Hemodynamic Behavior Research Articles

Fractal-Driven Distortion of Resting State Functional Networks in fMRI: A Simulation Study

Fractals are self-similar and scale-invariant patterns found ubiquitously in nature. A lot of evidences implying fractal properties such as 1/f power spectrums have been also observed in resting state fMRI time series. To explain the fractal behavior in rs-fMRI, we have proposed the fractal-based model of resting state hemodynamic response function (rs-HRF) whose properties can be summarized by a fractal exponent. Here we show, through a simulation studies, that the fractal behavior of cerebral hemodynamics may cause significant distortion of network properties between neuronal activities and BOLD signals. We simulated neuronal population activities based on the stochastic neural field model from the Macaque brain network, and then obtained their corresponding BOLD signals by convolving them with the rs-HRF filter. The precision of centrality estimated in each node was deteriorated overall in three networks based on transfer entropy, mutual information, and Pearson correlation; particularly the distortion of transfer entropy was more sensitive to the standard deviation of fractal exponents. A node with high centrality was resilient to desynchronized fractal dynamics over all frequencies while a node with small centrality exhibited huge distortion of both wavelet correlation and centrality over low frequencies. This theoretical expectation indicates that the difference of fractal exponents between brain regions leads to discrepancy of statistical network properties, especially at nodes with small centrality, between neuronal activities and BOLD signals, and that the traditional definitions of resting state functional connectivity may not effectively reflect the dynamics of spontaneous neuronal activities.

J022055 MR based CFDによる脳動脈瘤WSS分布推定における血管形状抽出法および血液の非ニュートン性の影響

J022055 MR based CFDによる脳動脈瘤WSS分布推定における血管形状抽出法および血液の非ニュートン性の影響

Vascular lumen simulation and highly-sensitive nitric oxide detection using three-dimensional gelatin chip coupled to TiC/C nanowire arrays microelectrode

Reproducing the physiological environment of blood vessels for the in vitro investigation of endothelial cell functions is very challenging. Here, we describe a vascular-like structure based on a three-dimensional (3D) gelatin chip with good compatibility and permeability which is also cost-effective and easy to produce. The controllable lumen diameter and wall thickness enable close mimicking of blood vessels in vitro. The 3D gelatin matrix between adjacent lumens is capable of generating soluble-factor gradients inside, and diffusion of molecules with different molecular weights through the matrix is studied. The cultured human umbilical vein endothelial cells proliferate on the gelatin lumen linings to form a vascular lumen. The hemodynamic behavior including adhesion, alignment of endothelial cells (ECs) under shear stress and pulsatile stretch is studied. Furthermore, a microelectrode comprising TiC/C nanowire arrays is fabricated to detect nitric oxide with sub-nM detection limits and NO generation from the cultured ECs is monitored in real time. This vascular model reproduces the surrounding parenchyma of endothelial cells and mimics the hemodynamics inside blood vessels very well, thereby enabling potential direct investigation of hemodynamics, angiogenesis, and tumor metastasis in vitro.

Hemodynamic Simulation of Intra-stent Blood Flow

The stent has been a major breakthrough for the treatment of atherosclerotic vascular disease. The permanent vascular implant of a stent, however, changes the blood flow hemodynamics and may consequently affect the restenosis process. Computational Fluid Dynamics (CFD) has been widely used to analyze the hemodynamic behavior and wall shear stress (WSS) distribution in stented arteries. The objective of this study is to present a thorough comparison among various CFD models to investigate the effects of rheological properties and pulsatile flow on hemodynamic simulation of the intra-stent blood flow. Several CFD models were developed with various modeling setups – axisymmetric parallel ring vs. 3-D stented artery model, Newtonian vs. non-Newtonian flow, and steady-state vs. pulsatile flow. Simulated results show that the minimum WSS occurs at the recirculation zones located at the downstream or backside of each stent struts. The rheological effect on WWS is minor in the axisymmetric parallel ring model; however, it becomes slightly significant in the 3-D stented artery model, with Newtonian flow being a more conservative assumption. For given pulsatile waveforms, the steady-state and pulsatile flow resulted in fairly similar trends in the WSS distribution. Therefore, it is reasonable to simulate the intra-stent blood flow as a steady-state Newtonian flow, which could be beneficial in more complex simulations and drastically reduce the computational time. These findings will provide great insights for future stent design optimization to reduce restenosis.

Cardiovascular stent design and wall shear stress distribution in coronary stented arteries

The stent is a major breakthrough in the treatment of coronary artery diseases. The permanent vascular implant of a stent, however, changes the intra-stent blood flow haemodynamics. There is a growing consensus that the stent implant may change the artery wall shear stress distribution and hence trigger the restenosis process. Computational fluid dynamics (CFD) has been widely used to analyse haemodynamics in stented arteries. In this Letter, CFD models were developed to investigate the effects of stent design pattern and strut geometry, respectively, on the wall shear stress distribution in coronary stented arteries. Assessment of the potential restenosis risk was primarily based on the wall shear stress distribution. Results show that the stent design pattern alone does not have a significant impact on the stent haemodynamic behaviour. Wall shear stress is very sensitive to strut thickness, while varying the strut width or crown radius has very little effect. The proposed methodology and findings will provide great insight for future optimisation of stent design to reduce the risk of restenosis.

Spontaneous hemodynamic oscillations during human sleep and sleep stage transitions characterized with near-infrared spectroscopy.

Understanding the interaction between the nervous system and cerebral vasculature is fundamental to forming a complete picture of the neurophysiology of sleep and its role in maintaining physiological homeostasis. However, the intrinsic hemodynamics of slow-wave sleep (SWS) are still poorly known. We carried out 30 all-night sleep measurements with combined near-infrared spectroscopy (NIRS) and polysomnography to investigate spontaneous hemodynamic behavior in SWS compared to light (LS) and rapid-eye-movement sleep (REM). In particular, we concentrated on slow oscillations (3–150 mHz) in oxy- and deoxyhemoglobin concentrations, heart rate, arterial oxygen saturation, and the pulsation amplitude of the photoplethysmographic signal. We also analyzed the behavior of these variables during sleep stage transitions. The results indicate that slow spontaneous cortical and systemic hemodynamic activity is reduced in SWS compared to LS, REM, and wakefulness. This behavior may be explained by neuronal synchronization observed in electrophysiological studies of SWS and a reduction in autonomic nervous system activity. Also, sleep stage transitions are asymmetric, so that the SWS-to-LS and LS-to-REM transitions, which are associated with an increase in the complexity of cortical electrophysiological activity, are characterized by more dramatic hemodynamic changes than the opposite transitions. Thus, it appears that while the onset of SWS and termination of REM occur only as gradual processes over time, the termination of SWS and onset of REM may be triggered more abruptly by a particular physiological event or condition. The results suggest that scalp hemodynamic changes should be considered alongside cortical hemodynamic changes in NIRS sleep studies to assess the interaction between the autonomic and central nervous systems.

Coronary perfusion: Impact of flow dynamics and geometric design of 2 different aortic prostheses of similar size

Aortic valve replacement leads to improvement of coronary flow but not to complete normalization. Coronary hypoperfusion contributes to higher left ventricular mass persistence, arrhythmias, congestive heart failure and sudden death. This prospective study compares 2 similarly sized aortic prostheses (mechanical and porcine) regarding coronary flow and hemodynamic performances in patients who underwent surgery for pure aortic stenosis. Sixty patients having undergone aortic valve replacement for pure aortic stenosis with Medtronic Mosaic Ultra bioprosthesis 21 mm (n = 30) or St Jude Regent mechanical valve 19 mm (n = 30) were evaluated preoperatively and 12 months postoperatively comparing the coronary flow and the hemodynamic behavior. Echocardiography and cardiac positron emission tomography were performed at rest and during exercise or adenosine maximal stimulation, respectively. The St Jude Regent mechanical valve, compared with the Medtronic Mosaic Ultra bioprosthesis, had reduced coronary flow reserve (2.1 ± 0.3 vs 2.3 ± 0.2; P = .003), less favorable systolic/diastolic time ratio (0.87 ± 0.02 vs 0.78 ± 0.03; P < .001), and higher mean transprosthetic gradient (46 ± 11 vs 38 ± 9; P = .003) during exercise. Multivariate analysis of impaired coronary reserve related indexed effective orifice area less than 0.65 cm/m(2) (risk ratio [RR], 1.9; 95% confidence intervals [CI], 1.5-2.8; P < .001), mechanical valve (RR, 2.5; 95% CI, 1.7-3.3; P < .001), and systolic/diastolic time ratio greater than 0.75 (RR, 2.6; 95% CI, 1.8-3.8; P < .001), as well as high transprosthetic gradient (RR, 1.7; 95% CI, 1.3-2.4; P < .001) ) during exercise with coronary reserve less than 2.2. Improvement of coronary flow and reserve was more evident for bioprostheses than for mechanical valves. The bioprostheses demonstrated superior hemodynamics during exercise, which may have some impact on exercise capability during normal daily life.

Identification and Control for Automated Regulation of Hemodynamic Variables During Hemodialysis

This paper proposes a novel model-based control methodology for a computer-controlled hemodialysis system, designed to maintain the hemodynamic stability of end-stage renal failure patients undergoing fluid removal during hemodialysis. The first objective of this paper is to introduce a linear parameter varying system to model the hemodynamic response of patients during hemodialysis. Ultrafiltration rate (UFR) and dialysate sodium concentration (DSC) are imposed as the inputs, and the model computes the relative blood volume (RBV), percentage change in heart rate ( ∆HR), and systolic blood pressure (SBP) during the course of hemodialysis. The model parameters were estimated based on data collected from 12 patients undergoing 4 profiled hemodialysis sessions. The modeling results demonstrated that the proposed model could be useful for estimating the individual patient's hemodynamic behavior during hemodialysis. Based on the model, the second objective is to implement a computer-controlled hemodialysis system for the regulation of RBV and HR during hemodialysis while maintaining SBP within stable range. The proposed controller is based on a model predictive control approach utilizing pre-defined constraints on the control inputs (UFR and DSC) as well as the output (SBP). The designed control system was experimentally verified on four patients. The results demonstrated that the proposed computer-controlled hemodialysis system regulated the RBV and HR of the patients according to individual reference profiles with an average mean square error of 0.24% and 2.6%, respectively, and thus can be potentially useful for ensuring the stability of patients undergoing hemodialysis by avoiding sudden changes in hemodynamic variables.

Normal Doppler velocimetry of renal vasculature in Persian cats

Renal diseases are common in older cats. Decreased renal blood flow may be the first sign of dysfunction and can be evaluated by Doppler ultrasound. But previous studies suggest that the resistive index (RI) has a low sensitivity for detecting renal disease. Doppler waveforms of renal and intrarenal arteries demonstrate decreased blood flow before there are any changes in the RI. The purpose of this study was to evaluate the normal Doppler flowmetrics parameters of renal arteries (RAs), interlobar arteries (IAs) and abdominal aorta (AO) in adult healthy, Persian cats. Twenty-five Persian cats (13 females and 12 males with mean age of 30 months and an age range 12-60 months) with normal clinical examinations and biochemical tests and normal systemic blood pressure were given B-mode ultrasonographies in order to exclude all nephropathies, including polycystic kidney disease. All measurements were performed on both kidneys. Both kidneys (n=50) were examined by color mapping of the renal vasculature. Pulsed Doppler was used to examine both RAs, the IAs at cranial, middle and caudal sites, and the AO. The RI was calculated for all of the vessels. Early systolic acceleration (ESA) of RA and IA was obtained with Doppler spectral analysis. Furthermore, the ratio indices between RA/AO, and IA/RA velocities were calculated. The mean values of peak systolic velocity (PSV) and the diameter for AO were 53.17±13.46 cm/s and 0.38±0.08 cm, respectively. The mean RA diameter for all 50 kidneys was 0.15±0.02 cm. Considering the velocimetric values in both RAs, the mean PSV and RI that were obtained were 41.17±9.40 cm/s and 0.54±0.07. The RA had a mean ESA of 1.12±1.14 m/s(2) and the calculated upper limit of the reference value was 3.40 m/s(2). The mean renal-aortic ratio was 0.828±0.296. The IA showed PSV and RI values of 32.16±9.33 cm/s and 0.52±0.06, respectively. The mean ESA of all IAs was 0.73±0.61 m/s(2). The calculated upper limit of the reference value was 2.0m/s(2). The mean renal-interlobar artery ratio was 1.45±0.57. The RI values obtained in this study were similar to values reported in the literature. Some conditions that lead to a decrease in compliance and to an increase in vascular resistance can affect the Doppler spectral waveforms without changes in RI. To our knowledge, there are no studies that were directed toward to the normal ESA values of the renal vasculature in Persian cats. This study introduced a new ratio between the PSV of the RA and the IA. This index was developed based on the well-known effects of Doppler on the detection of stenosis, regardless of the cause. Further studies are necessary to verify the hemodynamic behavior of this index under pathological conditions in cats as well as the effect of aging, nephropathies and systemic pressure on Doppler velocimetric parameters.

Prevalence, Associations and Risk Factors for Orthostatic Hypotension in Medical, Surgical and Trauma Inpatients: An Observational Cohort Study

ABSTRACT Background: Orthostatic hypotension (OH) is prevalent in hospitalized elderly patients. It is defined as a reduction in systolic blood pressure (SBP) of at least 20 mmHg and/or diastolic blood pressure (DBP) of at least 10 mmHg within 3 minutes of standing from a lying position. This observational cohort study describes the prevalence, association with symptoms, and risk factors for OH in medical, surgical, and trauma wards in a tertiary hospital and the differences in hemodynamic behaviors between OH-positive (OHP) and OH-negative (OHN) patients. Methods: All 76 patients who were hemodynamically stable and able to stand from 4 hospital wards had noninvasive supine and orthostatic blood pressures (BPs) and pulse rates (PRs) measured over 4 days. Results: Mean age of the 76 patients included in the study was 67.8 ± 19.6 years. Overall prevalence of OH was 23.7% (95% CI: 14.7%-34.8%) with 21.2% (95% CI: 9.0%-38.9%) in medical, 31.8% (95% CI: 13.9%-54.9%) in surgical, and 19.0% (95% CI: 5.4%-41.9%) ...

Mathematical multi-scale model of the cardiovascular system including mitral valve dynamics. Application to ischemic mitral insufficiency

BackgroundValve dysfunction is a common cardiovascular pathology. Despite significant clinical research, there is little formal study of how valve dysfunction affects overall circulatory dynamics. Validated models would offer the ability to better understand these dynamics and thus optimize diagnosis, as well as surgical and other interventions.MethodsA cardiovascular and circulatory system (CVS) model has already been validated in silico, and in several animal model studies. It accounts for valve dynamics using Heaviside functions to simulate a physiologically accurate "open on pressure, close on flow" law. However, it does not consider real-time valve opening dynamics and therefore does not fully capture valve dysfunction, particularly where the dysfunction involves partial closure. This research describes an updated version of this previous closed-loop CVS model that includes the progressive opening of the mitral valve, and is defined over the full cardiac cycle.ResultsSimulations of the cardiovascular system with healthy mitral valve are performed, and, the global hemodynamic behaviour is studied compared with previously validated results. The error between resulting pressure-volume (PV) loops of already validated CVS model and the new CVS model that includes the progressive opening of the mitral valve is assessed and remains within typical measurement error and variability. Simulations of ischemic mitral insufficiency are also performed. Pressure-Volume loops, transmitral flow evolution and mitral valve aperture area evolution follow reported measurements in shape, amplitude and trends.ConclusionsThe resulting cardiovascular system model including mitral valve dynamics provides a foundation for clinical validation and the study of valvular dysfunction in vivo. The overall models and results could readily be generalised to other cardiac valves.

IN VITROHEMODYNAMIC STUDY ON THE STENOTIC RIGHT CORONARY ARTERY USING EXPERIMENTAL AND NUMERICAL ANALYSIS

To investigate the hemodynamic and hemorheological features related to circulatory diseases, in vitro experiments are carried out using a micro-particle image velocimetry (μ-PIV) technique. Numerical simulations using a commercial computational fluid dynamics (CFD) code are also performed to compare with the experimental results. Five different non-Newtonian blood models and a Newtonian water model are employed to investigate the blood flow characteristics through a stenotic right coronary artery (RCA). The in vitro model is made of two-dimensional (2D) polydimethylsiloxane (PDMS) channel based on the clinical angiogram of the RCA with stenotic lesion. The hemodynamic and hemorheologic behaviors in the control volume near the stenotic lesion are evaluated by velocity profiles. The predicted and measured velocity profiles at the center of the channel have a reasonable agreement.

Hemodynamic Studies of Intracranial Dural Arteriovenous Fistulas Using Arterial Spin-Labeling MR Imaging

Arterial spin-labeling (ASL) magnetic resonance imaging (MRI) enables non-invasive acquisition of the brain perfusion information in cerebrovascular disease. We investigated hemodynamic changes in intracranial dural arteriovenous fistulas (DAVFs) using ASL-MRI. ASL-MRI by a Q2TIPS sequence on a 3.0-Tesla MRI was performed for three patients with Cognard's IIa+b type of DAVFs before and after treatment. Perfusion images obtained by ASL-MRI (ASL images) before treatment were visually compared with those by single-photon emission computed tomography images (SPECT images). Increasing rates of temporal changes of regional perfusion values in ASL images (ASL values) before and after treatment were also calculated. In all three patients, ASL images before treatment demonstrated high perfusion in regions around the shunting areas, where normal or low perfusion were detected on SPECT images; thus, ASL images might have demonstrated the abundant arterial shunting flow via the fistulas. On days eight to 20 after treatment, ASL values around the shunt areas remained the same or decreased, and those in the regions other than the shunt areas increased in all three patients. This might have been due to a combination of the following: a decrease in shunt flow volume, an amelioration of venous congestion, and a sustained an upward shift in the autoregulation of the brain perfusion pressure. All regional ASL values decreased on days 112 and 120 after treatment in two patients, which possibly reflects a reduction in the upward shift in autoregulation. ASL-MRI might be useful for identifying the hemodynamic behavior of DAVFs before and after treatment.

Multiscale models of the hybrid palliation for hypoplastic left heart syndrome

A less-invasive procedure that combines interventional stent placement in the ductus arteriosus and surgical banding of the branch pulmonary arteries has been recently introduced in the treatment of the hypoplastic left heart syndrome (HLHS). The hemodynamic behaviour of this hybrid approach has not been examined before in a mathematical model. In this study, a mathematical model of the hybrid procedure for HLHS is described, applying a multiscale approach that couples 3D models of the area of the surgical operation and lumped parameter models of the remaining circulation. The effects of various degrees of pulmonary banding and different stent sizes inserted in the ductus arteriosus on pulmonary–systemic flow ratio, cardiac output and oxygen delivery were assessed. Computational results suggest that balanced systemic and pulmonary blood flow and optimal systemic oxygen delivery are sensitive to the degree of pulmonary arterial banding and not to the size of the ductal stent.

First-principles modeling of fluid and solute exchange in the human during normal and hemodialysis conditions

A first-principles computer model of fluid and solute exchange under both physiological and hemodialysis condition is presented. The whole system has been modeled and simulated under the MODELICA integrated environment, which uses a hierarchical modeling strategy. The model performance has been analyzed by simulation in the light of existing hypothesis and physiological data used here for validation purposes. The results obtained provide a physiological interpretative key to patient’s hemodynamic behavior during hemodialysis.

Cerebral Blood Flow Modeling in Primate Cortex

We report new results on blood flow modeling over large volumes of cortical gray matter of primate brain. We propose a network method for computing the blood flow, which handles realistic boundary conditions, complex vessel shapes, and complex nonlinear blood rheology. From a detailed comparison of the available models for the blood flow rheology and the phase separation effect, we are able to derive important new results on the impact of network structure on blood pressure, hematocrit, and flow distributions. Our findings show that the network geometry (vessel shapes and diameters), the boundary conditions associated with the arterial inputs and venous outputs, and the effective viscosity of the blood are essential components in the flow distribution. In contrast, we show that the phase separation effect has a minor function in the global microvascular hemodynamic behavior. The behavior of the pressure, hematocrit, and blood flow distributions within the network are described through the depth of the primate cerebral cortex and are discussed.

Sickle Cell Biomechanics

As the predominant cell type in blood, red blood cells (RBCs) and their biomechanical properties largely determine the rheological and hemodynamic behavior of blood in normal and disease states. In sickle cell disease (SCD), mechanically fragile, poorly deformable RBCs contribute to impaired blood flow and other pathophysiological aspects of the disease. The major underlying cause of this altered blood rheology and hemodynamics is hemoglobin S (HbS) polymerization and RBC sickling under deoxygenated conditions. This review discusses the characterization of the biomechanical properties of sickle RBCs and sickle blood as well as their implications toward a better understanding of the pathophysiology of the disease.

Hemodynamic Factors Affecting the Fate of Valvular Bioprosthesis

Ce qui est simple est faux mais ce qui ne l’est pas est inutilisable. — —Paul Valery Since their introduction in 1969, valvular bioprostheses (ie, glutaraldehyde-processed animal valves)1 have experienced a surprising increase in use as a result of progress in valve processing2 and growing patient desire for nonthrombogenic valve surgery.3 However, the persistent risk of structural valve deterioration, particularly in the young population, remains a major concern. The 2 main causes of valve failure are valve degeneration and calcification. Among the numerous factors influencing the fate of a bioprosthesis, hemodynamic factors are addressed more rarely than biological factors. In this issue of Circulation , Flameng and colleagues4 add important information to the understanding of how hemodynamic factors play a role in structural valve failure. To do so, they revive an old debate on the practical significance of prosthesis-patient mismatch. First introduced by Rahimtoola in 19785 and having fed numerous discussions for many years, this paradigm led to the simple conclusion that, in aortic valve replacement, the larger the valve is, the better the hemodynamics and therefore the clinical result are. Accordingly, surgeons were advised to carefully measure the aortic valve orifice and to select a valve by fitting the aortic valve orifice in correlation …

A Comparative Study Between the Laryngoscope and Lighted Stylet in Tracheal Intubation

Approaching the airways with a laryngoscope can cause different types of injuries. The objective of the present study was to determine whether lighted stylet tracheal intubation can be a less traumatic alternative for patients when compared to direct laryngoscopy. Ninety-eight patients between 16 and 88 years and physical status ASA I and II participated in the present study. Patients were separated into two groups: Group L, 54 patients who were intubated with a laryngoscope, and Group E, 44 patients who were intubated with a lighted stylet. The number of attempts, time until intubation, variation in blood pressure and heart rate, and postoperative sore throat (odynophagia), dysphagia, and hoarseness were evaluated. Demographic data and hemodynamic parameters were similar in both groups. Statistically significant differences in the incidence of sore throat and dysphagia were not observed. Hoarseness was the only data that showed statistically significant differences, being more predominant in Group E (p = 0.05). The intubation techniques are similar regarding the hemodynamic behavior in both groups. However, hoarseness was more common in group with lighted stylet.

In-vitro study on haemodiluted blood flow in a sinusoidal microstenosis

In-vitro experiments were carried out to investigate the haemodynamic and haemorheological behaviours of haemodiluted blood flow through a microstenosis using a micro-particle image velocimetry (PIV) technique. The micro-PIV system employed in this study consisted of a two-head neodymium:yttrium-aluminium-garnet (Nd:YAG) laser, a cooled charge-coupled device camera, and a delay generator. To simulate blood flow in a stenosed vascular vessel, a polydimethylsiloxane (PDMS) microchannel with a sinusoidal throat of 80 per cent severity was employed. The width and depth of the microchannel were 100 microm and 50 microm, respectively. To compare the flow characteristics in the microstenosis, the same experiments were repeated in a straight microchannel under the same flow conditions. Using a syringe pump, human blood with 5 per cent haematocrit was supplied into the microstenosis channel. The flow characteristics and transport of blood cells through the microstenosis were investigated with various flowrates. The mean velocity fields were nearly symmetric with respect to the channel centreline. In the contraction section, the oncoming blood flow was accelerated rapidly, and the maximum velocity at the throat was almost 4.99 times faster than that of the straight microchannel without stenosis. In the diffusion section, the blood cells show rolling, deformation, twisting, and tumbling motion due to the flow-choking characteristics at the stenotic region. The results from this study will provide useful basic data for comparison with those obtained by clinical researchers.