In-silico assessment of the effects of right ventricular assist device on pulmonary arterial hypertension using an image based biventricular modeling framework.
In-silico assessment of the effects of right ventricular assist device on pulmonary arterial hypertension using an image based biventricular modeling framework.
复制标题
使用基于图像的双心室建模框架对右心室辅助装置对肺动脉高压的影响进行计算机评估。
DOI：
10.1016/j.mechrescom.2019.04.008
复制
发表时间：
2019
影响因子：
2.4
通讯作者：
Lee,LikChuan
中科院分区：
文献类型：
--
作者：
Shavik,SheikhMohammad;Zhong,Liang;Zhao,Xiaodan;Lee,LikChuan
肺动脉高压（PAH）是一种以肺动脉（PA）异常高压为特征的心脏病。虽然右心室辅助装置 (RVAD) 最近被认为是终末期 PAH 患者的一种治疗选择，但其对双心室力学的影响在很大程度上尚不清楚。为了解决这个问题，我们开发了一个基于图像的建模框架，该框架由双心室有限元 (FE) 模型组成，该模型与描述闭环系统中的肺循环和体循环的集总模型耦合。双心室几何结构是根据两名 PAH 患者和一名正常受试者的磁共振图像重建的，这些患者显示出不同程度的 RV 重塑。该框架经过校准，可匹配患者特定的左心室 (LV) 和 RV 容量及压力波形测量结果。 RVAD 模型被纳入校准框架中，并使用不同的泵速进行模拟。结果表明，RVAD 可以减轻 RV 负荷，改善心输出量并增加隔膜曲率，这在患有严重 RV 重塑的 PAH 患者中更为明显。然而，这些改进也伴随着 PA 压力的不利增加。这些结果表明，RVAD 植入可能需要根据疾病进展进行优化。
Pulmonary arterial hypertension (PAH) is a heart disease that is characterized by an abnormally high pressure in the pulmonary artery (PA). While right ventricular assist device (RVAD) has been considered recently as a treatment option for end-stage PAH patients, its effects on biventricular mechanics are, however, largely unknown. To address this issue, we developed an image-based modeling framework consisting of a biventricular finite element (FE) model that is coupled to a lumped model describing the pulmonary and systemic circulations in a closed-loop system. The biventricular geometry was reconstructed from the magnetic resonance images of two PAH patients showing different degree of RV remodeling and a normal subject. The framework was calibrated to match patient-specific measurements of the left ventricular (LV) and RV volume and pressure waveforms. An RVAD model was incorporated into the calibrated framework and simulations were performed with different pump speeds. Results showed that RVAD unloads the RV, improves cardiac output and increases septum curvature, which are more pronounced in the PAH patient with severe RV remodeling. These improvements, however, are also accompanied by an adverse increase in the PA pressure. These results suggest that the RVAD implantation may need to be optimized depending on disease progression.