Scarsoglio Stefania, Cazzato Fabio, Ridolfi Luca
Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
Medacta International SA, Castel San Pietro, Switzerland.
Chaos. 2017 Sep;27(9):093107. doi: 10.1063/1.5003791.
A network-based approach is presented to investigate the cerebrovascular flow patterns during atrial fibrillation (AF) with respect to normal sinus rhythm (NSR). AF, the most common cardiac arrhythmia with faster and irregular beating, has been recently and independently associated with the increased risk of dementia. However, the underlying hemodynamic mechanisms relating the two pathologies remain mainly undetermined so far; thus, the contribution of modeling and refined statistical tools is valuable. Pressure and flow rate temporal series in NSR and AF are here evaluated along representative cerebral sites (from carotid arteries to capillary brain circulation), exploiting reliable artificially built signals recently obtained from an in silico approach. The complex network analysis evidences, in a synthetic and original way, a dramatic signal variation towards the distal/capillary cerebral regions during AF, which has no counterpart in NSR conditions. At the large artery level, networks obtained from both AF and NSR hemodynamic signals exhibit elongated and chained features, which are typical of pseudo-periodic series. These aspects are almost completely lost towards the microcirculation during AF, where the networks are topologically more circular and present random-like characteristics. As a consequence, all the physiological phenomena at the microcerebral level ruled by periodicity-such as regular perfusion, mean pressure per beat, and average nutrient supply at the cellular level-can be strongly compromised, since the AF hemodynamic signals assume irregular behaviour and random-like features. Through a powerful approach which is complementary to the classical statistical tools, the present findings further strengthen the potential link between AF hemodynamic and cognitive decline.
本文提出了一种基于网络的方法,用于研究心房颤动(AF)期间相对于正常窦性心律(NSR)的脑血管血流模式。AF是最常见的心律失常,心跳更快且不规则,最近已独立地与痴呆风险增加相关。然而,到目前为止,将这两种病理联系起来的潜在血流动力学机制仍主要未确定;因此,建模和精细统计工具的作用很有价值。在此,利用最近从计算机模拟方法获得的可靠人工构建信号,评估了NSR和AF中沿代表性脑区(从颈动脉到脑毛细血管循环)的压力和流速时间序列。复杂网络分析以一种综合且新颖的方式表明,AF期间向远端/脑毛细血管区域的信号变化显著,而在NSR条件下则没有这种对应情况。在大动脉水平,从AF和NSR血流动力学信号获得的网络呈现出细长且链式的特征,这是伪周期序列的典型特征。在AF期间,这些特征在向微循环发展的过程中几乎完全消失,此时网络在拓扑结构上更呈圆形且具有类似随机的特征。因此,由于AF血流动力学信号呈现出不规则行为和类似随机的特征,所有由周期性决定的微脑水平的生理现象,如规律灌注、每搏平均压力和细胞水平的平均营养供应,都可能受到严重影响。通过一种与经典统计工具互补的强大方法,本研究结果进一步加强了AF血流动力学与认知衰退之间的潜在联系。