Key result
Soft robotic extra-aortic counterpulsation lowers peak systolic pressure by ~6 mmHg in HFpEF simulations.
Why the study?
Heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options and heterogeneous etiology with no patient-specific therapies.
Does a simulated soft robotic extra-aortic counterpulsation strategy improve hemodynamics in a patient-specific model of HFpEF?
Does a simulated soft robotic extra-aortic counterpulsation strategy improve hemodynamics in a patient-specific model of HFpEF?
A patient-specific simulation framework demonstrates that soft robotic extra-aortic counterpulsation can reduce systolic pressure and stroke work while increasing cardiac output in HFpEF, though it may increase left atrial pressure.
Hypothesis-generating for soft robotic counterpulsation in HFpEF; requires in vivo validation before clinical consideration.
Despite being responsible for half of heart failure-related hospitalizations, heart failure with preserved ejection fraction (HFpEF) has limited evidence-based treatment options. Currently, a substantial clinical issue is that the disease etiology is very heterogenous with no patient-specific treatment options. Modeling can provide a framework for evaluating alternative treatment strategies. Counterpulsation strategies have the capacity to improve left ventricular diastolic filling by reducing systolic blood pressure and augmenting the diastolic pressure that drives coronary perfusion. Here, we propose a framework for testing the effectiveness of a soft robotic extra-aortic counterpulsation strategy using a patient-specific closed-loop hemodynamic lumped parameter model of a patient with HFpEF. The soft robotic device prototype was characterized experimentally in a physiologically pressurized (50-150 mmHg) soft silicone vessel and modeled as a combination of a pressure source and a capacitance. The patient-specific model was created using open-source software and validated against hemodynamics obtained by imaging of a patient (male, 87 years, HR = 60 bpm) with HFpEF. The impact of actuation timing on the flows and pressures as well as systolic function was analyzed. Good agreement between the patient-specific model and patient data was achieved with relative errors below 5% in all categories except for the diastolic aortic root pressure and the end systolic volume. The most effective reduction in systolic pressure compared to baseline (147 vs. 141 mmHg) was achieved when actuating 350 ms before systole. In this case, flow splits were preserved, and cardiac output was increased (5.17 vs. 5.34 L/min), resulting in increased blood flow to the coronaries (0.15 vs. 0.16 L/min). Both arterial elastance (0.77 vs. 0.74 mmHg/mL) and stroke work (11.8 vs. 10.6 kJ) were decreased compared to baseline, however left atrial pressure increased (11.2 vs. 11.5 mmHg). A higher actuation pressure is associated with higher systolic pressure reduction and slightly higher coronary flow. The soft robotic device prototype achieves reduced systolic pressure, reduced stroke work, slightly increased coronary perfusion, but increased left atrial pressures in HFpEF patients. In future work, the framework could include additional physiological mechanisms, a larger patient cohort with HFpEF, and testing against clinically used devices.
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Arduini et al. (2022) studied Heart failure with preserved ejection fraction (HFpEF) (n=1). Soft robotic extra-aortic counterpulsation vs. Baseline (actuator off) was evaluated on Peak systolic pressure (mmHg). In a patient-specific HFpEF simulation, a soft robotic extra-aortic counterpulsation device reduced peak systolic pressure from 147 to 141 mmHg and increased cardiac output from 5.17 to 5.34 L/min.
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