Impaired coronary blood flow at higher heart rates during atrial fibrillation: Investigation via multiscale modelling.
Algorithms
Arteries
/ physiology
Atrial Fibrillation
/ diagnostic imaging
Computer Simulation
Coronary Circulation
Coronary Vessels
/ diagnostic imaging
Female
Heart
/ diagnostic imaging
Heart Rate
Hemodynamics
Humans
Male
Models, Cardiovascular
Myocardial Contraction
Myocardium
/ pathology
Oxygen
/ metabolism
Atrial fibrillation
Cardiovascular multiscale modelling
Computational hemodynamics
Coronary blood flow
Heart rate
Journal
Computer methods and programs in biomedicine
ISSN: 1872-7565
Titre abrégé: Comput Methods Programs Biomed
Pays: Ireland
ID NLM: 8506513
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
09
10
2018
revised:
27
02
2019
accepted:
08
04
2019
entrez:
21
5
2019
pubmed:
21
5
2019
medline:
18
12
2019
Statut:
ppublish
Résumé
Different mechanisms have been proposed to relate atrial fibrillation (AF) and coronary flow impairment, even in absence of relevant coronary artery disease (CAD). However, the underlying hemodynamics remains unclear. Aim of the present work is to computationally explore whether and to what extent ventricular rate during AF affects the coronary perfusion. AF is simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) through a 0D-1D multiscale validated model, which combines the left heart-arterial tree together with the coronary circulation. Artificially-built RR stochastic extraction mimics the in vivo beating features. All the hemodynamic parameters computed are based on the left anterior descending (LAD) artery and account for the waveform, amplitude and perfusion of the coronary blood flow. Alterations of the coronary hemodynamics are found to be associated either to the heart rate increase, which strongly modifies waveform and amplitude of the LAD flow rate, and to the beat-to-beat variability. The latter is overall amplified in the coronary circulation as HR grows, even though the input RR variability is kept constant at all HRs. Higher ventricular rate during AF exerts an overall coronary blood flow impairment and imbalance of the myocardial oxygen supply-demand ratio. The combined increase of heart rate and higher AF-induced hemodynamic variability lead to a coronary perfusion impairment exceeding 90-110 bpm in AF. Moreover, it is found that coronary perfusion pressure (CPP) is no longer a good measure of the myocardial perfusion for HR higher than 90 bpm.
Sections du résumé
BACKGROUND
BACKGROUND
Different mechanisms have been proposed to relate atrial fibrillation (AF) and coronary flow impairment, even in absence of relevant coronary artery disease (CAD). However, the underlying hemodynamics remains unclear. Aim of the present work is to computationally explore whether and to what extent ventricular rate during AF affects the coronary perfusion.
METHODS
METHODS
AF is simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) through a 0D-1D multiscale validated model, which combines the left heart-arterial tree together with the coronary circulation. Artificially-built RR stochastic extraction mimics the in vivo beating features. All the hemodynamic parameters computed are based on the left anterior descending (LAD) artery and account for the waveform, amplitude and perfusion of the coronary blood flow.
RESULTS
RESULTS
Alterations of the coronary hemodynamics are found to be associated either to the heart rate increase, which strongly modifies waveform and amplitude of the LAD flow rate, and to the beat-to-beat variability. The latter is overall amplified in the coronary circulation as HR grows, even though the input RR variability is kept constant at all HRs.
CONCLUSIONS
CONCLUSIONS
Higher ventricular rate during AF exerts an overall coronary blood flow impairment and imbalance of the myocardial oxygen supply-demand ratio. The combined increase of heart rate and higher AF-induced hemodynamic variability lead to a coronary perfusion impairment exceeding 90-110 bpm in AF. Moreover, it is found that coronary perfusion pressure (CPP) is no longer a good measure of the myocardial perfusion for HR higher than 90 bpm.
Identifiants
pubmed: 31104719
pii: S0169-2607(18)31468-8
doi: 10.1016/j.cmpb.2019.04.009
pii:
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
95-102Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.