The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation
BackgroundA large majority of thrombi causing ischemic complications under atrial fibrillation (AF) originate in the left atrial appendage (LAA), an anatomical structure departing from the left atrium, characterized by a large morphological variability between individuals. This work analyses the hem...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.894187/full |
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| author | Giulio Musotto Giulio Musotto Alessandra Monteleone Danila Vella Sofia Di Leonardo Alessia Viola Alessia Viola Giuseppe Pitarresi Bernardo Zuccarello Antonio Pantano Andrew Cook Giorgia M. Bosi Gaetano Burriesci Gaetano Burriesci |
| author_facet | Giulio Musotto Giulio Musotto Alessandra Monteleone Danila Vella Sofia Di Leonardo Alessia Viola Alessia Viola Giuseppe Pitarresi Bernardo Zuccarello Antonio Pantano Andrew Cook Giorgia M. Bosi Gaetano Burriesci Gaetano Burriesci |
| author_sort | Giulio Musotto |
| collection | DOAJ |
| description | BackgroundA large majority of thrombi causing ischemic complications under atrial fibrillation (AF) originate in the left atrial appendage (LAA), an anatomical structure departing from the left atrium, characterized by a large morphological variability between individuals. This work analyses the hemodynamics simulated for different patient-specific models of LAA by means of computational fluid–structure interaction studies, modeling the effect of the changes in contractility and shape resulting from AF.MethodsThree operating conditions were analyzed: sinus rhythm, acute atrial fibrillation, and chronic atrial fibrillation. These were simulated on four patient-specific LAA morphologies, each associated with one of the main morphological variants identified from the common classification: chicken wing, cactus, windsock, and cauliflower. Active contractility of the wall muscle was calibrated on the basis of clinical evaluations of the filling and emptying volumes, and boundary conditions were imposed on the fluid to replicate physiological and pathological atrial pressures, typical of the various operating conditions.ResultsThe LAA volume and shear strain rates were analyzed over time and space for the different models. Globally, under AF conditions, all models were well aligned in terms of shear strain rate values and predicted levels of risk. Regions of low shear rate, typically associated with a higher risk of a clot, appeared to be promoted by sudden bends and focused at the trabecule and the lobes. These become substantially more pronounced and extended with AF, especially under acute conditions.ConclusionThis work clarifies the role of active and passive contraction on the healthy hemodynamics in the LAA, analyzing the hemodynamic effect of AF that promotes clot formation. The study indicates that local LAA topological features are more directly associated with a thromboembolic risk than the global shape of the appendage, suggesting that more effective classification criteria should be identified. |
| first_indexed | 2024-04-12T08:50:35Z |
| format | Article |
| id | doaj.art-5cb464deee444254a30a49da405ad802 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T08:50:35Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-5cb464deee444254a30a49da405ad8022022-12-22T03:39:36ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-07-01910.3389/fcvm.2022.894187894187The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial FibrillationGiulio Musotto0Giulio Musotto1Alessandra Monteleone2Danila Vella3Sofia Di Leonardo4Alessia Viola5Alessia Viola6Giuseppe Pitarresi7Bernardo Zuccarello8Antonio Pantano9Andrew Cook10Giorgia M. Bosi11Gaetano Burriesci12Gaetano Burriesci13Bioengineering Unit, Ri.MED Foundation, Palermo, ItalyDepartment of Engineering, University of Palermo, Palermo, ItalyBioengineering Unit, Ri.MED Foundation, Palermo, ItalyBioengineering Unit, Ri.MED Foundation, Palermo, ItalyBioengineering Unit, Ri.MED Foundation, Palermo, ItalyBioengineering Unit, Ri.MED Foundation, Palermo, ItalyDepartment of Engineering, University of Palermo, Palermo, ItalyDepartment of Engineering, University of Palermo, Palermo, ItalyDepartment of Engineering, University of Palermo, Palermo, ItalyDepartment of Engineering, University of Palermo, Palermo, ItalyUCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London, United KingdomUCL Mechanical Engineering, University College London, London, United KingdomBioengineering Unit, Ri.MED Foundation, Palermo, ItalyUCL Mechanical Engineering, University College London, London, United KingdomBackgroundA large majority of thrombi causing ischemic complications under atrial fibrillation (AF) originate in the left atrial appendage (LAA), an anatomical structure departing from the left atrium, characterized by a large morphological variability between individuals. This work analyses the hemodynamics simulated for different patient-specific models of LAA by means of computational fluid–structure interaction studies, modeling the effect of the changes in contractility and shape resulting from AF.MethodsThree operating conditions were analyzed: sinus rhythm, acute atrial fibrillation, and chronic atrial fibrillation. These were simulated on four patient-specific LAA morphologies, each associated with one of the main morphological variants identified from the common classification: chicken wing, cactus, windsock, and cauliflower. Active contractility of the wall muscle was calibrated on the basis of clinical evaluations of the filling and emptying volumes, and boundary conditions were imposed on the fluid to replicate physiological and pathological atrial pressures, typical of the various operating conditions.ResultsThe LAA volume and shear strain rates were analyzed over time and space for the different models. Globally, under AF conditions, all models were well aligned in terms of shear strain rate values and predicted levels of risk. Regions of low shear rate, typically associated with a higher risk of a clot, appeared to be promoted by sudden bends and focused at the trabecule and the lobes. These become substantially more pronounced and extended with AF, especially under acute conditions.ConclusionThis work clarifies the role of active and passive contraction on the healthy hemodynamics in the LAA, analyzing the hemodynamic effect of AF that promotes clot formation. The study indicates that local LAA topological features are more directly associated with a thromboembolic risk than the global shape of the appendage, suggesting that more effective classification criteria should be identified.https://www.frontiersin.org/articles/10.3389/fcvm.2022.894187/fullleft atrial appendagefluid–structure interactionLAA morphologypatient-specific modelsatrial fibrillation (AF) |
| spellingShingle | Giulio Musotto Giulio Musotto Alessandra Monteleone Danila Vella Sofia Di Leonardo Alessia Viola Alessia Viola Giuseppe Pitarresi Bernardo Zuccarello Antonio Pantano Andrew Cook Giorgia M. Bosi Gaetano Burriesci Gaetano Burriesci The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation Frontiers in Cardiovascular Medicine left atrial appendage fluid–structure interaction LAA morphology patient-specific models atrial fibrillation (AF) |
| title | The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation |
| title_full | The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation |
| title_fullStr | The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation |
| title_full_unstemmed | The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation |
| title_short | The Role of Patient-Specific Morphological Features of the Left Atrial Appendage on the Thromboembolic Risk Under Atrial Fibrillation |
| title_sort | role of patient specific morphological features of the left atrial appendage on the thromboembolic risk under atrial fibrillation |
| topic | left atrial appendage fluid–structure interaction LAA morphology patient-specific models atrial fibrillation (AF) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.894187/full |
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