Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health
Background: Left ventricular assist device (LVAD) speed optimization and right heart failure post device implantation are major clinical challenges. Right heart catheterization (RHC)–guided speed titration studies are often performed to optimize LVAD settings, which are unknown and must be optimized...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133424001393 |
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| author | Mustafa M. Ahmed Holly Grant Jasmine Martinez Joshua Thomas Mohammad Al-Ani Alex Parker Juan Vilaro Juan Aranda Venkat Keshav Chivukula |
| author_facet | Mustafa M. Ahmed Holly Grant Jasmine Martinez Joshua Thomas Mohammad Al-Ani Alex Parker Juan Vilaro Juan Aranda Venkat Keshav Chivukula |
| author_sort | Mustafa M. Ahmed |
| collection | DOAJ |
| description | Background: Left ventricular assist device (LVAD) speed optimization and right heart failure post device implantation are major clinical challenges. Right heart catheterization (RHC)–guided speed titration studies are often performed to optimize LVAD settings, which are unknown and must be optimized for each patient. A virtual hemodynamic model (VHM) that can be tailored to each patient may provide useful guidance and reduce repeated studies. Methods: We conducted a retrospective analysis on 16 patients implanted with HeartMate 3 (HM3) who underwent RHC speed titration study as an outpatient. A custom-designed VHM was built and customized for each patient based on RHC measurements. VHM predictions were obtained for multiple scenarios: (1) population–based pulmonary system parameters, (2) patient-specific systemic and pulmonary resistance and capacitance parameters, (3) clinical optimization–based patient-specific mean arterial pressure (MAP), and (4) several MAP targets ranging from 70 to 90 mm Hg. Results: All patients who underwent RHC speed titration had a clinician–guided speed increase, with a median increase of 300 revolutions per minute (rpm). Using each patient’s customized VHM, virtual speed optimization demonstrated congruence with clinician-guided optimization, with a median predicted speed increase of 321 rpm. After virtual optimization, there was a decrease in the pulmonary artery pressure for 13 patients (81.25%), indicating a predicted improvement in pulmonary parameters. Conclusions: For our cohort of 16 patients, there was an overall congruence between clinician–guided and patient–specific VHM-predicted optimal LVAD speeds. The magnitude of speed change varied depending on individual patient targets. This may provide individualized speed titration goals and lessen the need for repeat invasive studies. |
| format | Article |
| id | doaj-art-df7ffdae4c064a06a50ddf487a5ca9ca |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-df7ffdae4c064a06a50ddf487a5ca9ca2025-02-09T05:01:58ZengElsevierJHLT Open2950-13342025-02-017100190Patient–specific hemodynamic modeling to optimize LVAD speed and right heart healthMustafa M. Ahmed0Holly Grant1Jasmine Martinez2Joshua Thomas3Mohammad Al-Ani4Alex Parker5Juan Vilaro6Juan Aranda7Venkat Keshav Chivukula8Division of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, Florida; Corresponding author: Mustafa M. Ahmed, Division of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FL.Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaDivision of Cardiovascular Medicine Heart Failure, University of Florida, Gainesville, FloridaBiomedical Engineering and Science, Florida Institute of Technology, Melbourne, FloridaBackground: Left ventricular assist device (LVAD) speed optimization and right heart failure post device implantation are major clinical challenges. Right heart catheterization (RHC)–guided speed titration studies are often performed to optimize LVAD settings, which are unknown and must be optimized for each patient. A virtual hemodynamic model (VHM) that can be tailored to each patient may provide useful guidance and reduce repeated studies. Methods: We conducted a retrospective analysis on 16 patients implanted with HeartMate 3 (HM3) who underwent RHC speed titration study as an outpatient. A custom-designed VHM was built and customized for each patient based on RHC measurements. VHM predictions were obtained for multiple scenarios: (1) population–based pulmonary system parameters, (2) patient-specific systemic and pulmonary resistance and capacitance parameters, (3) clinical optimization–based patient-specific mean arterial pressure (MAP), and (4) several MAP targets ranging from 70 to 90 mm Hg. Results: All patients who underwent RHC speed titration had a clinician–guided speed increase, with a median increase of 300 revolutions per minute (rpm). Using each patient’s customized VHM, virtual speed optimization demonstrated congruence with clinician-guided optimization, with a median predicted speed increase of 321 rpm. After virtual optimization, there was a decrease in the pulmonary artery pressure for 13 patients (81.25%), indicating a predicted improvement in pulmonary parameters. Conclusions: For our cohort of 16 patients, there was an overall congruence between clinician–guided and patient–specific VHM-predicted optimal LVAD speeds. The magnitude of speed change varied depending on individual patient targets. This may provide individualized speed titration goals and lessen the need for repeat invasive studies.http://www.sciencedirect.com/science/article/pii/S2950133424001393LVAD speed optimizationright heart failurevirtual patient modelhemodynamicsright heart catheterization |
| spellingShingle | Mustafa M. Ahmed Holly Grant Jasmine Martinez Joshua Thomas Mohammad Al-Ani Alex Parker Juan Vilaro Juan Aranda Venkat Keshav Chivukula Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health JHLT Open LVAD speed optimization right heart failure virtual patient model hemodynamics right heart catheterization |
| title | Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health |
| title_full | Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health |
| title_fullStr | Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health |
| title_full_unstemmed | Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health |
| title_short | Patient–specific hemodynamic modeling to optimize LVAD speed and right heart health |
| title_sort | patient specific hemodynamic modeling to optimize lvad speed and right heart health |
| topic | LVAD speed optimization right heart failure virtual patient model hemodynamics right heart catheterization |
| url | http://www.sciencedirect.com/science/article/pii/S2950133424001393 |
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