Cargando…

Age-Dependence of Flow Homeostasis in the Left Ventricle

Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and qua...

Descripción completa

Detalles Bibliográficos
Autores principales: Benito, Yolanda, Martinez-Legazpi, Pablo, Rossini, Lorenzo, Pérez del Villar, Candelas, Yotti, Raquel, Martín Peinador, Yolanda, Rodríguez-Pérez, Daniel, Desco, M. Mar, Medrano, Constancio, Antoranz, Jose Carlos, Fernández-Avilés, Francisco, del Álamo, Juan C., Bermejo, Javier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498893/
https://www.ncbi.nlm.nih.gov/pubmed/31105588
http://dx.doi.org/10.3389/fphys.2019.00485
_version_ 1783415701889875968
author Benito, Yolanda
Martinez-Legazpi, Pablo
Rossini, Lorenzo
Pérez del Villar, Candelas
Yotti, Raquel
Martín Peinador, Yolanda
Rodríguez-Pérez, Daniel
Desco, M. Mar
Medrano, Constancio
Antoranz, Jose Carlos
Fernández-Avilés, Francisco
del Álamo, Juan C.
Bermejo, Javier
author_facet Benito, Yolanda
Martinez-Legazpi, Pablo
Rossini, Lorenzo
Pérez del Villar, Candelas
Yotti, Raquel
Martín Peinador, Yolanda
Rodríguez-Pérez, Daniel
Desco, M. Mar
Medrano, Constancio
Antoranz, Jose Carlos
Fernández-Avilés, Francisco
del Álamo, Juan C.
Bermejo, Javier
author_sort Benito, Yolanda
collection PubMed
description Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and quantify these features in a wide population of healthy subjects and assess the relationships of these indices with age. Methods: We used color-Doppler echocardiography and custom post-processing methods to study 149 healthy volunteers from 26 days to 80 years old. From the intraventricular flow-velocity fields we obtained personalized maps of (1) the residence time of blood in the LV, and (2) the shear index, a metric accounting for the strongest occurrence of shear stresses inside the chamber. From these maps we derived quantitative indices of the overall intraventricular blood washout and shear exposure. We addressed the age-dependence of these indices and analyzed their relationship with age-related changes in filling-flow. Results: The entire intraventricular blood pool was replaced before 8 cycles. Average residence time of blood inside the LV was <3 cycles in all subjects and followed an inverse U-shape relationship with age, increasing from median (IQR) of 1.0 (0.7 to 1.2) cycles in the 1st year of life to 1.8 (1.4–2.2) cycles in young adults (17–30 years old), becoming shorter again thereafter. Shear index showed no relation with age and was bounded around 20 dyn·s/cm(2). Regions with the longest residence time and highest shear index were identified near the apex. Differences in the degree of apical penetration of the filling waves and the duration of the late-filling phase explained the age-dependence of residence time ([Formula: see text] = 0.48, p < 0.001). Conclusions: In average, blood spends 1 to 3 beats inside the LV with very low shear stress rates. The apical region is the most prone to blood stasis, particularly in mid-aged adults. The washout of blood in the normal LV is age-dependent due to physiological changes in the degree of apical penetration of the filling waves.
format Online
Article
Text
id pubmed-6498893
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-64988932019-05-17 Age-Dependence of Flow Homeostasis in the Left Ventricle Benito, Yolanda Martinez-Legazpi, Pablo Rossini, Lorenzo Pérez del Villar, Candelas Yotti, Raquel Martín Peinador, Yolanda Rodríguez-Pérez, Daniel Desco, M. Mar Medrano, Constancio Antoranz, Jose Carlos Fernández-Avilés, Francisco del Álamo, Juan C. Bermejo, Javier Front Physiol Physiology Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and quantify these features in a wide population of healthy subjects and assess the relationships of these indices with age. Methods: We used color-Doppler echocardiography and custom post-processing methods to study 149 healthy volunteers from 26 days to 80 years old. From the intraventricular flow-velocity fields we obtained personalized maps of (1) the residence time of blood in the LV, and (2) the shear index, a metric accounting for the strongest occurrence of shear stresses inside the chamber. From these maps we derived quantitative indices of the overall intraventricular blood washout and shear exposure. We addressed the age-dependence of these indices and analyzed their relationship with age-related changes in filling-flow. Results: The entire intraventricular blood pool was replaced before 8 cycles. Average residence time of blood inside the LV was <3 cycles in all subjects and followed an inverse U-shape relationship with age, increasing from median (IQR) of 1.0 (0.7 to 1.2) cycles in the 1st year of life to 1.8 (1.4–2.2) cycles in young adults (17–30 years old), becoming shorter again thereafter. Shear index showed no relation with age and was bounded around 20 dyn·s/cm(2). Regions with the longest residence time and highest shear index were identified near the apex. Differences in the degree of apical penetration of the filling waves and the duration of the late-filling phase explained the age-dependence of residence time ([Formula: see text] = 0.48, p < 0.001). Conclusions: In average, blood spends 1 to 3 beats inside the LV with very low shear stress rates. The apical region is the most prone to blood stasis, particularly in mid-aged adults. The washout of blood in the normal LV is age-dependent due to physiological changes in the degree of apical penetration of the filling waves. Frontiers Media S.A. 2019-04-26 /pmc/articles/PMC6498893/ /pubmed/31105588 http://dx.doi.org/10.3389/fphys.2019.00485 Text en Copyright © 2019 Benito, Martinez-Legazpi, Rossini, Pérez del Villar, Yotti, Martín Peinador, Rodríguez-Pérez, Desco, Medrano, Antoranz, Fernández-Avilés, del Álamo and Bermejo. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Benito, Yolanda
Martinez-Legazpi, Pablo
Rossini, Lorenzo
Pérez del Villar, Candelas
Yotti, Raquel
Martín Peinador, Yolanda
Rodríguez-Pérez, Daniel
Desco, M. Mar
Medrano, Constancio
Antoranz, Jose Carlos
Fernández-Avilés, Francisco
del Álamo, Juan C.
Bermejo, Javier
Age-Dependence of Flow Homeostasis in the Left Ventricle
title Age-Dependence of Flow Homeostasis in the Left Ventricle
title_full Age-Dependence of Flow Homeostasis in the Left Ventricle
title_fullStr Age-Dependence of Flow Homeostasis in the Left Ventricle
title_full_unstemmed Age-Dependence of Flow Homeostasis in the Left Ventricle
title_short Age-Dependence of Flow Homeostasis in the Left Ventricle
title_sort age-dependence of flow homeostasis in the left ventricle
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498893/
https://www.ncbi.nlm.nih.gov/pubmed/31105588
http://dx.doi.org/10.3389/fphys.2019.00485
work_keys_str_mv AT benitoyolanda agedependenceofflowhomeostasisintheleftventricle
AT martinezlegazpipablo agedependenceofflowhomeostasisintheleftventricle
AT rossinilorenzo agedependenceofflowhomeostasisintheleftventricle
AT perezdelvillarcandelas agedependenceofflowhomeostasisintheleftventricle
AT yottiraquel agedependenceofflowhomeostasisintheleftventricle
AT martinpeinadoryolanda agedependenceofflowhomeostasisintheleftventricle
AT rodriguezperezdaniel agedependenceofflowhomeostasisintheleftventricle
AT descommar agedependenceofflowhomeostasisintheleftventricle
AT medranoconstancio agedependenceofflowhomeostasisintheleftventricle
AT antoranzjosecarlos agedependenceofflowhomeostasisintheleftventricle
AT fernandezavilesfrancisco agedependenceofflowhomeostasisintheleftventricle
AT delalamojuanc agedependenceofflowhomeostasisintheleftventricle
AT bermejojavier agedependenceofflowhomeostasisintheleftventricle