Characterization of intraventricular filling vortices in the clinical setting

临床环境中脑室内充盈涡流的表征

• 批准号: 8264516
• 负责人: ANDREW KAHN
• 金额: $ 18.5万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-15 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8264516
• 关键词: Address; Affect; Apical; Biochemical; Blood; Blood flow; Cardiac; Cardiology; Clinical; Color; Coupled; Dependence; Diastole; Doppler velocimetry; Early Diagnosis; Echocardiography; Echocardiography, Doppler, Color; Engineering; Event; Evolution; Functional disorder; Generations; Goals; Heart; Heart failure; Human; Image; Intraventricular; Knowledge; Lead; Left; Left ventricular structure; Liquid substance; Magnetic Resonance Imaging; Maps; Measurement; Measures; Mechanics; Medical center; Methods; Modality; Myocardial; Myocardium; Outcome Study; Patient Selection; Patients; Pattern; Phase; Positioning Attribute; Process; Property; Protocols documentation; Research; Research Personnel; Role; Syndrome; Technology; Testing; Time; Ventricular; Ventricular Function; aortic valve; base; event cycle; hemodynamics; image processing; improved; indexing; insight; interest; novel; public health relevance; treatment strategy; two-dimensional; vector

DESCRIPTION (provided by applicant): Blood flow generation by the heart is the result of synchronized electromechanical myocardial events and fluid dynamics processes. Interactions between blood flow and the myocardium elicit the continuous remodeling of the heart, leading to flow patterns that minimize energy losses. The flow pattern in the normal left ventricle consists of a large diastolic vortex that channels the transit of blood towards the outflow tract. In a failing left ventricle, progressive adverse remodeling leads to abnormal flow patterns that are less efficient in channeling blood transit, and which may contribute further to the progression of heart failure. Thus, a deeper understanding of blood flow dynamics in normal and diseased left ventricles may provide insight on the pathophysiology of heart failure, leading to earlier diagnosis and improved treatment strategies of this syndrome. Recent years have witnessed a surge of interest in studying the role of flow patterns in blood transport inside the left ventricle. Despite significant advances, we still understand poorly how the fluid dynamical processes are synchronized with the electromechanical events to generate blood flow. Our preliminary studies suggest that the position and properties of diastolic vortices, and consequently, their ability to channel blood transit through the LV, are related to the timing of the myocardial events of the cycle. The goal of this research is to understand the dependence of the time evolution of the diastolic vortices on the duration of the left-ventricular filling phases, and to determine how this dependence affects blood flow transport and global ventricular function. In order to carry out the proposed research we have assembled an interdisciplinary team of investigators with complementary expertise ranging from cardiology, echocardiography and magnetic resonance imaging, to fluid dynamics, computational mechanics and image processing. We will validate and apply a novel echocardiographic modality to measure two-dimensional bi-directional time-resolved flow maps in the left ventricle in a group of patients undergoing cardiac resynchronization therapy at the UCSD Medical Center. We will use these measurements to determine the time evolution of diastolic vortices in these patients for different AV and VV delays, and characterize how these delays affect the transit of blood inside the left ventricle. We postulate that better knowledge of this dependence will increase our understanding of the benefits of cardiac resynchronization therapy. It will also improve current protocols for VV and AV optimization by improving patient selection and enabling LV contraction to take place under the most favorable hemodynamic conditions.

描述（由申请人提供）：心脏血流产生是同步机电心肌事件和流体动力学过程的结果。血流与心肌之间的相互作用引起心脏的连续重塑，从而导致流动模式最小化能量损失。正常左心室中的流动模式由大型舒张压涡流组成，该涡流将血液传播到流出道。在左心室失败的情况下，进行性不良反应重塑导致异常流动模式在传播血液传输方面效率较低，并且可能进一步有助于心力衰竭的发展。因此，对正常和患病的左心室血流动态的更深入了解可能会提供有关心力衰竭病理生理学的见解，从而导致早期诊断并改善了该综合征的治疗策略。近年来，人们对研究流动模式在左心室内部血液传输中的作用的兴趣激增。尽管取得了重大的进步，但我们仍然不太了解流体动力学过程如何与机电事件同步以产生血液。我们的初步研究表明，舒张期涡旋的位置和特性，因此，它们通过LV传播血液的能力与循环的心肌事件的时机有关。这项研究的目的是了解舒张涡流对左心室填充阶段持续时间的时间演变的依赖性，并确定这种依赖性如何影响血流的运输和全球心室功能。为了进行拟议的研究，我们组建了一个跨学科的研究人员团队，具有互补的专业知识，从心脏病学，超声心动图和磁共振成像到流体动力学，计算力学和图像处理。我们将验证并应用新型的超声心动图方式，以测量一组在UCSD医疗中心接受心脏重新同步治疗的患者的左心室中的二维双向时间分辨图。我们将使用这些测量值来确定这些患者在不同的AV和VV延迟中舒张期涡旋的时间演变，并表征了这些延迟如何影响左心室内的血液的过渡。我们假设对这种依赖性的更好了解将增加我们对心脏重新同步疗法的益处的理解。它还将通过改善患者选择并使LV收缩在最有利的血液动力学条件下进行，以改善目前的VV和AV优化方案。

项目成果

Topology of blood transport in the human left ventricle by novel processing of Doppler echocardiography.

• DOI: 10.1007/s10439-013-0853-z
• 发表时间: 2013-12
• 期刊: ANNALS OF BIOMEDICAL ENGINEERING
• 影响因子: 3.8
• 作者: Hendabadi, Sahar;Bermejo, Javier;Benito, Yolanda;Yotti, Raquel;Fernandez-Aviles, Francisco;del Alamo, Juan C.;Shadden, Shawn C.
• 通讯作者: Shadden, Shawn C.