Simulation of dilated heart failure with continuous flow circulatory support

Wang, Y and Loghmanpour, N and Ferreira, A and Antaki, J and Vandenberghe, S and Keller, B and Gorcsan, J (2014) Simulation of dilated heart failure with continuous flow circulatory support. PLoS ONE, 9 (1).

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Abstract

Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD) and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR) to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD) coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV) unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/ without pulmonary hypertension) in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery. © 2014 Wang et al.

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Details

Item Type:	Article
Status:	Published
Creators/Authors:	Creators Email Pitt Username ORCID Wang, Y Loghmanpour, N Ferreira, A Antaki, J Vandenberghe, S Keller, B Gorcsan, J gorcsan@pitt.edu GORCSAN
Contributors:	Contribution Contributors Name Email Pitt Username ORCID Editor Lionetti, Vincenzo UNSPECIFIED UNSPECIFIED UNSPECIFIED
Date:	17 January 2014
Date Type:	Publication
Journal or Publication Title:	PLoS ONE
Volume:	9
Number:	1
DOI or Unique Handle:	10.1371/journal.pone.0085234
Schools and Programs:	School of Medicine > Medicine
Refereed:	Yes
Date Deposited:	19 Jun 2014 15:27
Last Modified:	25 Jan 2019 20:55
URI:	http://d-scholarship.pitt.edu/id/eprint/21874

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