304 research outputs found
Impact of atrial fibrillation on the cardiovascular system through a lumped-parameter approach
Atrial fibrillation (AF) is the most common arrhythmia affecting millions of
people in the Western countries and, due to the widespread impact on the
population and its medical relevance, is largely investigated in both clinical
and bioengineering sciences. However, some important feedback mechanisms are
still not clearly established. The present study aims at understanding the
global response of the cardiovascular system during paroxysmal AF through a
lumped-parameter approach, which is here performed paying particular attention
to the stochastic modeling of the irregular heartbeats and the reduced
contractility of the heart. AF can be here analyzed by means of a wide number
of hemodynamic parameters and avoiding the presence of other pathologies, which
usually accompany AF. Reduced cardiac output with correlated drop of ejection
fraction and decreased amount of energy converted to work by the heart during
blood pumping, as well as higher left atrial volumes and pressures are some of
the most representative results aligned with the existing clinical literature
and here emerging during acute AF. The present modeling, providing new insights
on cardiovascular variables which are difficult to measure and rarely reported
in literature, turns out to be an efficient and powerful tool for a deeper
comprehension and prediction of the arrythmia impact on the whole
cardiovascular system.Comment: 16 pages, 8 figures, 2 tables, Medical & Biological Engineering &
Computing, 2014, Print ISSN: 0140-0118, Online ISSN: 1741-044
Alteration of cerebrovascular haemodynamic patterns due to atrial fibrillation: an in silico investigation
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
flowrate) 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.Comment: 13 pages, 9 Figures, 3 Table
From time-series to complex networks: Application to the cerebrovascular flow patterns in atrial fibrillation
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
microcerebral level ruled by periodicity - such as regular perfusion, mean
pressure per beat, and average nutrient supply at 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.Comment: 12 pages, 10 figure
Rate Control Management of Atrial Fibrillation: May a Mathematical Model Suggest an Ideal Heart Rate?
Background. Despite the routine prescription of rate control therapy for
atrial fibrillation (AF), clinical evidence demonstrating a heart rate target
is lacking. Aim of the present study was to run a mathematical model simulating
AF episodes with a different heart rate (HR) to predict hemodynamic parameters
for each situation.
Methods. The lumped model, representing the pumping heart together with
systemic and pulmonary circuits, was run to simulate AF with HR of 50, 70, 90,
110 and 130 bpm, respectively.
Results. Left ventricular pressure increased by 56.7%, from 33.92+-37.56 mmHg
to 53.15+-47.56 mmHg, and mean systemic arterial pressure increased by 27.4%,
from 82.66+-14.04 mmHg to 105.29+-7.63 mmHg, at the 50 and 130 bpm simulations,
respectively. Stroke volume (from 77.45+-8.5 to 39.09+-8.08 mL), ejection
fraction (from 61.1+-4.4 to 39.32+-5.42%) and stroke work (SW, from 0.88+-0.04
to 0.58+-0.09 J) decreased by 49.5, 35.6 and 34.2%, at the 50 and 130 bpm
simulations, respectively. In addition, oxygen consumption indexes (rate
pressure product, RPP, tension time index per minute, TTI/min, and pressure
volume area per minute, PVA/min) increased from the 50 to the 130 bpm
simulation, respectively, by 185.7% (from 5598+-1939 to 15995+-3219 mmHg/min),
55.5% (from 2094+-265 to 3257+-301 mmHg s/min) and 102.4% (from 57.99+-17.9 to
117.37+-25.96 J/min). In fact, left ventricular efficiency (SW/PVA) decreased
from 80.91+-2.91% at 50 bpm to 66.43+-3.72% at the 130 bpm HR simulation.
Conclusion. Awaiting compulsory direct clinical evidences, the present
mathematical model suggests that lower HRs during permanent AF relates to
improved hemodynamic parameters, cardiac efficiency, and lower oxygen
consumption.Comment: 9 page
Impaired coronary blood flow at higher heart rates during atrial fibrillation: investigation via multiscale modelling
Background. Different mechanisms have been proposed to relate atrial
fibrillation (AF) and coronary flow impairment, even in absence of relevant
coronary artery disease (CAD). However, the underlying hemodynamics remains
unclear. Aim of the present work is to computationally explore whether and to
what extent ventricular rate during AF affects the coronary perfusion.
Methods. AF is simulated at different ventricular rates (50, 70, 90, 110, 130
bpm) through a 0D-1D multiscale validated model, which combines the left
heart-arterial tree together with the coronary circulation. Artificially-built
RR stochastic extraction mimics the \emph{in vivo} beating features. All the
hemodynamic parameters computed are based on the left anterior descending (LAD)
artery and account for the waveform, amplitude and perfusion of the coronary
blood flow.
Results. Alterations of the coronary hemodynamics are found to be associated
either to the heart rate increase, which strongly modifies waveform and
amplitude of the LAD flow rate, and to the beat-to-beat variability. The latter
is overall amplified in the coronary circulation as HR grows, even though the
input RR variability is kept constant at all HRs.
Conclusions. Higher ventricular rate during AF exerts an overall coronary
blood flow impairment and imbalance of the myocardial oxygen supply-demand
ratio. The combined increase of heart rate and higher AF-induced hemodynamic
variability lead to a coronary perfusion impairment exceeding 90-110 bpm in AF.
Moreover, it is found that coronary perfusion pressure (CPP) is no longer a
good measure of the myocardial perfusion for HR higher than 90 bpm.Comment: 8 pages, 5 figures, 3 table
Characterizing the cardiovascular functions during atrial fibrillation through lumped-parameter modeling
Atrial fibrillation (AF), causing irregular and rapid heartbeats, is the most common
arrhythmia. Due to the widespread impact on the population and the disabling symptoms
related to rapid heart rate, AF is a subject of growing interest under several aspects:
statistical analyses on the heartbeat distributions, risk factors, impact on quality of life,
correlation with other cardiac pathologies. However, several key points on the
consequences induced by AF on the cardiovascular system are still not completely
understood. The proposed work aims at quantifying the impact of AF on the most relevant
cardiovascular parameters by means of a lumped-parameter modeling, paying particular
attention to the stochastic nature of the irregular heartbeats and the reduced contractility of
the heart. The global response leads to a rather impressive overall agreement with the
clinical state-of-the-art measures regarding AF: reduced cardiac output with correlated
arterial hypotension, as well as higher left atrial volume and pressure values are some of
the most representative outcomes emerging during AF. Moreover, new insights on
hemodynamic parameters such as cardiac flow rates, which are difficult to measure and
almost never offered in literature, are here provided
Insights from computational modeling on the potential hemodynamic effects of sinus rhythm versus atrial fibrillation
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
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 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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