Abstract 12086: Irregular Blood Flow Patterns in the Development of Pulmonary Hypertension
Introduction: Pulmonary Hypertension (PH) is a degenerative disease that ultimately leads to Right Ventricular (RV) failure. Gradual deterioration of RV functional performance, together with an increase in afterload, must be accompanied by changes to the flow patterns in the main Pulmonary Artery (PA). Much like a wake remaining long after the passing of jet engine, the fluid domain retains evidence of subtle changes to the solid domain and ventricular function, which could be clinically invaluable for: (1) patient stratification; (2) monitoring disease progression; and (3) assessing treatment efficacy.
Hypothesis: We hypothesized that vorticity in the main PA is statistically associated with prognostic functional metrics of the RV-PA axis.
Methods: 4 controls (non-PH with Chronic Obstructive Pulmonary Disorder) and 14 PH patients underwent right heart catheterization (RHC), cardiac MRI, and 4-D MRI. We estimated afterload as vascular elastance (Ea) of the Windkessel model, which accounts for changes in characteristic impedance (influencing the strength of wave reflections), pulmonary vascular resistance, and compliance. We also, incorporated patient data into a comprehensive 0-D model of the cardio-pulmonary system (Fig. 1a), which was used to simulate a hemodynamic challenge and compute an afterload-independent metric of contractility (end systolic elastance, Ees). These metrics were correlated against maximum systolic vorticity (ωsys), determined from flow pattern reconstruction of the 4D MRI dataset.
Results: PH patients revealed a significantly lower main PA vorticity than controls (P < 0.05). Furthermore, Ea is non-linearly associated with ωsys for both the control and PH populations (Fig. 1b). Contractility (Ees) also appears to increase proportionally with a decrease in vorticity (Fig. 1c).
Conclusions: Flow pattern changes in the main PA, in patients with PH and at risk of developing PH, are indicative of afterload and RV systolic function.
Author Disclosures: V.O. kheyfets: None. J. Smyser: None. A. Honeyman: None. J. Browning: None. J.R. Hertzberg: None. J. Schroeder: None. B. Fenster: None. R. Shandas: None.
- © 2014 by American Heart Association, Inc.