Abstract
The laws of fluid dynamics govern vortex ring formation and precede cardiac development by billions of years, suggesting that diastolic vortex ring formation is instrumental in defining the shape of the heart. Using novel and validated magnetic resonance imaging measurements, we show that the healthy left ventricle moves in tandem with the expanding vortex ring, indicating that cardiac form and function is epigenetically optimized to accommodate vortex ring formation for volume pumping. Healthy hearts demonstrate a strong coupling between vortex and cardiac volumes (R2 = 0.83), but this optimized phenotype is lost in heart failure, suggesting restoration of normal vortex ring dynamics as a new, and possibly important consideration for individualized heart failure treatment. Vortex ring volume was unrelated to early rapid filling (E-wave) velocity in patients and controls. Characteristics of vortex-wall interaction provide unique physiologic and mechanistic information about cardiac diastolic function that may be applied to guide the design and implantation of prosthetic valves, and have potential clinical utility as therapeutic targets for tailored medicine or measures of cardiac health.
Highlights
What determines the shape of the heart? Since the early days of the universe, fluid motion conforms to the laws of fluid dynamics
Lagrangian coherent structures (LCS) analysis differs from other vortex ring analyses in that it visualizes the outer borders of the vortex ring, not the vortex cores or local vorticity, and as such constitutes a fundamentally new approach to intracardiac vortex rings that may shed light on the problem of vortex-wall interaction
We studied 16 healthy controls and 23 heart failure patients with pathological dilatation of the left ventricle
Summary
Since the early days of the universe, fluid motion conforms to the laws of fluid dynamics These laws constitute a strong guiding force for biological evolution, and flow-function adaptations are plentiful in nature, for example the energy-saving vortex slalom of trout[1], the jet propulsion of squid[2], the maneuverability of jellyfish[3], and the occasional leisurely vortex ring play of dolphins[4]. Vortex rings in the heart provide a recurring fluid structure with a consistent amount of shear along its outer boundary, which could potentially constitute a hemodynamic framework, or “blueprint” for ventricular adaptation. For volume pumping in diastole the optimal ventricle is the smallest possible that will match endocardial expansion to the expanding boundary of the simultaneously generated vortex ring (Fig. 1). Our aim was to quantify the dynamics of the vortex ring boundary in relation to the left ventricular endocardium throughout diastole
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