Biology subjects

Duran, E.

Publications and source records attributed to Duran, E..

6 recordsLinked to original sources

bioRxiv2025

Effect of Wall Motion Sampling on CFD-Derived Left Atrial Flow Metrics

The temporal resolution of medical imaging sequences used to drive patient-specific computational fluid dynamics (CFD) simulations remains limited, typically providing 10-20 frames per cardiac cycle. Therefore, temporal interpolation to reconstruct left atrial (LA) wall motion and boundary conditions is required, but its impact on hemodynamic predictions has not been systematically characterized. To investigate this, we constructed high-temporal-resolution reference wall-motion data using electromechanical (EM) simulations on five patient-specific atrial geometries with a history of atrial fibrillation. We then generated temporally downsampled datasets to emulate clinical frame rates (5, 10, 20, and 40 frames per cycle) and performed CFD simulations to isolate the effects of temporal undersampling on hemodynamic metrics. The focus was placed on kinetic energy, KE, and residence time, TR, particularly in the left atrial appendage (LAA), where thrombosis is most likely to occur. We employed an immersed boundary method to prescribe the wall motion and computed blood TR through a passive scalar transport equation. Results indicate that while global LA hemodynamic indices were marginally affected by the frame rate (errors < 9%), LAA metrics were more sensitive with errors up to 31% compared to reference values. The results based on 20 and 40 frames per cycle yielded favorable agreement with reference results, while 5-and 10-frame reconstructions showed larger, though not systematically biased, deviations from the reference. Importantly, patient ranking by blood-stasis indices was largely preserved. The analysis suggests that patientspecific LA reconstructions derived from dynamic CT imaging provide a reliable basis for estimating LAA blood-stasis indices. Higher frame rates ([≥] 20 per cycle) offer improved quantitative accuracy, while lower temporal resolutions may remain informative for patient stratification purposes, where relative ranking is more relevant than absolute accuracy.

bioengineering↗

bioRxiv2024

Hemodynamics Affects Factor XI/XII Anticoagulation Efficacy in Patient-Specific Left Atrial Models

Atrial fibrillation (AF) disrupts the circulation of blood through the left atrium (LA), and may result in relative stasis in the left atrial appendage (LAA), increasing thromboembolic risk. Anticoagulant agents can lower this risk, but currently used agents target the common pathway central to the coagulation cascade, increasing bleeding risk. Anticoagulants such as factor XI/XII inhibitors target the initial phase of the intrinsic pathway, with a significantly lower associated bleeding risk. However, these agents efficacy in preventing thrombosis in patient-specific flow conditions is not fully understood. We hypothesized that patient-specific flow patterns in the LA and LAA not only influence the risk of thrombosis but also the effectiveness of anticoagulation agents. We simulated blood flow and the intrinsic coagulation pathway in patient-specific LA anatomies with and without factor XI/XII inhibition to test this hypothesis. We considered thirteen patients in sinus rhythm and AF, several of whom had an LAA clot or a history of transient ischemic attacks. We used computational fluid dynamics based on 4D CT imaging and a detailed 32-species coagulation system to run 247 simulations for 13 patients, systematically sweeping over a wide range of factor XI/XII inhibition levels. Implementing a novel multi-fidelity coagulation modeling approach accelerated computations by two orders of magnitude, enabling the large number of simulations performed. Our simulations provide spatiotemporally resolved maps of thrombin concentration throughout the LA, showing it peaks inside the LAA. Coagulation metrics based on peak LAA thrombin dynamics suggested patients could be classified as non-coagulating, moderately and severely coagulating cases. Severely coagulating cases had significantly slower flow and higher residence time than moderately coagulating patients inside the LAA, requiring stronger factor XI/XII inhibition to blunt thrombin growth. The methodology outlined in this study has the potential to enable personalized assessments of coagulation risk and tailor anticoagulation therapy based on medical imaging.

bioengineering↗

bioRxiv2024

Patient-specific multi-physics simulations of fibrotic changes in left atrial tissue mechanics impact on hemodynamics

Stroke is a leading cause of death and disability worldwide. Atrial myopathy, including fibrosis, is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association are poorly understood. Fibrosis modifies myocardial structure, impairing electrical propagation and tissue biomechanics, and creating stagnant flow regions where clots could form. Fibrosis can be mapped non-invasively using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, fibrosis maps are not currently incorporated into stroke risk calculations or computational electro-mechano-fluidic models. We present multi-physics simulations of left atrial (LA) myocardial motion and hemodynamics using patient-specific anatomies and fibrotic maps from LGE-MRI. We modify tissue stiffness and active tension generation in fibrotic regions and investigate how these changes affect LA flow for different fibrotic burdens. We find that fibrotic regions and, to a lesser extent, non-fibrotic regions experience reduced myocardial strain, resulting in decreased LA emptying fraction consistent with clinical observations. Both fibrotic tissue stiffening and hypocontractility independently reduce LA function, but together, these two alterations cause more pronounced effects than either one alone. Fibrosis significantly alters flow patterns throughout the atrial chamber, and particularly, the filling and emptying jets of the left atrial appendage (LAA). The effects of fibrosis in LA flow are largely captured by the concomitant changes in LA emptying fraction except inside the LAA, where a multi-factorial behavior is observed. This work illustrates how high-fidelity, multi-physics models can be used to study thrombogenesis mechanisms in patient-specific anatomies, shedding light onto the links between atrial fibrosis and ischemic stroke. Key pointsO_LILeft atrial (LA) fibrosis is associated with arrhythmogenesis and increased risk of ischemic stroke; its extent and pattern can be quantified on a patient-specific basis using late gadolinium enhancement magnetic resonance imaging. C_LIO_LICurrent stroke risk prediction tools have limited personalization, and their accuracy could be improved by incorporating patient-specific information like fibrotic maps and hemodynamic patterns. C_LIO_LIWe present the first electro-mechano-fluidic multi-physics computational simulations of LA flow, including fibrosis and anatomies from medical imaging. C_LIO_LIMechanical changes in fibrotic tissue impair global LA motion, decreasing LA and left atrial appendage (LAA) emptying fractions, especially in subjects with higher fibrosis burdens. C_LIO_LIFibrotic-mediated LA motion impairment alters LA and LAA flow near the endocardium and the whole cavity, ultimately leading to more stagnant blood regions in the LAA. C_LI

bioengineering↗

bioRxiv2023

Pulmonary vein flow split effects in patient-specific simulations of left atrial flow

Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of TIAs. Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke.

bioengineering↗

bioRxiv2021

Non-Newtonian Patient-specific Simulations of Left Atrial Hemodynamics

The lack of mechanically effective contraction of the left atrium (LA) during atrial fibrillation (AF) disturbs blood flow, increasing the risk of thrombosis and ischemic stroke. Thrombosis is most likely in the left atrial appendage (LAA), a small narrow sac where blood is prone to stagnate. Slow flow promotes the formation of erythrocyte aggregates in the LAA, also known as rouleaux, causing viscosity gradients that are usually disregarded in patient-specific simulations. To evaluate these non-Newtonian effects, we built atrial models derived from 4D computed tomography scans of patients and carried out computational fluid dynamics simulations using the Carreau-Yasuda constitutive relation. We examined six patients, three of whom had AF and LAA thrombosis or a history of transient ischemic attacks (TIAs). We modeled the effects of hematocrit and rouleaux formation kinetics by varying the parameterization of the Carreau-Yasuda relation and modulating non-Newtonian viscosity changes based on residence time. Comparing non-Newtonian and Newtonian simulations indicates that slow flow in the LAA increases blood viscosity, altering secondary swirling flows and intensifying blood stasis. While some of these effects can be subtle when examined using instantaneous metrics like shear rate or kinetic energy, they are manifested in the blood residence time, which accumulates over multiple heartbeats. Our data also reveal that LAA blood stasis worsens when hematocrit increases, offering a potential new mechanism for the clinically reported correlation between hematocrit and stroke incidence. In summary, we submit that hematocrit-dependent non-Newtonian blood rheology should be considered in calculating patient-specific blood stasis indices by computational fluid dynamics.

bioengineering↗

bioRxiv2019

The gap junction blocker mefloquine impairs sleep-dependent declarative memory consolidation in humans

During sleep, the time-compressed replay of engrams acquired during preceding wakefulness drives memory consolidation. We demonstrate in healthy humans that direct electrical coupling between neurons via gap junctions, i.e., electrical synapses, contributes to this beneficial effect of sleep. Twenty male participants learned a declarative word-pair task and a procedural finger sequence tapping task before receiving the antimalarial mefloquine that is known to block electrical synapses. Retrieval was tested after a retention interval of approximately 20.5 hours that included nocturnal sleep. As predicted, mefloquine given before sleep impaired the retention of declarative memory. In contrast, this effect was absent in control groups, which stayed awake or received mefloquine after sleep. Irrespective of sleep or administration time, mefloquine enhanced retention performance on the procedural memory control task. We conclude that sleep-dependent processes relying on electrical neuronal coupling enable hippocampus-dependent declarative memory consolidation, presumably via time-compressed hippocampal replay of memory traces within sharp-wave/ripple complexes. The recruitment of this understudied form of neuronal information transfer may be necessary to achieve fast-paced memory reprocessing during sleep. Considering that drugs targeting neurochemical synapses have recently fallen short of substantially advancing the treatment of memory impairments in Alzheimers disease, schizophrenia or during normal aging, unraveling the contribution of gap junctions to sleep-dependent declarative memory formation can be expected to open new therapeutic avenues. Significance statementSleep supports the strengthening and transformation of memory content via the active replay of previously encoded engrams. Surprisingly, blocking neurochemical synaptic transmission does not impair this function of sleep. Here we demonstrate that the direct electrical coupling between neurons via electrical synapses (gap junctions) is essential for the sleep-dependent formation of declarative memory, i.e., memory for episodes and facts. These findings are in line with the assumption that electrical synapses enable time-compressed neuronal firing patterns that emerge during sleep and drive declarative memory consolidation. Electrical synapses have so far not been linked to higher-order brain functions in humans; their contribution to sleep-dependent memory processing may provide a novel target for sleep-related clinical interventions.

neuroscience↗