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Assessment of wall elasticity variations on intraluminal haemodynamics in descending aortic dissections using a
Paula A Rudenick1, Bart H Bijnens2, Patrick Segers3
1University Hospital and Research Institute Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain.
Insights
Aortic wall elasticity significantly impacts blood flow dynamics in descending aortic dissection (DAD). Increased elasticity lowers systolic pressure and alters flow patterns, highlighting its clinical importance.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Medical Physics
Background:
- Descending aortic dissection (DAD) presents significant morbidity and mortality.
- Aortic wall stiffness is frequently altered in DAD patients, but its impact on outcomes remains unclear.
- Understanding the influence of aortic wall elasticity on intraluminal hemodynamics in DAD is crucial.
Purpose of the Study:
- To investigate the effect of aortic wall elasticity on intraluminal pressures and blood flow patterns in descending aortic dissection (DAD).
- To develop and validate a lumped-parameter model for simulating hemodynamics in DAD with varying wall elasticity.
Main Methods:
- A lumped-parameter model was created using experimental data from a pulsatile hydraulic circuit.
- The model was validated against 8 distinct clinical scenarios.
- Intraluminal pressures and flows were analyzed across a spectrum of aortic wall elasticity values.
Main Results:
- Increasing aortic wall elasticity from rigid to physiological values reduced systolic pressure by up to 33% and increased diastolic pressure by up to 63%.
- A significant decrease in pressure wave amplitude (up to 86%) was observed with increased elasticity.
- Multidirectional intraluminal flows and altered flow patterns, resembling a side-chamber vessel, were noted with greater elasticity.
Conclusions:
- Aortic wall elasticity is a critical determinant of intraluminal pressures and flow dynamics in DAD.
- Considering wall elasticity is essential for accurate clinical assessment and computational modeling of DAD.
- These findings underscore the importance of biomechanical properties in understanding DAD pathophysiology and patient outcomes.
Abstract:
Descending aortic dissection (DAD) is associated with high morbidity and mortality rates. Aortic wall stiffness is a variable often altered in DAD patients and potentially involved in long-term outcome. However, its relevance is still mostly unknown. To gain more detailed knowledge of how wall elasticity (compliance) might influence intraluminal haemodynamics in DAD, a lumped-parameter model was developed based on experimental data from a pulsatile hydraulic circuit and validated for 8 clinical scenarios. Next, the variations of intraluminal pressures and flows were assessed as a function of wall elasticity. In comparison with the most rigid-wall case, an increase in elasticity to physiological values was associated with a decrease in systolic and increase in diastolic pressures of up to 33% and 63% respectively, with a subsequent decrease in the pressure wave amplitude of up to 86%. Moreover, it was related to an increase in multidirectional intraluminal flows and transition of behaviour as 2 parallel vessels towards a vessel with a side-chamber. The model supports the extremely important role of wall elasticity as determinant of intraluminal pressures and flow patterns for DAD, and thus, the relevance of considering it during clinical assessment and computational modelling of the disease.
