Left ventricular outflow obstruction predicts increase in systolic pressure gradients and blood residence time after transcatheter mitral valve replacement.
Left ventricular outflow obstruction predicts increase in systolic pressure gradients and blood residence time after transcatheter mitral valve replacement.
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DOI：
10.1038/s41598-018-33836-7
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发表时间：
2018-10-19
影响因子：
4.6
通讯作者：
Niederer SA
中科院分区：
文献类型：
--
作者：
De Vecchi A;Marlevi D;Nordsletten DA;Ntalas I;Leipsic J;Bapat V;Rajani R;Niederer SA
左心室流出道（LVOT）梗阻是经导管二尖瓣置换术（TMVR）的一种相对常见的后果。尽管LVOT阻塞与心力衰竭和不良重塑有关，但其对左心室血液动力学的影响仍然很难描述。本研究使用经验证的计算模型来确定TMVR后导致心室血流动力学显著变化的LVOT阻塞程度。7例TMVR患者根据术前成像数据进行了个性化的血流模拟。在每种情况下模拟不同的虚拟阀配置，总共32次模拟，并且所得到的阻塞程度与压力梯度和流动停留时间相关。这些模拟确定了35%的阈值LVOT阻塞程度，超过该阈值观察到收缩功能显著恶化。峰值收缩压梯度较基线（TMVR前）的平均增幅从5.7%升至高于该阈值的30.1%。阻塞程度大于35%时，心室内滞留2个周期以上的平均血流量由4.4%增加到57.5%，而1个周期内进出心室的血流量减少13.9%。这些结果证明了建模预测TMVR血流动力学后果并协助临床决策过程的独特能力。
Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalised flow simulations based on pre-procedural imaging data. Different virtual valve configurations were simulated in each case, for a total of 32 simulations, and the resulting obstruction degree was correlated with pressure gradients and flow residence times. These simulations identified a threshold LVOT obstruction degree of 35%, beyond which significant deterioration of systolic function was observed. The mean increase from baseline (pre-TMVR) in the peak systolic pressure gradient rose from 5.7% to 30.1% above this threshold value. The average blood volume staying inside the ventricle for more than two cycles also increased from 4.4% to 57.5% for obstruction degrees above 35%, while the flow entering and leaving the ventricle within one cycle decreased by 13.9%. These results demonstrate the unique ability of modelling to predict the hemodynamic consequences of TMVR and to assist in the clinical decision-making process.
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影响因子：
9.7
作者：
Carlhall, Carl Johan;Bolger, Ann
通讯作者：
Bolger, Ann
DOI：
10.1016/s0735-1097(10)80062-2
发表时间：
1990-02-01
影响因子：
24
作者：
DELEMARRE, BJ;VISSER, CA;DEKONING, H
通讯作者：
DEKONING, H
影响因子：
24
作者：
Cheung, Anson;Webb, John G.;Ye, Jian
通讯作者：
Ye, Jian
影响因子：
14
作者：
Blanke, Philipp;Naoum, Christopher;Leipsic, Jonathon
通讯作者：
Leipsic, Jonathon
影响因子：
3.1
作者：
Lee, J.;Cookson, A.;Nordsletten, D. A.
通讯作者：
Nordsletten, D. A.