Key result
Computational modeling of atrial fibrillation demonstrated that severe mitral and aortic regurgitation strongly impaired hemodynamics, reducing cardiac output by 22.5% and 20.5% respectively compared to lone AF.
Why the study?
Does the presence and severity of specific left-sided valvular diseases alter hemodynamics during atrial fibrillation compared to lone atrial fibrillation?
Does the presence and severity of specific left-sided valvular diseases alter hemodynamics during atrial fibrillation compared to lone atrial fibrillation?
Answers are grounded in this paper and cite their sources.
Computational modeling reveals that regurgitant valvular lesions and mitral stenosis exert more profound hemodynamic derangements during atrial fibrillation than aortic stenosis, suggesting these patients may benefit most from rhythm control.
BACKGROUND: Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. METHODS: We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i) irregular, uncorrelated and faster heart rate; (ii) atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation), by varying-through the valve opening angle-the valve area. RESULTS: Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. DISCUSSION: The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive treatment of AF. Present findings, if clinically confirmed, hold the potential to impact AF management (e.g., adoption of a rhythm control strategy) in specific valvular diseases.
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Scarsoglio et al. (2016) studied Atrial fibrillation with left-sided valvular diseases. Left-sided valvular diseases (aortic stenosis, mitral stenosis, aortic regurgitation, mitral regurgitation) vs. Lone atrial fibrillation was evaluated on Hemodynamic parameters (cardiac output, pulmonary vein pressure, left atrial pressure). Computational modeling of atrial fibrillation demonstrated that severe mitral and aortic regurgitation strongly impaired hemodynamics, reducing cardiac output by 22.5% and 20.5% respectively compared to lone AF.
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