The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (2024)

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Bioengineering

Volume 11

Issue 6

10.3390/bioengineering11060603

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Article

by

Wolfgang Anton Goetz

The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (6)Wolfgang Anton Goetz

1,†The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (7),

Jiang Yao

2,†,

Michael Brener

3,

Rishi Puri

4,

Martin Swaans

5The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (12),

Simon Schopka

1,

Sigrid Wiesner

1,

Marcus Creutzenberg

The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (15)Marcus Creutzenberg

1,

Horst Sievert

The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (16)Horst Sievert

Horst Sievert is the Director of the CardioVascular Center Frankfurt and of the Department of and of[...]

Read more

6 and

Ghassan S. Kassab

The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (17)Ghassan S. Kassab

7,*

1

Cardiothoracic Surgery, University Hospital Regensburg, 93053 Regensburg, Germany

2

Dassault Systèmes, Johnston, RI 02919, USA

3

Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10027, USA

4

Cleveland Clinic, Cleveland, OH 44195, USA

5

St. Antonius Ziekenhuis, 3435 Nieuwegein, The Netherlands

6

CardioVascular Center, 60389 Frankfurt, Germany

7

California Medical Innovations Institute, San Diego, CA 92121, USA

*

Author to whom correspondence should be addressed.

These authors contributed equally to this work.

Bioengineering 2024, 11(6), 603; https://doi.org/10.3390/bioengineering11060603

Submission received: 12 April 2024 / Revised: 4 June 2024 / Accepted: 10 June 2024 / Published: 12 June 2024

(This article belongs to the Special Issue Computational Models in Cardiovascular System)

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Abstract

During systole, longitudinal shortening of the left ventricle (LV) displaces the aortic root toward the apex of the heart and stretches the ascending aorta (AA). An in silico study (Living Left Heart Human Model, Dassault Systèmes Simulia Corporation) demonstrated that stiffening of the AA affects myocardial stress and LV strain patterns. With AA stiffening, myofiber stress increased overall in the LV, with particularly high-stress areas at the septum. The most pronounced reduction in strain was noted along the septal longitudinal region. The pressure–volume loops showed that AA stiffening caused a deterioration in LV function, with increased end-systolic volume, reduced systolic LV pressure, decreased stroke volume and effective stroke work, but elevated end-diastolic pressure. An increase in myofiber contractility indicated that stroke volume and effective stroke work could be recovered, with an increase in LV end-systolic pressure and a decrease in end-diastolic pressure. Longitudinal and radial strains remained reduced, but circumferential strains increased over baseline, compensating for lost longitudinal LV function. Myofiber stress increased overall, with the most dramatic increase in the septal region and the LV apex. We demonstrate a direct mechanical pathophysiologic link between stiff AA and reduced longitudinal left ventricular strain which are common in patients with HFpEF.

Keywords: in silico; finite element method; computational simulation; aortic stiffness; atrioventricular plane displacement; ventricular strain; ventricular function; HFpEF

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MDPI and ACS Style

Goetz, W.A.; Yao, J.; Brener, M.; Puri, R.; Swaans, M.; Schopka, S.; Wiesner, S.; Creutzenberg, M.; Sievert, H.; Kassab, G.S. The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model. Bioengineering 2024, 11, 603. https://doi.org/10.3390/bioengineering11060603

AMA Style

Goetz WA, Yao J, Brener M, Puri R, Swaans M, Schopka S, Wiesner S, Creutzenberg M, Sievert H, Kassab GS. The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model. Bioengineering. 2024; 11(6):603. https://doi.org/10.3390/bioengineering11060603

Chicago/Turabian Style

Goetz, Wolfgang Anton, Jiang Yao, Michael Brener, Rishi Puri, Martin Swaans, Simon Schopka, Sigrid Wiesner, Marcus Creutzenberg, Horst Sievert, and Ghassan S. Kassab. 2024. "The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model" Bioengineering 11, no. 6: 603. https://doi.org/10.3390/bioengineering11060603

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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MDPI and ACS Style

Goetz, W.A.; Yao, J.; Brener, M.; Puri, R.; Swaans, M.; Schopka, S.; Wiesner, S.; Creutzenberg, M.; Sievert, H.; Kassab, G.S. The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model. Bioengineering 2024, 11, 603. https://doi.org/10.3390/bioengineering11060603

AMA Style

Goetz WA, Yao J, Brener M, Puri R, Swaans M, Schopka S, Wiesner S, Creutzenberg M, Sievert H, Kassab GS. The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model. Bioengineering. 2024; 11(6):603. https://doi.org/10.3390/bioengineering11060603

Chicago/Turabian Style

Goetz, Wolfgang Anton, Jiang Yao, Michael Brener, Rishi Puri, Martin Swaans, Simon Schopka, Sigrid Wiesner, Marcus Creutzenberg, Horst Sievert, and Ghassan S. Kassab. 2024. "The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model" Bioengineering 11, no. 6: 603. https://doi.org/10.3390/bioengineering11060603

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (18)

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The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model (2024)

FAQs

The Stiffness of the Ascending Aorta Has a Direct Impact on Left Ventricular Function: An In Silico Model? ›

An in silico study (Living Left Heart Human Model, Dassault Systèmes Simulia Corporation) demonstrated that stiffening of the AA affects myocardial stress and LV strain patterns. With AA stiffening, myofiber stress increased overall in the LV, with particularly high-stress areas at the septum.

What is between the left ventricle and the ascending aorta? ›

The aortic valve is one of four heart valves and is the final one encountered by oxygenated blood as it leaves the heart. It is also called aortic semilunar due to its semilunar shape. It is between the left ventricle and the aorta to ensure that oxygen-rich blood does not flow back into the left ventricle.

What does the ascending aorta do? ›

The ascending aorta is the first part of the aorta, which is the largest blood vessel in your body. It comes out of your heart and pumps blood through the aortic arch and into the descending aorta. The aorta plays an essential role as the main “pipe” supplying blood to your entire body.

What is the ascending aorta pericardium? ›

The ascending aorta, contained in the middle mediastinum with the heart and the pulmonary trunk, means the first part of the aorta, which arise from the aortic orifice. It moves upward, exiting the fibrous pericardium and entering the superior mediastinum, where it becomes the aortic arch.

What is the function of the left ventricle? ›

The primary function of the left ventricle is to provide sufficient cardiac output to maintain blood flow to other organ systems. Cardiac output results from systolic contraction of the left ventricle, which can be influenced by preload, afterload, and contractility.

How do you treat a mildly dilated ascending aorta? ›

The most common type of surgery is open abdominal or chest repair, where the doctor opens up your chest or abdomen, depending on where the problem is, removes the bulge in your aorta, and replaces it with a fabric tube called a graft.

Which is worse, ascending or descending aortic aneurysm? ›

An ascending aortic aneurysm is especially serious. A rupture in this part of the body can be life-threatening.

What is the life expectancy after ascending aorta surgery? ›

About 85% of people who have elective thoracic aortic aneurysm repair survive for at least five years.

What size of ascending aorta requires surgery? ›

An ascending aortic aneurysm greater than 5.5 centimeters requires surgery for all patients. In the presence of bicuspid aortic valve, the criteria for surgery is five centimeters. In the presence of genetic abnormalities, such as Marfan, an aneurysm of 4.5 centimeters would indicate surgery.

What should you not do with an ascending aortic aneurysm? ›

If you have a thoracic aortic aneurysm, your health care provider may tell you not to do heavy lifting and some vigorous physical activities. Such activities can increase blood pressure, putting additional pressure on your aneurysm.

Is a 4 cm ascending aorta bad? ›

An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size. Aortic aneurysms less than 4 centimeters in size have a low chance of bursting, but an aneurysm more than 5. 5 centimeters in diameter has an increasing chance of rupturing in the next year.

What is the normal size of the ascending aorta by age? ›

The upper normal limit for ascending aorta can be calculated with the formula D(mm) = 31 + 0.16*age and for descending aorta with the formula D(mm) = 21 + 0.16*age. Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m.

How do you treat left ventricular function? ›

Heart failure (HF) with abnormal left ventricular (LV) ejection fraction should be identified and treated. Treat hypertension with diuretics, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers. Treat myocardial ischemia with nitrates and β-blockers. Treat volume overload and HF with diuretics.

What happens if the left ventricle is not working properly? ›

Left-sided heart failure occurs when the heart loses its ability to pump blood. This prevents organs from receiving enough oxygen. The condition can lead to complications that include right-sided heart failure and organ damage.

How serious is left ventricular hypertrophy? ›

Once LVH is developed, it puts the patient at significant risk of developing myocardial ischemia and infarction, heart failure, dysrhythmias, or even sudden death. The risk of cardiovascular disease and adverse major cardiac events increases with increasing LVM and decreases with the regression of LVH.

What is present between left ventricle and aorta? ›

aortic valve: located between the left ventricle and the aorta.

What is the vessel between the left ventricle and the aorta? ›

The mitral valve separates the left atrium and left ventricle. The pulmonary valve separates the right ventricle and the pulmonary artery. The aortic valve separates the left ventricle and aorta.

What leads from the left ventricle to the aorta? ›

The mitral valve connects your left atrium and left ventricle. The aortic valve connects your left ventricle and aorta (large artery that carries blood away from your heart to the rest of your body).

Is a 4.3 cm ascending aortic an aneurysm? ›

An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size. Aortic aneurysms less than 4 centimeters in size have a low chance of bursting, but an aneurysm more than 5. 5 centimeters in diameter has an increasing chance of rupturing in the next year.

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