Francesco Fedele

Università degli Studi di Torino, Torino, Piedmont, Italy

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Publications (283)866.36 Total impact

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    ABSTRACT: There is an established tradition of cardiovascular simulation tools, but the application of this kind of technology in the e-Learning arena is a novel approach. This paper presents an e-Learning environment aimed at teaching the interaction of cardiovascular and lung systems to health-care professionals. Heart-lung interaction must be analyzed while assisting patients with severe respiratory problems or with heart failure in intensive care unit. Such patients can be assisted by mechanical ventilatory assistance or by thoracic artificial lung."In silico" cardiovascular simulator was experimented during a training course given to graduate students of the School of Specialization in Cardiology at 'Sapienza' University in Rome.The training course employed CARDIOSIM(C): a numerical simulator of the cardiovascular system. Such simulator is able to reproduce pathophysiological conditions of patients affected by cardiovascular and/or lung disease. In order to study the interactions among the cardiovascular system, the natural lung and the thoracic artificial lung (TAL), the numerical model of this device has been implemented. After having reproduced a patient's pathological condition, TAL model was applied in parallel and hybrid model during the training course.Results obtained during the training course show that TAL parallel assistance reduces right ventricular end systolic (diastolic) volume, but increases left ventricular end systolic (diastolic) volume. The percentage changes induced by hybrid TAL assistance on haemodynamic variables are lower than those produced by parallel assistance. Only in the case of the mean pulmonary arterial pressure, there is a percentage reduction which, in case of hybrid assistance, is greater (about 40%) than in case of parallel assistance (20-30%). At the end of the course, a short questionnaire was submitted to students in order to assess the quality of the course. The feedback obtained was positive, showing good results with respect to the degree of students' learning and the ease of use of the software simulator.
    BioMedical Engineering OnLine 12/2014; 13(172). · 1.75 Impact Factor
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    ABSTRACT: Although increased pulmonary pressure is caused by changes in the pulmonary vasculature, prognosis in idiopathic pulmonary arterial hypertension (IPAH) is strongly associated with right ventricular (RV) function. The aim of this study was to describe the best RV adaptive remodeling pattern to increased afterload in IPAH.Methods In 60 consecutive IPAH patients RV morphological and functional features were evaluated by echocardiography and magnetic resonance. To address the question of the best RV adaptation pattern, we divided the study population into two groups by the median value of RV mass/volume (M/V) ratio (0.46), as this parameter allows the distinction between RV eccentric (≤0.46) and concentric hypertrophy (>0.46). The two groups were compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT).ResultsDespite similar pulmonary vascular resistance (PVR), mean pulmonary pressure and compliance, patients with eccentric hypertrophy had advanced WHO class, worse 6MWT, hemodynamics, RV remodeling and systolic function parameters compared to patients with concentric hypertrophy. The latter group had higher RV to pulmonary arterial coupling (VA coupling) compared to the former (1.24±0.26 vs 0.83±0.33; p=0.0001), indicating higher RV efficiency. A significant correlation was found between PVR and VA coupling (r=-0.55, r2=0.31; p=0.0001), with those patients with RV M/V ratio >0.46 at the higher part of the scatterplot, confirming a more adequate RV function.Conclusions Concentric hypertrophy might represent a more favorable RV adaptive remodeling pattern to increased afterload in IPAH, as it is associated with a more suitable systolic function and mechanical efficiency.
    The Journal of Heart and Lung Transplantation 11/2014; · 5.61 Impact Factor
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    ABSTRACT: The aim of this work is the realization of an "Artificial Arm Pressure" permitting to reproduce oscillometric waveforms able to replace expensive clinical trials for validating and testing a Holter blood pressure device. To perform this new device a hybrid simulator (numerical/hydraulic) of the left cardiocirculatory network was implemented in order to reproduce in different fixed times different oscillometric blood arterial pressure waveforms. The “Artificial Arm Pressure" consists of a numerical simulator of the left cardiovascular system, in which it is possible to fix the left atrial pressure (preload) and the left arterial pressure (afterload) and of an hydraulic system consisting of a D/A converter, a servo-amplifier, a D/C motor and a “gear pump”. The numerical simulator allows to vary the heart rate, the time duration of systole/diastole and the morphology of the ventricular/aortic pressure waveform in order to reproduce different physiopathology cardiovascular diseases. The hybrid simulator can be used to program the type and amount of steps you want to perform in 24/48-h to check the correct operation/calibration of the Holter blood pressure device. A Holter programmed to acquire data every 15 min has been tested for 24-h on the "Artificial Arm Pressure". The comparison between simulated and measured data shown that for systolic (diastolic) blood pressure the percentage of variation was in average about ±2.6% (±2.9). In the case of HR, the percentage of variation was in average about ±2.0%.
    Journal of Advances in Biomedical Engineering and Technology. 10/2014; 1(1):27-34.
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    ABSTRACT: Abstract Background: Over the last two decades the development and analysis of a number of registries have enhanced the knowledge of the epidemiology, presentation, natural history, and pathophysiology of pulmonary arterial hypertension (PAH). The understanding of the effectiveness of available treatments has also been greatly improved. However, most of the registries present some methodological issues, such as differences in the classification of patients and presence of confounding factors or missing values, that can impact on the generalizability of the results. Objective: The aim of this study is to present the Italian Pulmonary Hypertension Network (iPHnet) Project, a database used to collect health records on patients with PAH that can also be used for research purposes to retrieve ad hoc information. Results: iPHnet presents various characteristics such as facilitated access, data sharing and interoperability, update, patient's anonymity and data integrity. The system also enables the creation of patients' electronic health records (EHR), the exportation and personalization of data and the possibility to design CRF and collect information usable in clinical trials. In addition, it is possible to analyze the information present in the registry, creating graphs or other immediately-available charts to evaluate the trends of a specific data and perform therapeutic or clinic adjustments. Treatment of data in the iPHnet database complies with FDA requirements, backup and disaster recovery policies and patients' privacy. Conclusions: iPHnet is a flexible tool that integrates the capabilities of an EHR for PAH patients with those of a PAH registry. The ability to retrieve relevant information - although with all the limitations of any registry-based analysis - and to create appropriate CRF will facilitate the development of prospective and retrospective trials aimed at providing new 'real-life' evidence on PAH.
    Current Medical Research and Opinion 09/2014; · 2.37 Impact Factor
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    ABSTRACT: Right ventricle compromise affects survival of patients with HIV-associated pulmonary artery hypertension (PAH).
    AIDS (London, England) 08/2014; · 6.56 Impact Factor
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    ABSTRACT: Journal of Vascular Diagnostics Dovepress submit your manuscript | www.dovepress.com Dovepress 59 S t u Dy P r o t o c o l open access to scientific and medical research open Access Full text Article http://dx.doi.org/10.2147/JVD.S60526 using the MEM-net program to report on mapping the EchocolorDoppler assessment for chronic cerebro spinal venous insufficiency Introduction: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by multiple
    journal of vascular diagnostics. 07/2014;
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    ABSTRACT: Background The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. Methods and results A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. Conclusions The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
    International Journal of Cardiology. 06/2014; 174(2):360–367.
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    ABSTRACT: Limited data are available on prognostic indicators for HIV patients presenting with ACS.
    Thrombosis Research 06/2014; · 2.43 Impact Factor
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    ABSTRACT: Background Right ventricular (RV) dyssynchrony has been described in pulmonary arterial hypertension (PAH), but no evidence is available on its morphological determinants and its effect on systolic function. Aim of this study was to evaluate the morphological determinants of RV dyssynchrony by echocardiographic and cardiac magnetic resonance imaging and its effect on systolic function. Methods In 60 consecutive idiopathic PAH (IPAH) patients with narrow QRS, RV dyssynchrony was evaluated by 2D speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal RV segments (RV-SD4). Patients were grouped by the median value of RV-SD4 (19 ms) and compared for RV remodeling and systolic function parameters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT). Results Despite similar pulmonary vascular resistance and mean pulmonary arterial pressure, patients with RV-SD4 >19 ms had advanced WHO class, worse 6MWT, RV hemodynamics, RV remodeling and systolic function parameters compared to patients ≤19 ms. The morphological determinants of RV dyssynchrony resulted RV end-diastolic area, LV diastolic-eccentricity index and RV mass-volume ratio (r= 0.69; r2= 0.47; p<0.0001). Finally we found a significant inverse correlation between RV mid-basal segments post-systolic shortening time and cardiac index (r=-0.64, r2=0.41, p=0.001), accounting for the significant correlation between RV-SD4 and CI (r=0.57, r2=0.32, p=0.003). Conclusions In IPAH with narrow QRS, RV dyssynchrony is associated with RV dilatation and eccentric hypertrophy pattern, suggesting a role of segmental wall stress heterogeneity as the major determinant of mechanical delay. Post-systolic shortening, as inefficient contraction, contributes to pump dysfunction.
    The Journal of Heart and Lung Transplantation 06/2014; · 5.61 Impact Factor
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    ABSTRACT: The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
    International journal of cardiology 04/2014; · 6.18 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2014; 33(4):S148. · 5.61 Impact Factor
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    ABSTRACT: Objectives The aim of this study was to determine whether clinical presentation and type of cell death in acute myocarditis might contribute to cardiac magnetic resonance (CMR) sensitivity. Background Growing evidence indicates CMR is the reference noninvasive tool for the diagnosis of acute myocarditis. However, factors affecting CMR sensitivity are still unclear. Methods We retrospectively evaluated 57 consecutive patients with a diagnosis of acute myocarditis made on the basis of clinical history (≤3 months) and endomyocardial biopsy evidence of lymphocytic infiltrates (≥14 infiltrating leukocytes/mm2 at immunohistochemistry) in association with damage of the adjacent myocytes and absence or minimal evidence of myocardial fibrosis. CMR acquisition protocol included T2-weighted (edema), early (hyperemia), and late (fibrosis/necrosis) gadolinium enhancement sequences. Presence of ≥2 CMR criteria denoted myocarditis. Type of cell death was evaluated by using in situ ligation with hairpin probes. Results Three clinical myocarditis patterns were recognized: infarct-like (pattern 1, n = 21), cardiomyopathic (pattern 2, n = 21), and arrhythmic (pattern 3, n = 15). Tissue edema was observed in 81% of pattern 1, 28% of pattern 2, and 27% of pattern 3. Early enhancement was evident in 71% of pattern 1, 67% of pattern 2, and 40% of pattern 3. Late gadolinium enhancement was documented in 71% of pattern 1, 57% of pattern 2, and 47% of pattern 3. CMR sensitivity was significantly higher in pattern 1 (80%) compared with pattern 2 (57%) and pattern 3 (40%) (p < 0.05). Cell necrosis was the prevalent mechanism of death in pattern 1 compared with pattern 2 (p < 0.001) and pattern 3 (p < 0.05), whereas apoptosis prevailed in pattern 2 (p < 0.001 vs. pattern 1 and p < 0.05 vs. pattern 3). Conclusions In acute myocarditis, CMR sensitivity is high for infarct-like, low for cardiomyopathic, and very low for arrhythmic clinical presentation; it correlates with the extent of cell necrosis–promoting expansion of interstitial space.
    JACC. Cardiovascular imaging 03/2014; · 14.29 Impact Factor
  • International journal of cardiology 01/2014; · 6.18 Impact Factor
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    ABSTRACT: Background Several studies have shown that unnecessary right ventricular pacing has detrimental effects. Objective We evaluated whether minimization of ventricular pacing improves clinical outcomes compared with standard dual chamber pacing (DDD) in patients referred for pacemaker or implantable cardioverter defibrillator (ICD) replacement. Methods In a randomized single-blinded multi-center international trial we compared DDD pacing with Managed Ventricular Pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no CRT upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete AV block. Follow-up was for 2 years. Primary endpoint was cardiovascular hospitalization. Analysis was intention-to-treat using Kaplan-Meier estimates and log-rank test. Results We randomized 605 patients (556 pacemaker, 49 ICD), aged 75±11 years, 365 (60%) males, at 7.7±3.3 years from first device implantation, to MVP (N=299) or DDD (N=306). We found no significant differences in the primary endpoint cardiovascular hospitalization (MVP: 16.3% vs. DDD:14.5%, p=0.72) and the secondary endpoints persistent AF (MVP: 15.4% vs. DDD=11.2%, p=0.08), permanent AF (MVP:4.1% vs. DDD: 3.1%, p=0.44) and composite of death and cardiovascular hospitalization (MVP: 23.9% vs. DDD: 20.2% p=0.48). MVP reduced right ventricular pacing (medians: 5% vs. 86%, Wilcoxon p<0.0001) compared to DDD. Conclusions In pacemaker and ICD replacement patients with clinically well tolerated long term exposure to more than 40% pacing in the ventricle, a strategy to minimize ventricular pacing is not superior in reducing incidence of cardiovascular hospitalizations compared to standard DDD pacing.
    Heart Rhythm. 01/2014;
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    ABSTRACT: Staging of heart failure represents a major issue in clinical practice. In this setting, MOGE(S) classification has been designed to be similar to TNM used in oncology. Nevertheless, MOGE(S) nosology is far away from the key elements of TNM classification, as well as simplicity and clinical applicability. In fact, MOGE(S) acronym refers to morphofunctional characteristics (M), organ involvement (O), genetic or familial inheritance pattern (G), etiological informations (E) and functional status (S). Recently, a new TNM-like classification for heart failure has been proposed. This classification, named HLM, refers to the heart damage, raising from impaired systolic or diastolic function without structural injury to bi-ventricular dysfunction (H), different stages of lung involvement (L) and malfunction of peripheral organs, like kidney, liver and brain (M). HLM classification is inspired to key elements of TNM staging: simplicity, clinical usefulness, efficacy for planning the therapeutic strategy and skill to identify patient prognosis. In conclusion, HLM classification seems to be easily applicable in the real world and to be valuable in order to balance economic resources to the clinical complexity of patients.
    Journal of the American College of Cardiology 01/2014; · 15.34 Impact Factor
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    ABSTRACT: Abstract Background: Chronic cerebrospinal venous insufficiency (CCSVI) is a new vascular pattern recently associated with multiple sclerosis (MS). Aim of this study was to assess the presence of CCSVI parameter and vascular abnormalities, in the Internal Jugular Veins (IJVs) and/or Vertebral Veins (VVs) in sitting and supine posture, in MS patients versus first degree relatives with MS familiarity and general population. Methods: We investigated in 272 MS patients, in 118 first degree relative of MS patients and in 97 healthy controls, morphologic and hemodynamic venous abnormalities of the IJVs and/or VVs by means of high resolution B-mode ultrasounds. Diagnostic five parameters recently approved in a consensus conference were calculated in both supine and sitting positions. Results: CCSVI showed positiveness for at least 2 criteria in 179/272 (83%) MS patients, in 24/118 (20%) first degree relatives and in 24/97 (25%) of healthy controls. MS patients showed a statistically significant higher incidence of reflux in the intracranial veins (parameter two) versus first degree relatives and controls (51% vs. 16% and 12%, respectively, p<0.001) and also higher number of IJVs hemodynamic but not morphologically significant stenosis (62% vs. 41% and 37%, p<0.01). The other parameters did not show statistically significant differences among the three groups except for a greater incidence of venous abnormalities in MS patients (septa, membranes or intraluminal defects); no correlation was found between the severity of CCSVI and MS clinical form. Conclusions: CCSVI is a new cerebrospinal venous system disease recently associated with MS, however these venous abnormalities are also present, even less frequently, in first degree relatives and in healthy controls. When analyzing the influence of hemodynamic stenosis on cerebral flow drainage, only intracranial veins reflux was highly statistically significant. CCSVI transversely crosses the entire general population, but the largest number of intraluminal defects of the veins observed in MS patients (septa, membranes, immobile or hypoplastic valves) could lead to stenosis or obstruction in the IJVs and other veins, contributing to the development or exacerbation of multiple sclerosis. Future larger studies are needed to assess the definite correlation between these venous abnormalities and multiple sclerosis and also to assess their role in the general population
    European Heart Journal – Cardiovascular Imaging 12/2013; 14(Suppl.2):P1245. · 2.65 Impact Factor
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    ABSTRACT: The aim of this work was to compare the prevalence of right ventricle involvement in a population of patients with myocardial infarction as detected by cardiac magnetic resonance (CMR), clinical presentation, electrocardiographic (ECG) and echocardiographic criteria. A total of 97 consecutive patients, admitted to our institution for acute myocardial infarction, underwent a standard CMR examination within 5 days after the event. The presence of myocardial oedema and late enhancement of the right ventricle were compared to infarct location (anterior vs. inferior), clinical data, ECG, echocardiography results and other CMR findings. The results were analysed statistically using the Student's t test for independent samples and the K statistic. Among the 97 patients included in the study, a diagnosis of right ventricular infarction was established in 12, 14 and 24 cases on the basis of the clinical data, the ECG and echocardiography, respectively. CMR demonstrated myocardial oedema and late enhancement of the right ventricle in 48 and 32 cases, respectively. The right ventricle was involved in 46 % of patients with inferior myocardial infarction (15/32) and in 30 % with anterior myocardial infarction (17/56), correlating to a worsening of both right and left ventricular performance (p = 0.001-0.05). The right ventricle is frequently involved in myocardial infarction, correlating to a worse functional impairment of both ventricles and a worse prognosis. This finding, which is often underestimated by traditional cardiological tests, is well revealed by CMR, with potential clinical and therapeutic impact.
    La radiologia medica 12/2013; · 1.37 Impact Factor
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    ABSTRACT: The cardio-renal syndrome plays a critical role in acute heart failure (HF). Levosimendan, an inodilator drug, has a positive but controversial effect on kidney. Our aim was to evaluate its effects on both renal and systemic haemodynamic parameters as well as on renal function, explaining the possible mechanisms involved. Patients with acute decompensated HF, moderate renal impairment, wedge pressure >20 mmHg and EF <40% were eligible. Twenty-one patients were randomized to infusion of levosimendan or placebo, on top of standard therapy. Systemic haemodynamic parameters (wedge and cardiac output) were evaluated at baseline and at 8, 16, 24, 48, and 72 h. An intravascular renal artery Doppler exam was performed at baseline, after levosimendan bolus, and 1 h thereafter. Renal blood flow, glomerular filtration rate (GFR), cystatin C, blood urea nitrogen (BUN), urinary output, sodium excretion, and plasma sodium were measured. The effect of levosimendan was beneficial and significantly different from placebo on several renal and cardiac parameters. Specifically, the levosimendan and placebo group exhibited significantly different changes over time in GFR (P = 0.037), renal blood flow (P = 0.037), and renal artery diameter (P = 0.033), with ensuing improvements in serum levels of BUN (P = 0.014), creatinine (P = 0.042), and cystatin C (P = 0.05). Concomitantly, levosimendan provided a significant increase in urine output up to 72 h (P = 0.02). These beneficial results on renal parameters were accompanied by similarly significant and favourable changes in cardiac index (P = 0.029) and PCWP (P < 0.001). Levosimendan, in acute decompensated HF, has an immediate renoprotective effect, mediated by an increase in renal blood flow, due to a selective renal arterial and venous vasodilating action. NCT00527059.
    European Journal of Heart Failure 12/2013; · 5.25 Impact Factor
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    ABSTRACT: To analyze the presence of chronic cerebrospinal venous insufficiency parameter and vascular abnormalities, in the internal jugular veins (IJVs) and/or vertebral veins in sitting and supine posture, in patients with Meniere's disease compared to healthy general population. A prospective study on 32 patients affected by definite Ménière was performed from February 2012 to January 2013. All subjects underwent an echo-color Doppler examination of the cerebrospinal venous flow. 21 of the 32 Menieric patients showed a statistically significant reflux in the intracranial veins versus healthy (65.6 vs 25%; P < 0.001). A high prevalence of IJVs stenosis with hemodynamic changes (increased velocity or absence of flow) was observed (66.7 vs 33.3%; P < 0.05). The other parameters considered did not show statistically significant differences among the two groups. The results obtained showed a vascular pattern of cerebrospinal venous system present in patients affected by definite Meniere. This vascular impairment significantly affects the vascular areas more directly involved in the venous drainage of the inner ear. Thus venous stasis may be considered a further pathogenetic mechanism for development of Meniere's disease.
    Archives of Oto-Rhino-Laryngology 12/2013; · 1.61 Impact Factor
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    ABSTRACT: Patients assisted with left ventricular assist device (LVAD) may require prolonged mechanical ventilatory assistance secondary to postoperative respiratory failure. The goal of this work is the study of the interdependent effects LVAD like pulsatile catheter (PUCA) pump and mechanical ventilatory support or thoracic artificial lung (TAL), by the hemodynamic point of view, using a numerical simulator of the human cardiovascular system. In the simulator, different circulatory sections are described using lumped parameter models. Lumped parameter models have been designed to describe the hydrodynamic behavior of both PUCA pump and thoracic artificial lung. Ventricular behavior atrial and septum functions were reproduced using variable elastance model. Starting from simulated pathological conditions we studied the effects produced on some hemodynamic variables by simultaneous PUCA pump, thoracic artificial lung or mechanical ventilation assistance. Thoracic artificial lung was applied in parallel or in hybrid mode. The effects of mechanical ventilation have been simulated by changing mean intrathoracic pressure value from -4mmHg to +5mmHg. The hemodynamic variables observed during the simulations, in different assisted conditions, were: left and right ventricular end systolic (diastolic) volume, systolic/diastolic aortic pressure, mean pulmonary arterial pressure, left and right mean atrial pressure, mean systemic venous pressure and the total blood flow. Results show that the application of PUCA (without mechanical ventilatory assistance) increases the total blood flow, reduces the left ventricular end systolic volume and increases the diastolic aortic pressure. Parallel TAL assistance increases the right ventricular end diastolic (systolic) volume reduction both when PUCA is switched "ON" and both when PUCA is switched "OFF". By switching "OFF" the PUCA pump, it seems that parallel thoracic artificial lung assistance produces a greater cardiac output (respect to hybrid TAL assistance). Results concerning PUCA and TAL interaction produced by simulations cannot be compared with "in vivo" results since they are not presented in literature. But results concerning the effects produced by LVAD and mechanical ventilation have a trend consistent with those presented in literature.
    Computer methods and programs in biomedicine 11/2013; · 1.56 Impact Factor

Publication Stats

3k Citations
866.36 Total Impact Points

Institutions

  • 2014
    • Università degli Studi di Torino
      • Department of Medical Science
      Torino, Piedmont, Italy
  • 1987–2014
    • Sapienza University of Rome
      • • Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences
      • • Department of Clinical Medicine
      Roma, Latium, Italy
  • 2013
    • University of Catania
      Catania, Sicily, Italy
    • National Research Council
      Roma, Latium, Italy
  • 2012
    • Umberto I Policlinico di Roma
      Roma, Latium, Italy
    • The American University of Rome
      Roma, Latium, Italy
  • 2011
    • Università degli Studi di Bari Aldo Moro
      Bari, Apulia, Italy
  • 2010
    • Policlinico Casilino
      Romeno, Trentino-Alto Adige, Italy
  • 2008
    • Northwestern University
      • Division of Cardiology (Dept. of Medicine)
      Evanston, IL, United States
    • European Hospital
      Roma, Latium, Italy
  • 1993–2008
    • Catholic University of the Sacred Heart
      • • Institute of Cardiology
      • • Institute of Biochemistry and Clinical Biochemistry
      Roma, Latium, Italy
  • 2003
    • Advocate Illinois Masonic Medical Center
      Chicago, Illinois, United States
  • 2001–2003
    • A.C.O. San Filippo Neri
      Roma, Latium, Italy
  • 1998
    • Tufts University
      • Department of Medicine
      Medford, MA, United States
  • 1990–1998
    • Università degli Studi dell'Aquila
      • • Department of Internal Medicine and Public Health
      • • SS in Radiology
      • • Department of Biotechnological and Applied Clinical Sciences
      Aquila, Abruzzo, Italy
  • 1991–1996
    • Università degli Studi del Sannio
      Benevento, Campania, Italy
  • 1993–1995
    • University of Rome Tor Vergata
      Roma, Latium, Italy