The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD.
The role of innovative modeling and imaging techniques in improving outcomes in patients with LVAD.
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DOI：
10.3389/fcvm.2023.1248300
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发表时间：
2023
影响因子：
3.6
通讯作者：
Kassi, Mahwash
中科院分区：
文献类型：
--
作者：
Wilson, Shannon I.;Ingram, Katelyn E.;Oh, Albert;Moreno, Michael R.;Kassi, Mahwash
心力衰竭仍然是美国和世界各地死亡的重要原因。虽然器官移植被公认为终末期心力衰竭的金标准治疗，但供应有限，许多患者接受左心室辅助装置（LVAD）治疗。LVAD延长和改善了患者的生命，但它们并非没有自身的并发症，特别是血液相容性相关不良事件（HRAE），包括卒中、出血和泵血栓形成。目前用于评估适当器械功能和排除并发症的主流成像技术（如超声心动图和心脏计算机断层扫描）提供了一些见解，但无法全面了解导致HRAE的泵诱导流量变化。相比之下，有些技术仅限于实验室，如计算流体动力学和模拟循环回路与粒子图像测速等方法相结合，可以评估流量指标，但尚未针对临床护理进行优化。在这篇综述中，我们概述了融合现有技术以产生新的成像技术的潜在作用和当前限制，以及评估血流动力学流量以确定LVAD患者是否可能具有较高的HRAE风险的潜在效用。诊断和监测能力的增加可以改善心力衰竭患者LVAD诱导并发症的预防和治疗。
Heart failure remains a significant cause of mortality in the United States and around the world. While organ transplantation is acknowledged as the gold standard treatment for end stage heart failure, supply is limited, and many patients are treated with left ventricular assist devices (LVADs). LVADs extend and improve patients' lives, but they are not without their own complications, particularly the hemocompatibility related adverse events (HRAE) including stroke, bleeding and pump thrombosis. Mainstream imaging techniques currently in use to assess appropriate device function and troubleshoot complications, such as echocardiography and cardiac computed tomography, provide some insight but do not provide a holistic understanding of pump induced flow alterations that leads to HRAEs. In contrast, there are technologies restricted to the benchtop—such as computational fluid dynamics and mock circulatory loops paired with methods like particle image velocimetry—that can assess flow metrics but have not been optimized for clinical care. In this review, we outline the potential role and current limitations of converging available technologies to produce novel imaging techniques, and the potential utility in evaluating hemodynamic flow to determine whether LVAD patients may be at higher risk of HRAEs. This addition to diagnostic and monitoring capabilities could improve prevention and treatment of LVAD-induced complications in heart failure patients.
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DOI：
10.1016/j.jtcvs.2020.04.164
发表时间：
2021-11
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
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作者：
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影响因子：
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发表时间：
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期刊：
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影响因子：
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影响因子：
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影响因子：
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