Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support
Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatm...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.895291/full |
| _version_ | 1818179574578544640 |
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| author | Mattia Arduini Jonathan Pham Alison L. Marsden Alison L. Marsden Ian Y. Chen Ian Y. Chen Daniel B. Ennis Daniel B. Ennis Daniel B. Ennis Seraina A. Dual Seraina A. Dual |
| author_facet | Mattia Arduini Jonathan Pham Alison L. Marsden Alison L. Marsden Ian Y. Chen Ian Y. Chen Daniel B. Ennis Daniel B. Ennis Daniel B. Ennis Seraina A. Dual Seraina A. Dual |
| author_sort | Mattia Arduini |
| collection | DOAJ |
| description | Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50–150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices. |
| first_indexed | 2024-12-11T21:06:02Z |
| format | Article |
| id | doaj.art-ef6fac7a7ee14e6f8497a883f3d289a4 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-11T21:06:02Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-ef6fac7a7ee14e6f8497a883f3d289a42022-12-22T00:50:51ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-08-01910.3389/fcvm.2022.895291895291Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation supportMattia Arduini0Jonathan Pham1Alison L. Marsden2Alison L. Marsden3Ian Y. Chen4Ian Y. Chen5Daniel B. Ennis6Daniel B. Ennis7Daniel B. Ennis8Seraina A. Dual9Seraina A. Dual10Department of Radiology, Stanford University, Palo Alto, CA, United StatesMechanical Engineering, Stanford University, Palo Alto, CA, United StatesDepartment of Bioengineering, Stanford University, Palo Alto, CA, United StatesDepartment of Pediatrics, Stanford University, Palo Alto, CA, United StatesCardiovascular Institute, Stanford University, Palo Alto, CA, United StatesDivision of Medicine (Cardiology), Veterans Affairs Health Care System, Palo Alto, CA, United StatesDepartment of Radiology, Stanford University, Palo Alto, CA, United StatesCardiovascular Institute, Stanford University, Palo Alto, CA, United StatesDivision of Radiology, Veterans Affairs Health Care System, Palo Alto, CA, United StatesDepartment of Radiology, Stanford University, Palo Alto, CA, United StatesCardiovascular Institute, Stanford University, Palo Alto, CA, United StatesDespite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50–150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices.https://www.frontiersin.org/articles/10.3389/fcvm.2022.895291/fullHFpatient-specifichemodynamicslumped parametercounterpulsationMcKibben |
| spellingShingle | Mattia Arduini Jonathan Pham Alison L. Marsden Alison L. Marsden Ian Y. Chen Ian Y. Chen Daniel B. Ennis Daniel B. Ennis Daniel B. Ennis Seraina A. Dual Seraina A. Dual Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support Frontiers in Cardiovascular Medicine HF patient-specific hemodynamics lumped parameter counterpulsation McKibben |
| title | Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support |
| title_full | Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support |
| title_fullStr | Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support |
| title_full_unstemmed | Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support |
| title_short | Framework for patient-specific simulation of hemodynamics in heart failure with counterpulsation support |
| title_sort | framework for patient specific simulation of hemodynamics in heart failure with counterpulsation support |
| topic | HF patient-specific hemodynamics lumped parameter counterpulsation McKibben |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.895291/full |
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