1
|
Sarashina-Motoi M, Iwano H, Motoi K, Ishizaka S, Chiba Y, Tsujinaga S, Murayama M, Nakabachi M, Yokoyama S, Nishino H, Okada K, Kaga S, Anzai T. Functional significance of intra-left ventricular vortices on energy efficiency in normal, dilated, and hypertrophied hearts. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:358-367. [PMID: 33098167 DOI: 10.1002/jcu.22938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the influence of changes in vortices within the left ventricle (LV) on energy efficiency (EE) in normal and diseased hearts. METHODS We performed vector flow mapping echocardiography in 36 normal participants (N), 36 patients with dilated cardiomyopathy (D), and 36 patients with LV hypertrophy (H). The circulation of the main anterior vortex was measured as a parameter of vortex strength. Energy loss (EL) was measured for one cardiac cycle, and EE was calculated as EL divided by stroke work (SW), which represents the loss of kinetic energy per unit of LV external work. RESULTS Circulation increased in the order of N, H, and D (N: 15 ± 4, D: 19 ± 8, H: 17 ± 6 × 10-3 m2 /s; analysis of variance [ANOVA] P < .01). Conversely, EE increased in the order of N, D, and H (N: 0.22 ± 0.07, D: 0.26 ± 0.16, H: 0.30 ± 0.16 10-5 J/mm Hg mL m s; ANOVA P = .04), suggesting worst EE in group H. We found a positive correlation between circulation and SW only in group N, and positive correlation between circulation and EE only in diseased groups (D: R = 0.55, P < .01; H: R = 0.44, P < .01). Multivariable analyses revealed that circulation was the independent determinant of EE in groups D and H. CONCLUSIONS Enhanced vortices could be associated with effective increase in LV external work in normal hearts. Conversely, they were associated with loss of EE without an optimal increase in external work in failing hearts, regardless of the LV morphology.
Collapse
Affiliation(s)
- Miwa Sarashina-Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michito Murayama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
2
|
Aigner P, Schweiger M, Fraser K, Choi Y, Lemme F, Cesarovic N, Kertzscher U, Schima H, Hübler M, Granegger M. Ventricular Flow Field Visualization During Mechanical Circulatory Support in the Assisted Isolated Beating Heart. Ann Biomed Eng 2019; 48:794-804. [PMID: 31741229 PMCID: PMC6949310 DOI: 10.1007/s10439-019-02406-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/07/2019] [Indexed: 01/17/2023]
Abstract
Investigations of ventricular flow patterns during mechanical circulatory support are limited to in vitro flow models or in silico simulations, which cannot fully replicate the complex anatomy and contraction of the heart. Therefore, the feasibility of using echocardiographic particle image velocimetry (Echo-PIV) was evaluated in an isolated working heart setup. Porcine hearts were connected to an isolated, working heart setup and a left ventricular assist device (LVAD) was implanted. During different levels of LVAD support (unsupported, partial support, full support), microbubbles were injected and echocardiographic images were acquired. Iterative PIV algorithms were applied to calculate flow fields. The isolated heart setup allowed different hemodynamic situations. In the unsupported heart, diastolic intra-ventricular blood flow was redirected at the heart’s apex towards the left ventricular outflow tract (LVOT). With increasing pump speed, large vortex formation was suppressed, and blood flow from the mitral valve directly entered the pump cannula. The maximum velocities in the LVOT were significantly reduced with increasing support. For the first time, cardiac blood flow patterns during LVAD support were visualized and quantified in an ex vivo model using Echo-PIV. The results reveal potential regions of stagnation in the LVOT and, in future the methods might be also used in clinical routine to evaluate intraventricular flow fields during LVAD support.
Collapse
Affiliation(s)
- P Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria. .,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
| | - M Schweiger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - K Fraser
- Department of Mechanical Engineering, University of Bath, Bath, UK
| | - Y Choi
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - F Lemme
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - N Cesarovic
- Division of Surgical Research, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - U Kertzscher
- Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - H Schima
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, AKH-4L, 1090, Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - M Hübler
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Granegger
- Pediatric Cardiovascular Surgery, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Biofluid Mechanics Laboratory, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Sampath K, Harfi TT, George RT, Katz J. Optimized Time-Resolved Echo Particle Image Velocimetry– Particle Tracking Velocimetry Measurements Elucidate Blood Flow in Patients With Left Ventricular Thrombus. J Biomech Eng 2018; 140:2668583. [DOI: 10.1115/1.4038886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 02/04/2023]
Abstract
Contrast ultrasound is a widely used clinical tool to obtain real-time qualitative blood flow assessments in the heart, liver, etc. Echocardiographic particle image velocimetry (echo-PIV) is a technique for obtaining quantitative velocity maps from contrast ultrasound images. However, unlike optical particle image velocimetry (PIV), routine echo images are prone to nonuniform spatiotemporal variations in tracer distribution, making analysis difficult for standard PIV algorithms. This study introduces optimized procedures that integrate image enhancement, PIV, and particle tracking velocimetry (PTV) to obtain reliable time-resolved two-dimensional (2D) velocity distributions. During initial PIV analysis, multiple results are obtained by varying processing parameters. Optimization involving outlier removal and smoothing is used to select the correct vector. These results are used in a multiparameter PTV procedure. To demonstrate their clinical value, the procedures are implemented to obtain velocity and vorticity distributions over multiple cardiac cycles using images acquired from four left ventricular thrombus (LVT) patients. Phase-averaged data elucidate flow structure evolution over the cycle and are used to calculate penetration depth and strength of left ventricular (LV) vortices, as well as apical velocity induced by them. The present data are consistent with previous time-averaged results for the minimum vortex penetration depth associated with LVT occurrence. However, due to decay and fragmentation of LV vortices, as they migrate away from the mitral annulus, in two cases with high penetration, there is still poor washing near the resolved clot throughout the cycle. Hence, direct examination of entire flow evolution may be useful for assessing risk of LVT relapse before prescribing anticoagulants.
Collapse
Affiliation(s)
- Kaushik Sampath
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe 223, Baltimore, MD 21218 e-mail:
| | - Thura T. Harfi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287 e-mail:
| | - Richard T. George
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287 e-mail:
| | - Joseph Katz
- Department of Mechanical Engineering, Johns Hopkins University, 3400 North Charles Street, Latrobe 122, Baltimore, MD 21218 e-mail:
| |
Collapse
|
4
|
Fassina L, Rozzi G, Rossi S, Scacchi S, Galetti M, Lo Muzio FP, Del Bianco F, Colli Franzone P, Petrilli G, Faggian G, Miragoli M. Cardiac kinematic parameters computed from video of in situ beating heart. Sci Rep 2017; 7:46143. [PMID: 28397830 PMCID: PMC5387404 DOI: 10.1038/srep46143,10.1038/srep46143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/13/2017] [Indexed: 04/01/2024] Open
Abstract
Mechanical function of the heart during open-chest cardiac surgery is exclusively monitored by echocardiographic techniques. However, little is known about local kinematics, particularly for the reperfused regions after ischemic events. We report a novel imaging modality, which extracts local and global kinematic parameters from videos of in situ beating hearts, displaying live video cardiograms of the contraction events. A custom algorithm tracked the movement of a video marker positioned ad hoc onto a selected area and analyzed, during the entire recording, the contraction trajectory, displacement, velocity, acceleration, kinetic energy and force. Moreover, global epicardial velocity and vorticity were analyzed by means of Particle Image Velocimetry tool. We validated our new technique by i) computational modeling of cardiac ischemia, ii) video recordings of ischemic/reperfused rat hearts, iii) videos of beating human hearts before and after coronary artery bypass graft, and iv) local Frank-Starling effect. In rats, we observed a decrement of kinematic parameters during acute ischemia and a significant increment in the same region after reperfusion. We detected similar behavior in operated patients. This modality adds important functional values on cardiac outcomes and supports the intervention in a contact-free and non-invasive mode. Moreover, it does not require particular operator-dependent skills.
Collapse
Affiliation(s)
- Lorenzo Fassina
- Dipartimento di Ingegneria Industriale e dell’Informazione, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
- Centre for Health Technologies (C.H.T.), Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Giacomo Rozzi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
- Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Stefano Rossi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
- CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Simone Scacchi
- Dipartimento di Matematica, Università degli Studi di Milano, Via Saldini 50, 20133 Milano, Italy
| | - Maricla Galetti
- CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Francesco Paolo Lo Muzio
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Fabrizio Del Bianco
- Dipartimento di Ingegneria Industriale e dell’Informazione, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
- Centre for Health Technologies (C.H.T.), Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Piero Colli Franzone
- Dipartimento di Matematica, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Giuseppe Petrilli
- Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Giuseppe Faggian
- Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Michele Miragoli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
- CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
- Humanitas Clinical and Research Center, Via Manzoni 56, 20090 Rozzano, Italy
- Institute of Genetic and Biomedical Research, National Research Council, Via Manzoni 56, 20090 Rozzano, Italy
| |
Collapse
|
5
|
Fassina L, Rozzi G, Rossi S, Scacchi S, Galetti M, Lo Muzio FP, Del Bianco F, Colli Franzone P, Petrilli G, Faggian G, Miragoli M. Cardiac kinematic parameters computed from video of in situ beating heart. Sci Rep 2017; 7:46143. [PMID: 28397830 PMCID: PMC5387404 DOI: 10.1038/srep46143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/13/2017] [Indexed: 12/21/2022] Open
Abstract
Mechanical function of the heart during open-chest cardiac surgery is exclusively monitored by echocardiographic techniques. However, little is known about local kinematics, particularly for the reperfused regions after ischemic events. We report a novel imaging modality, which extracts local and global kinematic parameters from videos of in situ beating hearts, displaying live video cardiograms of the contraction events. A custom algorithm tracked the movement of a video marker positioned ad hoc onto a selected area and analyzed, during the entire recording, the contraction trajectory, displacement, velocity, acceleration, kinetic energy and force. Moreover, global epicardial velocity and vorticity were analyzed by means of Particle Image Velocimetry tool. We validated our new technique by i) computational modeling of cardiac ischemia, ii) video recordings of ischemic/reperfused rat hearts, iii) videos of beating human hearts before and after coronary artery bypass graft, and iv) local Frank-Starling effect. In rats, we observed a decrement of kinematic parameters during acute ischemia and a significant increment in the same region after reperfusion. We detected similar behavior in operated patients. This modality adds important functional values on cardiac outcomes and supports the intervention in a contact-free and non-invasive mode. Moreover, it does not require particular operator-dependent skills.
Collapse
Affiliation(s)
- Lorenzo Fassina
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy.,Centre for Health Technologies (C.H.T.), Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Giacomo Rozzi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy.,Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Stefano Rossi
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy.,CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Simone Scacchi
- Dipartimento di Matematica, Università degli Studi di Milano, Via Saldini 50, 20133 Milano, Italy
| | - Maricla Galetti
- CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Francesco Paolo Lo Muzio
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Fabrizio Del Bianco
- Dipartimento di Ingegneria Industriale e dell'Informazione, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy.,Centre for Health Technologies (C.H.T.), Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Piero Colli Franzone
- Dipartimento di Matematica, Università degli Studi di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - Giuseppe Petrilli
- Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Giuseppe Faggian
- Dipartimento di Cardiochirurgia, Università degli Studi di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126 Verona, Italy
| | - Michele Miragoli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy.,CERT, Centro di Eccellenza per la Ricerca Tossicologica, INAIL-exISPESL, Università degli Studi di Parma, Via Gramsci 14, 43124 Parma, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20090 Rozzano, Italy.,Institute of Genetic and Biomedical Research, National Research Council, Via Manzoni 56, 20090 Rozzano, Italy
| |
Collapse
|