Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device: A Biventricular Finite-Element and Lumped-Parameter Analysis

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Abstract

The risk of right ventricle (RV) failure remains a major contraindication for continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with heart failure. It is therefore critical to identify the patients who will benefit from early intervention to avoid adverse outcomes. We sought to advance the computational modeling description of the mechanisms underlying RV failure in LVAD-supported patients. RV failure was studied by computational modeling of hemodynamic and cardiac mechanics using lumped-parameter and biventricular finite element (FE) analysis. Findings were validated by comparison of bi-dimensional speckle-tracking echocardiographic strain assessment of the RV free wall vs. patient-specific computational strain estimations, and by non-invasive lumped-based hemodynamic predictions vs. invasive right heart catheterization data. Correlation analysis revealed that lumped-derived RV cardiac output (R = 0.94) and RV stroke work index (R = 0.85) were in good agreement with catheterization data collected from 7 patients with CF-LVAD. Biventricular FE analysis showed abnormal motion of the interventricular septum towards the left ventricular free wall, suggesting impaired right heart mechanics. Good agreement between computationally predicted and echocardiographic measured longitudinal strains was found at basal (− 19.1 ± 3.0% for ECHO, and − 16.4 ± 3.2% for FEM), apical (− 20.0 ± 3.7% for ECHO, and − 17.4 ± 2.7% for FEM), and mid-level of the RV free wall (− 20.1 ± 5.9% for echo, and − 18.0 ± 5.4% for FEM). Simulation approach here presented could serve as a tool for less invasive and early diagnosis of the severity of RV failure in patients with LVAD, although future studies are needed to validate our findings against clinical outcomes.

Original languageEnglish
Pages (from-to)427-437
Number of pages11
JournalCardiovascular Engineering and Technology
Volume9
Issue number3
DOIs
Publication statusPublished - Sep 15 2018

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Heart Ventricles
Finite element method
Hemodynamics
Mechanics
Finite Element Analysis
Speckle
Cardiac Catheterization
Catheterization
Cardiac Output
Early Diagnosis
Heart Failure
Stroke

Keywords

  • Finite-element analysis
  • Left ventricular assist device
  • Lumped-parameter
  • Right ventricular failure
  • Speckle-tracking echocardiography

ASJC Scopus subject areas

  • Biomedical Engineering
  • Cardiology and Cardiovascular Medicine

Cite this

@article{66d50bc161c340eba3283b48aad39b54,
title = "Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device: A Biventricular Finite-Element and Lumped-Parameter Analysis",
abstract = "The risk of right ventricle (RV) failure remains a major contraindication for continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with heart failure. It is therefore critical to identify the patients who will benefit from early intervention to avoid adverse outcomes. We sought to advance the computational modeling description of the mechanisms underlying RV failure in LVAD-supported patients. RV failure was studied by computational modeling of hemodynamic and cardiac mechanics using lumped-parameter and biventricular finite element (FE) analysis. Findings were validated by comparison of bi-dimensional speckle-tracking echocardiographic strain assessment of the RV free wall vs. patient-specific computational strain estimations, and by non-invasive lumped-based hemodynamic predictions vs. invasive right heart catheterization data. Correlation analysis revealed that lumped-derived RV cardiac output (R = 0.94) and RV stroke work index (R = 0.85) were in good agreement with catheterization data collected from 7 patients with CF-LVAD. Biventricular FE analysis showed abnormal motion of the interventricular septum towards the left ventricular free wall, suggesting impaired right heart mechanics. Good agreement between computationally predicted and echocardiographic measured longitudinal strains was found at basal (− 19.1 ± 3.0{\%} for ECHO, and − 16.4 ± 3.2{\%} for FEM), apical (− 20.0 ± 3.7{\%} for ECHO, and − 17.4 ± 2.7{\%} for FEM), and mid-level of the RV free wall (− 20.1 ± 5.9{\%} for echo, and − 18.0 ± 5.4{\%} for FEM). Simulation approach here presented could serve as a tool for less invasive and early diagnosis of the severity of RV failure in patients with LVAD, although future studies are needed to validate our findings against clinical outcomes.",
keywords = "Finite-element analysis, Left ventricular assist device, Lumped-parameter, Right ventricular failure, Speckle-tracking echocardiography",
author = "Francesco Scardulla and Valentina Agnese and Giuseppe Romano and {Di Gesaro}, Gabriele and Sergio Sciacca and Diego Bellavia and Francesco Clemenza and Michele Pilato and Salvatore Pasta",
year = "2018",
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doi = "10.1007/s13239-018-0358-x",
language = "English",
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journal = "Cardiovascular Engineering and Technology",
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T1 - Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device

T2 - A Biventricular Finite-Element and Lumped-Parameter Analysis

AU - Scardulla, Francesco

AU - Agnese, Valentina

AU - Romano, Giuseppe

AU - Di Gesaro, Gabriele

AU - Sciacca, Sergio

AU - Bellavia, Diego

AU - Clemenza, Francesco

AU - Pilato, Michele

AU - Pasta, Salvatore

PY - 2018/9/15

Y1 - 2018/9/15

N2 - The risk of right ventricle (RV) failure remains a major contraindication for continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with heart failure. It is therefore critical to identify the patients who will benefit from early intervention to avoid adverse outcomes. We sought to advance the computational modeling description of the mechanisms underlying RV failure in LVAD-supported patients. RV failure was studied by computational modeling of hemodynamic and cardiac mechanics using lumped-parameter and biventricular finite element (FE) analysis. Findings were validated by comparison of bi-dimensional speckle-tracking echocardiographic strain assessment of the RV free wall vs. patient-specific computational strain estimations, and by non-invasive lumped-based hemodynamic predictions vs. invasive right heart catheterization data. Correlation analysis revealed that lumped-derived RV cardiac output (R = 0.94) and RV stroke work index (R = 0.85) were in good agreement with catheterization data collected from 7 patients with CF-LVAD. Biventricular FE analysis showed abnormal motion of the interventricular septum towards the left ventricular free wall, suggesting impaired right heart mechanics. Good agreement between computationally predicted and echocardiographic measured longitudinal strains was found at basal (− 19.1 ± 3.0% for ECHO, and − 16.4 ± 3.2% for FEM), apical (− 20.0 ± 3.7% for ECHO, and − 17.4 ± 2.7% for FEM), and mid-level of the RV free wall (− 20.1 ± 5.9% for echo, and − 18.0 ± 5.4% for FEM). Simulation approach here presented could serve as a tool for less invasive and early diagnosis of the severity of RV failure in patients with LVAD, although future studies are needed to validate our findings against clinical outcomes.

AB - The risk of right ventricle (RV) failure remains a major contraindication for continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with heart failure. It is therefore critical to identify the patients who will benefit from early intervention to avoid adverse outcomes. We sought to advance the computational modeling description of the mechanisms underlying RV failure in LVAD-supported patients. RV failure was studied by computational modeling of hemodynamic and cardiac mechanics using lumped-parameter and biventricular finite element (FE) analysis. Findings were validated by comparison of bi-dimensional speckle-tracking echocardiographic strain assessment of the RV free wall vs. patient-specific computational strain estimations, and by non-invasive lumped-based hemodynamic predictions vs. invasive right heart catheterization data. Correlation analysis revealed that lumped-derived RV cardiac output (R = 0.94) and RV stroke work index (R = 0.85) were in good agreement with catheterization data collected from 7 patients with CF-LVAD. Biventricular FE analysis showed abnormal motion of the interventricular septum towards the left ventricular free wall, suggesting impaired right heart mechanics. Good agreement between computationally predicted and echocardiographic measured longitudinal strains was found at basal (− 19.1 ± 3.0% for ECHO, and − 16.4 ± 3.2% for FEM), apical (− 20.0 ± 3.7% for ECHO, and − 17.4 ± 2.7% for FEM), and mid-level of the RV free wall (− 20.1 ± 5.9% for echo, and − 18.0 ± 5.4% for FEM). Simulation approach here presented could serve as a tool for less invasive and early diagnosis of the severity of RV failure in patients with LVAD, although future studies are needed to validate our findings against clinical outcomes.

KW - Finite-element analysis

KW - Left ventricular assist device

KW - Lumped-parameter

KW - Right ventricular failure

KW - Speckle-tracking echocardiography

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