Scientific article
OA Policy
English

The Impact of Left Ventricular Performance and Afterload on the Evaluation of Aortic Valve Stenosis: A 1D Mathematical Modeling Approach

Published inBioengineering, vol. 10, no. 4, 425
Publication date2023-03-28
First online date2023-03-28
Abstract

The transaortic valvular pressure gradient (TPG) plays a central role in decision-making for patients suffering from severe aortic stenosis. However, the flow-dependence nature of the TPG makes the diagnosis of aortic stenosis challenging since the markers of cardiac performance and afterload present high physiological interdependence and thus, isolated effects cannot be measured directly in vivo. We used a validated 1D mathematical model of the cardiovascular system, coupled with a model of aortic stenosis, to assess and quantify the independent effect of the main left ventricular performance parameters (end-systolic (Ees) and end-diastolic (Eed) elastance) and principal afterload indices (total vascular resistance (TVR) and total arterial compliance (TAC)) on the TPG for different levels of aortic stenosis. In patients with critical aortic stenosis (aortic valve area (AVA) ≤ 0.6 cm2), a 10% increase of Eed from the baseline value was associated with the most important effect on the TPG (-5.6 ± 0.5 mmHg, p < 0.001), followed by a similar increase of Ees (3.4 ± 0.1 mmHg, p < 0.001), in TAC (1.3 ±0.2 mmHg, p < 0.001) and TVR (-0.7 ± 0.04 mmHg, p < 0.001). The interdependence of the TPG left ventricular performance and afterload indices become stronger with increased aortic stenosis severity. Disregarding their effects may lead to an underestimation of stenosis severity and a potential delay in therapeutic intervention. Therefore, a comprehensive evaluation of left ventricular function and afterload should be performed, especially in cases of diagnostic challenge, since it may offer the pathophysiological mechanism that explains the mismatch between aortic severity and the TPG.

Keywords
  • Aortic valve stenosis
  • Left ventricular systolic and diastolic function
  • Total arterial compliance
  • Total vascular resistance
  • Transaortic valvular pressure gradient
Citation (ISO format)
ÇELIKBUDAK ORHON, Cemre et al. The Impact of Left Ventricular Performance and Afterload on the Evaluation of Aortic Valve Stenosis: A 1D Mathematical Modeling Approach. In: Bioengineering, 2023, vol. 10, n° 4, p. 425. doi: 10.3390/bioengineering10040425
Main files (1)
Article (Published version)
Identifiers
Additional URL for this publicationhttps://www.mdpi.com/2306-5354/10/4/425
Journal ISSN2306-5354
72views
52downloads

Technical informations

Creation29/07/2024 13:59:50
First validation29/07/2024 14:04:14
Update29/07/2024 14:04:14
Status update29/07/2024 14:04:14
Last indexation01/11/2024 10:36:38
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack