Vogl Brennan J, Vitale Emily, Ahn Sunyoung, Sularz Agata, Chavez Ponce Alejandra, Lo Russo Gerardo V, Collins Jeremy, Bavo Alessandra Maria, El Shaer Ahmed, Kramer Anders, Jia Yuheng, Lulic Davorka, De Beule Matthieu, Nielsen-Kudsk Jens Erik, De Backer Ole, Alkhouli Mohamad, Hatoum Hoda
Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC Adv. 2024 Oct 15;3(11):101339. doi: 10.1016/j.jacadv.2024.101339. eCollection 2024 Nov.
Device-related thrombosis (DRT) occurs in up to 4% of patients undergoing left atrial appendage occlusion (LAAO) and is associated with substantial morbidity and mortality. However, its pathophysiology, predictors, and optimal management remain unclear.
This study aims to assess flow dynamic factors correlating to DRT.
A multicenter registry of patients who underwent LAAO and had pre- and post-computed tomography imaging was used. Patient-specific 3-dimensional digital models of the left atrium were created, and finite element simulations were performed to implant an LAAO device into each model in a position that matched the clinical deployment. Computational fluid dynamic simulations were performed to quantify the following flow dynamic parameters: time averaged wall shear stress, oscillatory shear index, and endothelial cell activation potential.
A total of 38 patients (19 with DRT and 19 without DRT) were included. Left atrium volumes and mitral valve areas were larger in the DRT cohort compared with controls. Patients with DRT had a significantly lower time averaged wall shear stress (1.76 ± 1.24 Pa vs 2.90 ± 2.70 Pa), a higher oscillatory shear index (0.19 ± 0.11 vs 0.17 ± 0.11), and a higher endothelial cell activation potential (0.23 ± 0.58 Pa vs 0.17 ± 0.30 Pa) than the controls ( < 0.001 for all). Thrombus locations identified from in-vivo images correlated well with the flow dynamic parameters tested.
Flow dynamic parameters may be able to predict the risk of DRT after LAAO. Further investigation with a larger patient cohort and long-term follow-up is needed to assess the role of computational fluid dynamics in the risk stratification of patients considered for LAAO.
与装置相关的血栓形成（DRT）在接受左心耳封堵术（LAAO）的患者中发生率高达4%，并与显著的发病率和死亡率相关。然而，其病理生理学、预测因素和最佳管理仍不清楚。
本研究旨在评估与DRT相关的血流动力学因素。
使用一个多中心登记库，纳入接受LAAO并进行了术前和术后计算机断层扫描成像的患者。创建了患者特异性的左心房三维数字模型，并进行有限元模拟，将LAAO装置植入每个模型中与临床部署相匹配的位置。进行计算流体动力学模拟以量化以下血流动力学参数：时间平均壁面剪应力、振荡剪应力指数和内皮细胞激活潜能。
共纳入38例患者（19例发生DRT，19例未发生DRT）。与对照组相比，DRT队列中的左心房容积和二尖瓣面积更大。发生DRT的患者的时间平均壁面剪应力显著更低（1.76±1.24 Pa vs 2.90±2.70 Pa），振荡剪应力指数更高（0.19±0.11 vs 0.17±0.11），内皮细胞激活潜能更高（0.23±0.58 Pa vs 0.17±0.30 Pa），与对照组相比差异均有统计学意义（均P<0.001）。从体内图像确定的血栓位置与所测试的血流动力学参数相关性良好。
血流动力学参数可能能够预测LAAO术后DRT的风险。需要对更大的患者队列进行进一步研究并进行长期随访，以评估计算流体动力学在考虑接受LAAO的患者风险分层中的作用。
