellingShingle Bioengineering
Scarsoglio, Stefania
Saglietto, Andrea
Gaita, Fiorenzo
Ridolfi, Luca
Anselmino, Matteo
Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title_full Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title_fullStr Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title_full_unstemmed Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title_short Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
title_sort computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation
topic Bioengineering
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974931/
https://www.ncbi.nlm.nih.gov/pubmed/27547548
http://dx.doi.org/10.7717/peerj.2240
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