An in silico study of the effects of left ventricular assist device on right ventricular function and inter-ventricular interaction.
An in silico study of the effects of left ventricular assist device on right ventricular function and inter-ventricular interaction.
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左心室辅助装置对右心室功能和心室间相互作用影响的计算机研究。
DOI：
10.1111/aor.14649
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发表时间：
2023
影响因子：
2.4
通讯作者：
Lee,LikChuan
中科院分区：
文献类型：
--
作者：
Fan,Lei;Choy,JennyS;Lee,Sangjin;Campbell,KennethS;Wenk,JonathanF;Kassab,GhassanS;Burkhoff,Daniel;Lee,LikChuan
背景左心室辅助装置(LVAD)与右室衰竭的发生率高有关，右室衰竭被认为是由于左心室卸载时发生的室间相互作用引起的。导致这些相互作用的因素尚不清楚。方法我们使用计算机模拟来研究HeartMate 3 LVAD对RV功能的影响。该模型首先根据与心力衰竭(HF)患者相关的压力-体积(PV)环进行校准，并在动物实验中根据室间相互作用的测量进行验证。然后应用该模型研究了LVAD对(1)由收缩末期PV关系得出的V60指标的右室收缩功能和(2)由V20由其舒张末PV关系指标的RV舒张期功能的影响。结果在泵速低于4k rpm时，室间隔厚度和局部收缩能力对右室收缩功能的影响较小。然而，在4K到9K 转速之间较高的泵速时，RV腔的收缩性能降低(在6k 转速时降低约3%，在9k 转速时降低约10%)。室间隔较薄或室间隔或右室游离壁心肌收缩能力较低时，右室收缩能力下降更明显。结论当泵速高于4k rpm时，右室收缩能力降低，当室间隔较薄或局部心肌收缩能力较低时，下降幅度更大。本研究结果可能对识别可能患有右室衰竭的左心AD患者有临床意义。
BackgroundLeft ventricular assist device (LVAD) is associated with a high incidence of right ventricular (RV) failure, which is hypothesized to be caused by the occurring inter‐ventricular interactions when the LV is unloaded. Factors contributing to these interactions are unknown.MethodsWe used computer modeling to investigate the impact of the HeartMate 3 LVAD on RV functions. The model was first calibrated against pressure–volume (PV) loops associated with a heart failure (HF) patient and validated against measurements of inter‐ventricular interactions in animal experiments. The model was then applied to investigate the effects of LVAD on (1) RV chamber contractility indexed by V60 derived from its end‐systolic PV relationship, and (2) RV diastolic function indexed by V20 derived from its end‐diastolic PV relationship. We also investigated how septal wall thickness and regional contractility affect the impact of LVAD on RV function.ResultsThe impact of LVAD on RV chamber contractility is small at a pump speed lower than 4k rpm. At a higher pump speed between 4k and 9k rpm, however, RV chamber contractility is reduced (by ~3% at 6k rpm and ~10% at 9k rpm). The reduction of RV chamber contractility is greater with a thinner septal wall or with a lower myocardial contractility at the LV free wall, septum, or RV free wall.ConclusionRV chamber contractility is reduced at a pump speed higher than 4k rpm, and this reduction is greater with a thinner septal wall or lower regional myocardial contractility. Findings here may have clinical implications in identifying LVAD patients who may suffer from RV failure.