Computational modeling of ventricular-ventricular interactions suggest a role in clinical conditions involving heart failure.
Computational modeling of ventricular-ventricular interactions suggest a role in clinical conditions involving heart failure.
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DOI：
10.3389/fphys.2023.1231688
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发表时间：
2023
影响因子：
4
通讯作者：
中科院分区：
文献类型：
--
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简介：左心室（LV）和右心室（RV）在生物学、血流动力学和机械学上是相连的，这种现象称为心室相互依赖性。虽然LV功能长期以来一直被认为会影响RV功能，但越来越多的人认识到，反过来也具有临床重要性。考虑到所需的侵入性测量（包括双心室导管插入术）和混杂因素（如合并症、容量状态和受试者变异性的其他方面），临床上研究心室相互依赖性具有挑战性。 方法：计算建模允许在不存在这些混杂因素的情况下调查机械和血液动力学相互作用。在这里，我们使用一个三段双心室心脏模型和简单的循环系统来研究心室的相互依赖性条件下的收缩和舒张功能障碍的LV和RV的存在下的代偿性容量负荷。我们使用舒张末期压力-容积关系、收缩末期压力-容积关系、Frank Starling曲线和心脏功率输出作为指标。 结果：结果表明，左室收缩和舒张功能障碍导致右室代偿，如右室功率增加所示。此外，RV收缩和舒张功能障碍导致LV充盈受损，可解释为LV硬化，特别是在容量负荷以维持全身压力的情况下。 讨论内容：这些结果表明，一部分左心室收缩功能完整并被诊断为左心室舒张功能受损（归类为射血分数保留性心力衰竭（HFpEF））的患者实际上可能患有原发性右心室衰竭。将这种计算方法应用于临床数据集，特别是HFpEF，可能会改善诊断和治疗策略，从而改善结局。
Introduction: The left (LV) and right (RV) ventricles are linked biologically, hemodynamically, and mechanically, a phenomenon known as ventricular interdependence. While LV function has long been known to impact RV function, the reverse is increasingly being realized to have clinical importance. Investigating ventricular interdependence clinically is challenging given the invasive measurements required, including biventricular catheterization, and confounding factors such as comorbidities, volume status, and other aspects of subject variability. Methods: Computational modeling allows investigation of mechanical and hemodynamic interactions in the absence of these confounding factors. Here, we use a threesegment biventricular heart model and simple circulatory system to investigate ventricular interdependence under conditions of systolic and diastolic dysfunction of the LV and RV in the presence of compensatory volume loading. We use the end-diastolic pressure-volume relationship, end-systolic pressure-volume relationship, Frank Starling curves, and cardiac power output as metrics. Results: The results demonstrate that LV systolic and diastolic dysfunction lead to RV compensation as indicated by increases in RV power. Additionally, RV systolic and diastolic dysfunction lead to impaired LV filling, interpretable as LV stiffening especially with volume loading to maintain systemic pressure. Discussion: These results suggest that a subset of patients with intact LV systolic function and diagnosed to have impaired LV diastolic function, categorized as heart failure with preserved ejection fraction (HFpEF), may in fact have primary RV failure. Application of this computational approach to clinical data sets, especially for HFpEF, may lead to improved diagnosis and treatment strategies and consequently improved outcomes.
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