The impact of contrast retention on thrombus formation risks in patients with atrial fibrillation: A numerical study
Lan Ge,
Yawei Xu,
Jun Li,
Yuan Li,
Yifeng Xi,
Xinyan Wang,
Jing Wang,
Yang Mu,
Hongsen Wang,
Xu Lu,
Jun Guo,
Zengsheng Chen,
Tao Chen,
Yundai Chen
Affiliations
Lan Ge
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Yawei Xu
Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
Jun Li
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Yuan Li
Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
Yifeng Xi
Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
Xinyan Wang
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Jing Wang
Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Yang Mu
Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Hongsen Wang
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Xu Lu
Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Jun Guo
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China
Zengsheng Chen
Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
Tao Chen
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China; Corresponding author. Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
Yundai Chen
Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing 100853, China; Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China; Corresponding author. Senior Department of Cardiology, the Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, China.
Background: Contrast retention (CR) is an important predictor of left atrial appendage thrombus (LAAT) and stroke in patients with non-valvular atrial fibrillation (AF). We sought to explore the underlying mechanisms of CR using computational fluid dynamic (CFD) simulations. Methods: A total of 12 patients with AF who underwent both cardiac computed tomography angiography (CTA) and transesophageal echocardiography (TEE) before left atrial appendage occlusion (LAAO) were included in the study. The patients were allocated into the CR group or non-CR group based on left atrial appendage (LAA) angiography. Patient-specific models were reconstructed to evaluate time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP). Additionally, the incidence of thrombosis was predicted using residence time (RT) at different time-points. Results: TAWSS was lower [median (Interquartile Range) 0.27 (0.19–0.47) vs 1.35 (0.92–1.79), p < 0.001] in LAA compared to left atrium. In contrast, RRT [1438 (409.70–13869) vs 2.23 (1.81–3.14), p < 0.001] and ECAP [122.70 (30.01–625.70) vs 0.19 (0.16–0.27), p < 0.001)] was higher in the LAA. The patients in the CR group had significantly higher RRT [(mean ± SD) 16274 ± 11797 vs 639.70 ± 595.20, p = 0.009] and ECAP [610.80 ± 365.30 vs 54.26 ± 54.38, p = 0.004] in the LAA compared to the non-CR group. Additionally, patients with CR had a wider range of thrombus-prone regions [0.44(0.27–0.66)% vs 0.05(0.03–0.27)%, p = 0.009] at the end of the 15th cardiac cycle. Conclusions: These findings suggest that CR might be an indicator of high-risk thrombus formation in the LAA. And CT-based CFD simulation may be a feasible substitute for the evaluation of LAA thrombotic risk in patients with AF, especially in patients with CR.
