Intraventricular flow patterns during right ventricular apical pacing

Objectives To assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm. Methods We cross-sectionally enrolled 12 consecutive patients (mean age 74\ub18 years, 60% male, mean left ventricular ejection fraction 58%\ub16 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMKstimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry. Results Compared with sinus rhythm, BFM shifted from 27\ub13.3 to 34\ub17.6\ub0 (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17\ub13.3 to 11%\ub12.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively). Conclusions In RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure

A Robust Asymptotically Based Modeling Approach for Two-Phase Flows

A simple semitheoretical method for calculating two-phase frictional pressure gradient in horizontal circular pipes using asymptotic analysis to develop a robust compact model is presented. Two-phase frictional pressure gradient is expressed in terms of the asymptotic single-phase frictional pressure gradients for liquid and gas flowing alone. The proposed model can be transformed into either a two-phase frictional multiplier for liquid flowing alone (ϕl2) or two-phase frictional multiplier for gas flowing alone (ϕg2) as a function of the Lockhart-Martinelli parameter, X. Single-phase friction factors are calculated using the Churchill model which allows for prediction over the full range of laminar-transition-turbulent regions and allows for pipe roughness effects. The proposed model is compared against published data to show the asymptotic behavior. Comparison with other existing correlations for two-phase frictional pressure gradient such as the Chisholm correlation, the Friedel correlation, and the Müller-Steinhagen and Heck correlation, is also presented. Comparison with experimental data for both ϕl and ϕl versus X is also presented. At the end of the paper, the present asymptotic model is also extended to minichannels and microchannels