Subject-specific factors affecting particle residence time distribution of left atrial appendage in atrial fibrillation: A computational model-based study

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

William J. Federspiel¹  Sanjeev G. Shroff¹  Prahlad G. Menon¹  Soroosh Sanatkhani¹  Sotirios Nedios²  Sandeep K. Jain³  Samir F. Saba³ 

[1] Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States;Department of Electrophysiology, Massachusetts General Hospital, Boston, MA, United States;Heart Center, Department of Electrophysiology, University of Leipzig, Leipzig, Germany;Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands;Heart and Vascular Institute, UPMC Presbyterian, Pittsburgh, PA, United States;

关键词: mean residence time;    computational fluid dynamics;    confounding variables;    pulmonary vein flow;    pulsatility;    hematocrit;    simulation length;   

DOI  :  10.3389/fcvm.2023.1070498

 received in 2022-10-14, accepted in 2023-02-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAtrial fibrillation (AF) is a prevalent arrhythmia, that causes thrombus formation, ordinarily in the left atrial appendage (LAA). The conventional metric of stroke risk stratification, CHA2DS2-VASc score, does not account for LAA morphology or hemodynamics. We showed in our previous study that residence time distribution (RTD) of blood-borne particles in the LAA and its associated calculated variables (i.e., mean residence time, tm, and asymptotic concentration, C∞) have the potential to improve CHA2DS2-VASc score. The purpose of this research was to investigate the effects of the following potential confounding factors on LAA tm and C∞: (1) pulmonary vein flow waveform pulsatility, (2) non-Newtonian blood rheology and hematocrit level, and (3) length of the simulation.MethodsSubject-Specific data including left atrial (LA) and LAA cardiac computed tomography, cardiac output (CO), heart rate, and hematocrit level were gathered from 25 AF subjects. We calculated LAA tm and C∞ based on series of computational fluid dynamics (CFD) analyses.ResultsBoth LAA tm and C∞ are significantly affected by the CO, but not by temporal pattern of the inlet flow. Both LAA tm and C∞ increase with increasing hematocrit level and both calculated indices are higher for non-Newtonian blood rheology for a given hematocrit level. Further, at least 20,000 s of CFD simulation is needed to calculate LAA tm and C∞ values reliably.ConclusionsSubject-specific LA and LAA geometries, CO, and hematocrit level are essential to quantify the subject-specific proclivity of blood cell tarrying inside LAA in terms of the RTD function.

【 授权许可】

Unknown   
© 2023 Sanatkhani, Nedios, Menon, Saba, Jain, Federspiel and Shroff.