Comput Math Methods Med - Influence of distal resistance and proximal stiffness on hemodynamics and RV afterload in progression and treatments of pulmonary hypertension: a computational study with validation using animal models.

Tópicos

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Resumo

We develop a simple computational model based on measurements from a hypoxic neonatal calf model of pulmonary hypertension (PH) to investigate the interplay between vascular and ventricular measures in the setting of progressive PH. Model parameters were obtained directly from in vivo and ex vivo measurements of neonatal calves. Seventeen sets of model-predicted impedance and mean pulmonary arterial pressure (mPAP) show good agreement with the animal measurements, thereby validating the model. Next, we considered a predictive model in which three parameters, PVR, elastic modulus (EM), and arterial thickness, were varied singly from one simulation to the next to study their individual roles in PH progression. Finally, we used the model to predict the individual impacts of clinical (vasodilatory) and theoretical (compliance increasing) PH treatments on improving pulmonary hemodynamics. Our model (1) displayed excellent patient-specific agreement with measured global pulmonary parameters; (2) quantified relationships between PVR and mean pressure and PVS and pulse pressure, as well as studiying the right ventricular (RV) afterload, which could be measured as a hydraulic load calculated from spectral analysis of pulmonary artery pressure and flow waves; (3) qualitatively confirmed the derangement of vascular wall shear stress in progressive PH; and (4) established that decreasing proximal vascular stiffness through a theoretical treatment of reversing proximal vascular remodeling could decrease RV afterload.

Resumo Limpo

develop simpl comput model base measur hypox neonat calf model pulmonari hypertens ph investig interplay vascular ventricular measur set progress ph model paramet obtain direct vivo ex vivo measur neonat calv seventeen set modelpredict imped mean pulmonari arteri pressur mpap show good agreement anim measur therebi valid model next consid predict model three paramet pvr elast modulus em arteri thick vari singl one simul next studi individu role ph progress final use model predict individu impact clinic vasodilatori theoret complianc increas ph treatment improv pulmonari hemodynam model display excel patientspecif agreement measur global pulmonari paramet quantifi relationship pvr mean pressur pvs puls pressur well studiy right ventricular rv afterload measur hydraul load calcul spectral analysi pulmonari arteri pressur flow wave qualit confirm derang vascular wall shear stress progress ph establish decreas proxim vascular stiff theoret treatment revers proxim vascular remodel decreas rv afterload

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