Pulmonary hypertension (PH) is a degenerative disease characterized by progressively increased right ventricular (RV) afterload that leads to ultimate functional decline. Recent observational studies have documented a decrease in left ventricular (LV) torsion during ejection, with preserved LV ejection fraction (EF) in pediatric and adult PH patients. The objective of this study was to develop a computational model of the biventricular heart and use it to evaluate changes in LV torsion mechanics in response to mechanical, structural, and hemodynamic changes in the RV free wall. The heart model revealed that LV torsion and apical rotation were decreased when increasing RV mechanical rigidity and during re-orientation of RV myocardial fibers, both of which have been demonstrated in PH. Furthermore, structural changes to the RV appear to have a notable impact on RV EF, but little influence on LV EF. Finally, RV pressure overload exponentially increased LV myocardial stress. The computational results found in this study are consistent with clinical observations in adult and pediatric PH patients, which reveal a decrease in LV torsion with preserved LV EF. Furthermore, discovered causes of decreased LV torsion are consistent with RV structural adaptations seen in PH rodent studies, which might also explain suspected stress-induced changes in LV myocardial gene and protein expression.
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Structural and Biomechanical Adaptations of Right Ventricular Remodeling—In Pulmonary Arterial Hypertension—Reduces Left Ventricular Rotation During Contraction: A Computational Study
Vitaly O. Kheyfets,
Vitaly O. Kheyfets
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: vitaly.kheyfets@ucdenver.edu
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: vitaly.kheyfets@ucdenver.edu
1Corresponding author.
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Uyen Truong,
Uyen Truong
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Uyen.Truong@childrenscolorado.org
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Uyen.Truong@childrenscolorado.org
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Dunbar Ivy,
Dunbar Ivy
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Dunbar.Ivy@childrenscolorado.org
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Dunbar.Ivy@childrenscolorado.org
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Robin Shandas
Robin Shandas
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: robin.shandas@ucdenver.edu
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: robin.shandas@ucdenver.edu
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Vitaly O. Kheyfets
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: vitaly.kheyfets@ucdenver.edu
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: vitaly.kheyfets@ucdenver.edu
Uyen Truong
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Uyen.Truong@childrenscolorado.org
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Uyen.Truong@childrenscolorado.org
Dunbar Ivy
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Dunbar.Ivy@childrenscolorado.org
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: Dunbar.Ivy@childrenscolorado.org
Robin Shandas
University of Colorado Anschutz Medical Campus,
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: robin.shandas@ucdenver.edu
Children's Hospital Colorado,
Aurora, CO 80045
e-mail: robin.shandas@ucdenver.edu
1Corresponding author.
Manuscript received February 14, 2018; final manuscript received January 24, 2019; published online March 25, 2019. Assoc. Editor: Alison Marsden.
J Biomech Eng. May 2019, 141(5): 051002 (10 pages)
Published Online: March 25, 2019
Article history
Received:
February 14, 2018
Revised:
January 24, 2019
Citation
Kheyfets, V. O., Truong, U., Ivy, D., and Shandas, R. (March 25, 2019). "Structural and Biomechanical Adaptations of Right Ventricular Remodeling—In Pulmonary Arterial Hypertension—Reduces Left Ventricular Rotation During Contraction: A Computational Study." ASME. J Biomech Eng. May 2019; 141(5): 051002. https://doi.org/10.1115/1.4042682
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