Computer Simulation of Coronary Flow Waveforms during Caval Occlusion

2009 ◽  
Vol 48 (02) ◽  
pp. 113-122 ◽  
Author(s):  
D. Neglia ◽  
G. Ferrari ◽  
F. Bernini ◽  
M. Micalizzi ◽  
A L’Abbate ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiovascular System ◽  
Coronary Flow ◽  
Coronary Circulation ◽  
Left Ventricular Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Lumped Parameter ◽  
Flow Waveforms

Summary Objectives: Mathematical modeling of the cardiovascular system is a powerful tool to extract physiologically relevant information from multi-parametric experiments. The purpose of the present work was to reproduce by means of a computer simulator, systemic and coronary measurements obtained by in vivo experiments in the pig. Methods: We monitored in anesthetized open-chest pig the phasic blood flow of the left descending coronary artery, aortic pressure, left ventricular pressure and volume. Data were acquired before, during, and after caval occlusion.Inside the software simulator (CARDIOSIM©) of the cardiovascular system, coronary circulation was modeled in three parallel branching sections. Both systemic and pulmonary circulations were simulated using a lumped parameter mathematical model. Variable elastance model reproduced Starling’s law of the heart. Results: Different left ventricular pressure-volume loops during experimental caval occlusion and simulated cardiac loops are presented. The sequence of coronary flow-aortic pressure loops obtained in vivo during caval occlusion together with the simulated loops reproduced by the software simulator are reported. Finally experimental and simulated instantaneous coronary blood flow waveforms are shown. Conclusions: The lumped parameter model of the coronary circulation, together with the cardiovascular system model, is capable of reproducing the changes during caval occlusion, with the profound shape deformation of the flow signal observed during the in vivo experiment. In perspectives, the results of the present model could offer new tool for studying the role of the different determinants of myocardial perfusion, by using the coronary loop shape as a “sensor” of ventricular mechanics in various physiological and pathophysiological conditions.

Contribution of extravascular compression to reduction of maximal coronary blood flow

1992 ◽  
Vol 262 (1) ◽  
pp. H68-H77
Author(s):  
F. L. Abel ◽  
R. R. Zhao ◽  
R. F. Bond
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Coronary Flow ◽  
Perfusion Pressure ◽  
Left Ventricular Pressure ◽  
Coronary Perfusion Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Coronary Perfusion ◽  
Storage Site

Effects of ventricular compression on maximally dilated left circumflex coronary blood flow were investigated in seven mongrel dogs under pentobarbital anesthesia. The left circumflex artery was perfused with the animals' own blood at a constant pressure (63 mmHg) while left ventricular pressure was experimentally altered. Adenosine was infused to produce maximal vasodilation, verified by the hyperemic response to coronary occlusion. Alterations of peak left ventricular pressure from 50 to 250 mmHg resulted in a linear decrease in total circumflex flow of 1.10 ml.min-1 x 100 g heart wt-1 for each 10 mmHg of peak ventricular to coronary perfusion pressure gradient; a 2.6% decrease from control levels. Similar slopes were obtained for systolic and diastolic flows as for total mean flow, implying equal compressive forces in systole as in diastole. Increases in left ventricular end-diastolic pressure accounted for 29% of the flow changes associated with an increase in peak ventricular pressure. Doubling circumferential wall tension had a minimal effect on total circumflex flow. When the slopes were extrapolated to zero, assuming linearity, a peak left ventricular pressure of 385 mmHg greater than coronary perfusion pressure would be required to reduce coronary flow to zero. The experiments were repeated in five additional animals but at different perfusion pressures from 40 to 160 mmHg. Higher perfusion pressures gave similar results but with even less effect of ventricular pressure on coronary flow or coronary conductance. These results argue for an active storage site for systolic arterial flow in the dilated coronary system.

Abstract 3628: Neuronal Nitric Oxide Synthase (nNOS) Regulates Basal Flow in the Human Coronary Circulation I n Vivo

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Mike Seddon ◽  
Phil Chowienczyk ◽  
Narbeh Melikian ◽  
Rafal Dworakowski ◽  
Barbara Casadei ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Blood Flow ◽  
Substance P ◽  
Coronary Flow ◽  
Vascular Tone ◽  
Coronary Circulation ◽  
Physiological Regulation ◽  
Intracoronary Doppler ◽  
Basal Flow

Endothelial NO synthase (eNOS) is thought to be the major source of nitric oxide (NO) involved in the local regulation of human vascular tone. However, in studies using a selective neuronal NOS (nNOS) inhibitor S-methyl-L-thiocitrulline (SMTC), we recently reported that basal human forearm blood flow is regulated by nNOS. SMTC had no effect on acetylcholine-induced vasodilatation which however was inhibited by the non-selective NOS inhibitor N G monomethyl-L-arginine (L-NMMA). This study investigated the effects of nNOS in the human coronary circulation in vivo . We studied patients undergoing diagnostic cardiac catheterisation who had angiographically normal coronary arteries. Coronary flow velocity was measured by an intracoronary Doppler wire and epicardial artery diameter by QCA. We compared the effects of intracoronary SMTC or L-NMMA infusion on basal flow and the responses to substance P and isosorbide dinitrate (endothelium-dependent and -independent dilators, respectively). L-NMMA (25 μmol/min) reduced basal coronary flow by 22.3±5.3% and inhibited dilation to substance P (20 pmol/min) by 57±5.7% (n=8; both P<0.01). SMTC (0.625 μmol/min) also reduced basal flow (−34.8±6.3%; n=8; P<0.01), but had no effect on the response to substance P (inhibited by −2±14%; P=NS). The effects of SMTC were abolished by L-arginine (240μmol/ min; n=3). Both L-NMMA and SMTC reduced epicardial artery diameter (−2.5±0.6% and −2.8±0.9% respectively; P<0.05) but only L-NMMA reduced dilatation to substance P (5.6±1.3% before versus 3.0±0.8% after L-NMMA; P<0.05). These data indicate that local nNOS-derived NO regulates basal coronary blood flow in humans in vivo , whereas substance P-stimulated vasodilatation is eNOS-mediated. Our results indicate that nNOS and eNOS have distinct local roles in the physiological regulation of human coronary vascular tone in vivo .

Myocardial substrate metabolism influences left ventricular energetics in vivo

2000 ◽  
Vol 278 (4) ◽  
pp. H1345-H1351 ◽  
Author(s):  
Christian Korvald ◽  
Odd Petter Elvenes ◽  
Truls Myrmel
Keyword(s):  
Fatty Acid ◽  
Coronary Flow ◽  
Left Ventricular Pressure ◽  
Random Order ◽  
Left Ventricular ◽  
Acid Oxidation ◽  
Left Ventricular Volumes ◽  
Acid Consumption ◽  
Myocardial Substrate

The myocardial oxygen consumption (MV˙o 2) to left ventricular pressure-volume area (PVA) relationship is assumed unaltered by substrates, despite varying phosphate-to-oxygen ratios and possible excess MV˙o 2 associated with fatty acid consumption. The validity of this assumption was tested in vivo. Left ventricular volumes and pressures were assessed with a combined conductance-pressure catheter in eight anesthetized pigs. MV˙o 2 was calculated from coronary flow and arterial-coronary sinus O2 differences. Metabolism was altered by glucose-insulin-potassium (GIK) or Intralipid-heparin (IH) infusions in random order and monitored with [14C]glucose and [3H]oleate tracers. Profound shifts in glucose and fatty acid oxidation were observed. Contractility, coronary flow, and slope of the MV˙o 2-PVA relationship were unchanged during GIK and IH infusions. MV˙o 2 at zero PVA (unloaded MV˙o 2) was 0.16 ± 0.13 J ⋅ beat− 1 ⋅ 100 g− 1 higher during IH compared with GIK infusion ( P = 0.001), a 48% increase. The study demonstrates a marked energetic advantage of glucose oxidation in the myocardium, profoundly affecting the MV˙o 2-PVA relationship. This may in part explain the “oxygen-wasting” effect of lipid-enhancing interventions such as adrenergic drugs and ischemia.

Intramyocardial Pressure and Coronary Extravascular Resistance

1985 ◽  
Vol 107 (1) ◽  
pp. 46-50 ◽  
Author(s):  
P. D. Stein ◽  
H. N. Sabbah ◽  
M. Marzilli
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Coronary Flow ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Driving Pressure ◽  
Ventricular Pressure ◽  
Intramyocardial Pressure ◽  
Extravascular Resistance

Intramyocardial pressure is an indicator of coronary extravascular resistance. During systole, pressure in the subendocardium exceeds left ventricular intracavitary pressure; whereas pressure in the subepicardium is lower than left ventricular intracavitary pressure. Conversely, during diastole, subepicardial pressure exceeds both subendocardial pressure and left ventricular pressure. These observations suggest that coronary flow during systole is possible only in the subepicardial layers. During diastole, however, a greater driving pressure is available for perfusion of the subendocardial layers relative to the subepicardial layers. On this basis, measurements of intramyocardial pressure contribute to an understanding of the mechanisms of regulation of the phasic and transmural distribution of coronary blood flow.

scholarly journals In vivo selective expression of thyroid hormone receptor α1 in endothelial cells attenuates myocardial injury in experimental myocardial infarction in mice

2014 ◽  
Vol 307 (3) ◽  
pp. R340-R346 ◽  
Author(s):  
Jorge Suarez ◽  
Hong Wang ◽  
Brian T. Scott ◽  
Haiyun Ling ◽  
Ayako Makino ◽  
...  
Keyword(s):  
Heart Rate ◽  
Endothelial Cells ◽  
Blood Flow ◽  
Thyroid Hormone Receptor ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Experimental Myocardial Infarction ◽  
Negative Consequences ◽  
Selective Expression

Ischemic heart disease (IHD) is the single most common cause of death. New approaches to enhance myocardial perfusion are needed to improve outcomes for patients with IHD. Thyroid hormones (TH) are known to increase blood flow; however, their usefulness for increasing perfusion in IHD is limited because TH accelerates heart rate, which can be detrimental. Therefore, selective activation of TH effects is desirable. We hypothesized that cell-type-specific TH receptor (TR) expression can increase TH action in the heart, while avoiding the negative consequences of TH treatment. We generated a binary transgenic (BTG) mouse that selectively expresses TRα1 in endothelial cells in a tetracycline-inducible fashion. In BTG mice, endothelial TRα1 protein expression was increased by twofold, which, in turn, increased coronary blood flow by 77%, coronary conductance by 60%, and coronary reserve by 47% compared with wild-type mice. Systemic blood pressure was decreased by 20% in BTG mice after TRα1 expression. No effects on heart rate were observed. Endothelial TRα1 expression activated AKT/endothelial nitric oxide synthase pathway and increased A2AR adenosine receptor. Furthermore, hearts from BTG mice overexpressing TRα1 that were submitted to 20 min ischemia and 20 min reperfusion showed a 20% decline in left ventricular pressure (LVP) compared with control mice where LVP was decreased by 42%. Studies using an infarction mouse model demonstrated that endothelial overexpression of TRα1 decreased infarct size by 45%. In conclusion, selective expression of TRα1 in endothelial cells protects the heart against injury after an ischemic insult and does not result in adverse cardiac or systemic effects.

Estimation of intramyocardial pressure and coronary blood flow distribution

1988 ◽  
Vol 255 (3) ◽  
pp. H664-H672 ◽  
Author(s):  
Y. Sun ◽  
H. Gewirtz
Keyword(s):  
Blood Flow ◽  
Coronary Blood Flow ◽  
Coronary Circulation ◽  
Regression Line ◽  
Flow Distribution ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Blood Flow Distribution ◽  
Intramyocardial Pressure ◽  
D Model

To characterize the intramyocardial pressure (IMP) and coronary blood flow distribution in a stenosed coronary circulation, we compared four analog circuits for modeling coronary impedance. The resistor (R)-diode (D) model simulates vascular collapse, and the capacitor (C) simulates compliance effect. Identification of the best model and magnitudes of the endocardial and epicardial IMPs (IMPendo and IMPepi) was done retrospectively using data from studies in 28 anesthetized swine. Performance evaluation was based on comparison of model predicted vs. observed coronary distal pressure (DP) waveforms and endocardial-to-epicardial (endo-epi) flow ratios as determined by radiolabeled microspheres. The R-D-C model gave the best performance at IMPendo = 1.1 times left ventricular pressure (LVP), and IMPepi = 0.1.LVP + 15 mmHg; with good fit to DP (r = 0.98, slope of regression line = 1.0) and estimates of endo-epi flow ratio (r = 0.78, slope = 1.01, P less than 0.02, SEE = 0.21, n = 139). The R-D model gave comparable results even though capacitance was omitted. Although R-C and R models predicted distal coronary pressure well, they failed to predict endo-epi flow ratios (r less than 0.50). The R-D-C and R-D models were applied in seven prospective studies. Both models generated reasonable estimates of endo-epi flow distribution (r = 0.78, n = 50). Thus the R-D-C or R-D models of the stenosed coronary circulation can be used to provide reliable estimates of transmural blood flow distribution.

scholarly journals Influence of the coronary circulation on thermal tolerance and cardiac performance during warming in rainbow trout

2017 ◽  
Vol 312 (4) ◽  
pp. R549-R558 ◽  
Author(s):  
Andreas Ekström ◽  
Michael Axelsson ◽  
Albin Gräns ◽  
Jeroen Brijs ◽  
Erik Sandblom
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Rainbow Trout ◽  
Cardiac Function ◽  
Thermal Tolerance ◽  
Coronary Flow ◽  
Coronary Circulation ◽  
Cardiac Performance ◽  
Juvenile Trout

Thermal tolerance in fish may be related to an oxygen limitation of cardiac function. While the hearts of some fish species receive oxygenated blood via a coronary circulation, the influence of this oxygen supply on thermal tolerance and cardiac performance during warming remain unexplored. Here, we analyzed the effect in vivo of acute warming on coronary blood flow in adult sexually mature rainbow trout ( Onchorhynchus mykiss) and the consequences of chronic coronary ligation on cardiac function and thermal tolerance in juvenile trout. Coronary blood flow at 10°C was higher in females than males (0.56 ± 0.08 vs. 0.30 ± 0.08 ml·min−1·g ventricle−1), and averaged 0.47 ± 0.07 ml·min−1·g ventricle−1 across sexes. Warming increased coronary flow in both sexes until 14°C, at which it peaked and plateaued at 0.78 ± 0.1 and 0.61 ± 0.1 ml·min−1·g ventricle−1 in females and males, respectively. Thus, the scope for increasing coronary flow was 101% in males, but only 39% in females. Coronary-ligated juvenile trout exhibited elevated heart rate across temperatures, reduced Arrhenius breakpoint temperature for heart rate (23.0 vs. 24.6°C), and reduced upper critical thermal maximum (25.3 vs. 26.3°C). To further analyze the effects of coronary flow restriction on cardiac rhythmicity, electrocardiogram characteristics were determined before and after coronary occlusion in anesthetized trout. Occlusion resulted in reduced R-wave amplitude and an elevated S-T segment, indicating myocardial ischemia, while heart rate was unaffected. This suggests that the tachycardia in ligated trout across temperatures in vivo was mainly to compensate for reduced cardiac contractility to maintain cardiac output. Moreover, our findings show that coronary flow increases with warming in a sex-specific manner. This may improve whole animal thermal tolerance, presumably by sustaining cardiac oxygenation and contractility at high temperatures.

Myocardial responses to alpha-adrenoceptor stimulation with methoxamine hydrochloride in lambs

1982 ◽  
Vol 242 (3) ◽  
pp. H405-H410 ◽  
Author(s):  
J. C. Lee ◽  
R. R. Fripp ◽  
S. E. Downing
Keyword(s):  
Blood Flow ◽  
Diastolic Pressure ◽  
Left Ventricular Pressure ◽  
Aortic Pressure ◽  
Atropine Sulfate ◽  
Left Ventricular ◽  
Inotropic Action ◽  
Ventricular Performance ◽  
Positive Inotropic Action ◽  
Alpha Adrenergic Receptors

This study was undertaken to evaluate the effects of methoxamine on left ventricular performance, coronary blood flow (CBF), and myocardial oxygen consumption (MVO2) in lambs. Measurement of maximum rate of rise of left ventricular pressure (LV dP/dtmax), left ventricular end-diastolic pressure (LVEDP), CBF, and MVO2 were made in nine lambs using a hemodynamically controlled preparation. The lambs were given atropine sulfate (1 mg), tetraethylammonium chloride (100 mg), and practolol (4 mg/kg) to provide parasympathetic, ganglionic, and beta-adrenergic blockades. Aortic pressure and blood flow and heart rate were held constant in each lamb. Dose-related increases in LV dP/dtmax and decreases in LVEDP were observed after progressively larger doses of methoxamine ranging from 0.4 to 6.0 mg/kg were given. These positive inotropic responses were eliminated by giving phentolamine (2 mg/kg). CBF, myocardial O2 extraction, and MVO2 did not change significantly. A positive inotropic action of methoxamine was also demonstrated in five additional animals by obtaining ventricular function curves. Initially the mean stroke volume at LVEDP 10 cmH2O (SV10) was 4.11 +/- 0.16 (SE) ml. This value increased to 5.09 +/- 0.28 ml after methoxamine (P less than 0.01). After phentolamine, SV 10 fell to 4.37 +/- 0.08 ml (P less than 0.05). These observations support the hypothesis that alpha-adrenergic receptors are present and mediate a substantial positive inotropic action on neonatal lamb myocardium.

Scalability and in vivo validation of a multiscale numerical model of the left coronary circulation

2014 ◽  
Vol 306 (4) ◽  
pp. H517-H528 ◽  
Author(s):  
Jonathan P. Mynard ◽  
Daniel J. Penny ◽  
Joseph J. Smolich
Keyword(s):  
Wave Propagation ◽  
Coronary Flow ◽  
Coronary Circulation ◽  
Multiscale Model ◽  
Aortic Pressure ◽  
Lumped Parameter Model ◽  
Waveform Analysis ◽  
Promising Tool ◽  
Propagation Effects

Multiscale modeling is a promising tool for the study of coronary hemodynamics. A key strength of this approach is that it accounts for microvascular properties and extravascular forces that differ regionally and transmurally, as well as wave propagation effects in the conduit arteries. However, little validation of such models has been reported and no models of the newborn coronary circulation have been described. We therefore validated a multiscale model of the left coronary circulation using high-fidelity data from nine adult sheep and nine newborn lambs and investigated whether wave propagation effects are more prominent in adults, whose body size (and hence wave transit distance) is greater. The model consisted of a one-dimensional (1D) network of the major conduit arteries and a lumped parameter model of microvascular beds. Intramyocardial pressure was considered to arise via contraction-related myocyte thickening and transmission of ventricular cavity pressure into the heart wall. 1D network geometry from published human anatomical data was scaled using myocardial weights, while subject-specific aortic pressure/flow and ventricular pressure formed model inputs. Total vascular resistance was determined iteratively from measured mean circumflex coronary flow (CxQ), but no fitting of phasic aspects of the waveform was performed. Excellent agreement was obtained between simulated and measured CxQ waveforms in most cases. Detailed flow waveform analysis did not clearly reveal a greater prominence of wave propagation effects in adults compared with newborns. This multiscale model is likely to be useful for investigating wave phenomena and phasic aspects of coronary flow in adults and during development.

Recapitulating aortic valve disease hemodynamics with a highly tunable bio-inspired soft robotic aortic sleeve

2021 ◽  
Author(s):  
Luca Rosalia ◽  
Caglar Ozturk ◽  
Yiling Fan ◽  
Jaume Coll-Font ◽  
Shi Chen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pressure Overload ◽  
Left Ventricular Pressure ◽  
Flow Patterns ◽  
Left Ventricular ◽  
Patient Specific ◽  
Congenital Defects ◽  
Lumped Parameter

Abstract Existing models of aortic stenosis (AS) are limited to inducing left ventricular pressure overload. As they have reduced control over the severity of aortic constriction, the clinical relevance of these models is largely hindered by their inability to mimic AS hemodynamics and recapitulate flow patterns associated with congenital valve defects, responsible for the accelerated onset and progression of AS. Here we report the development of a highly tunable bio-inspired soft robotic tool that enables the recapitulation of AS in a porcine model, in which customization of actuation patterns allows hemodynamic mimicry of AS and congenital aortic valve defects. In vitro and computational tools including lumped-parameter, finite element, and computational fluid dynamics platforms were developed to predict the hemodynamics induced by the bio-inspired soft robotic sleeve. The controllability of our in vivo model and its ability to replicate flow patterns of AS and congenital defects were demonstrated in swine through echocardiography, left ventricular catheterization, and magnetic resonance imaging. This work supports the use of soft robotics to simulate human physiology and disease, while paving the way towards the development of patient-specific models of AS and congenital defects that can guide clinical decisions to improve the management and treatment of these patients.

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