Key result
Dilated ICM is linked to an ~84% higher LV vortex ring mixing fraction versus healthy volunteers.
Observational (n=13)
Vortex ring mixing in the human left ventricle does not correlate with vortex formation ratio, contrasting with water tank models, and is higher in patients with dilated ischemic cardiomyopathy.
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Higher mixing in dilated ischemic cardiomyopathy is hypothesis-generating; challenges vortex formation ratio surrogacy and leaves open prognostic or therapeutic relevance.
Background During rapid filling of the left ventricle, a vortex ring forms downstream from the mitral valve. Previous experiments in water tanks have shown that vortex ring formation is an optimized method for fluid transport. The rotation of the vortex ring leads to mixing of the inflowing blood and blood that was already in the ventricle (Figure 1). In water tanks, the amount of mixing decreases with increasing vortex formation ratio (VFR), a dimensionless parameter relating inflowing volume to the annulus diameter (Figure 2). However, the flow and anatomy of the left ventricle is more complex which may affect this established relationship. Therefore, we aimed to investigate if the relationship between VFR and mixing ratio demonstrated in water tank experiments holds in the human heart.
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Töger et al. (2013) conducted an observational in Dilated ischemic cardiomyopathy (n=13). Dilated ischemic cardiomyopathy vs. Healthy volunteers was evaluated on Mixing fraction (p=0.006). Patients with dilated ischemic cardiomyopathy had a significantly higher left ventricular vortex ring mixing fraction compared to healthy volunteers (35% vs. 19%, p=0.006).
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