Rocchi Maria, Gross Christoph, Moscato Francesco, Schlöglhofer Thomas, Meyns Bart, Fresiello Libera
Unit of Cardiac Surgery, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Front Physiol. 2023 Jul 25;14:1155032. doi: 10.3389/fphys.2023.1155032. eCollection 2023.
Ventricular assist devices (LVADs) are a valuable therapy for end-stage heart failure patients. However, some adverse events still persist, such as suction that can trigger thrombus formation and cardiac rhythm disorders. The aim of this study is to validate a suction module (SM) as a test bench for LVAD suction detection and speed control algorithms. The SM consists of a latex tube, mimicking the ventricular apex, connected to a LVAD. The SM was implemented into a hybrid - cardiovascular simulator. Suction was induced simulating hypovolemia in a profile of a dilated cardiomyopathy and of a restrictive cardiomyopathy for pump speeds ranging between 2,500 and 3,200 rpm. Clinical data collected in 38 LVAD patients were used for the validation. Clinical and simulated LVAD flow waveforms were visually compared. For a more quantitative validation, a binary classifier was used to classify simulated suction and non-suction beats. The obtained classification was then compared to that generated by the simulator to evaluate the specificity and sensitivity of the simulator. Finally, a statistical analysis was run on specific suction features (e.g., minimum impeller speed pulsatility, minimum slope of the estimated flow, and timing of the maximum slope of the estimated flow). The simulator could reproduce most of the pump waveforms observed . The simulator showed a sensitivity and specificity and of 90.0% and 97.5%, respectively. Simulated suction features were in the interquartile range of clinical ones. The SM can be used to investigate suction in different pathophysiological conditions and to support the development of LVAD physiological controllers.
心室辅助装置（LVADs）是治疗终末期心力衰竭患者的一种有效疗法。然而，一些不良事件仍然存在，例如可能引发血栓形成和心律失常的抽吸现象。本研究的目的是验证一种抽吸模块（SM）作为LVAD抽吸检测和速度控制算法的测试平台。该SM由一根模仿心尖的乳胶管连接到一个LVAD组成。该SM被应用于一个混合心血管模拟器中。在模拟扩张型心肌病和限制型心肌病的血容量不足情况下，以2500至3200转/分钟的泵速诱导抽吸。收集了38例LVAD患者的临床数据用于验证。对临床和模拟的LVAD血流波形进行了视觉比较。为了进行更定量的验证，使用二元分类器对模拟的抽吸和非抽吸搏动进行分类。然后将获得的分类与模拟器生成的分类进行比较，以评估模拟器的特异性和敏感性。最后，对特定的抽吸特征（例如，最小叶轮速度搏动性、估计流量的最小斜率以及估计流量最大斜率的时间）进行了统计分析。该模拟器能够重现观察到的大多数泵波形。该模拟器的敏感性和特异性分别为90.0%和97.5%。模拟的抽吸特征处于临床特征的四分位间距范围内。该SM可用于研究不同病理生理条件下的抽吸情况，并支持LVAD生理控制器的开发。
