title: Cardiac fluid dynamics anticipates heart adaptation.
abstract: Hemodynamic forces represent an epigenetic factor during heart development and are supposed to influence the pathology of the grown heart. Cardiac blood motion is characterized by a vortical dynamics, and it is common belief that the cardiac vortex has a role in disease progressions or regression. Here we provide a preliminary demonstration about the relevance of maladaptive intra-cardiac vortex dynamics in the geometrical adaptation of the dysfunctional heart. We employed an in vivo model of patients who present a stable normal heart function in virtue of the cardiac resynchronization therapy (CRT, bi-ventricular pace-maker) and who are expected to develop left ventricle remodeling if pace-maker was switched off. Intra-ventricular fluid dynamics is analyzed by echocardiography (Echo-PIV). Under normal conditions, the flow presents a longitudinal alignment of the intraventricular hemodynamic forces. When pacing is temporarily switched off, flow forces develop a misalignment hammering onto lateral walls, despite no other electro-mechanical change is noticed. Hemodynamic forces result to be the first event that evokes a physiological activity anticipating cardiac changes and could help in the prediction of longer term heart adaptations.
authors.affiliation: Department of Engineering and Architecture, University of Trieste, Trieste, Italy. Electronic address: giannip@dica.units.it.
authors.forename: Gianni
authors.initials: G
authors.lastname: Pedrizzetti
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
authors.forename: Alfonso R
authors.initials: AR
authors.lastname: Martiniello
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
authors.forename: Pio
authors.initials: P
authors.lastname: Caso
authors.affiliation: Cardiology Division, "G. d'Annunzio" University, Chieti, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tonti
mesh_terms: D000222:Adaptation, Physiological; D058406:Cardiac Resynchronization Therapy; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D008875:Middle Aged; D014463:Ultrasonography
keywords: Cardiac fluid dynamics; Cardiac remodeling; Hemodynamic forces; Vortex