Patient-Specific Computational Modeling To Identify Right Heart Failure Risk Associated With Continuous-Flow Left Ventricular Assist Device

Document Type

Conference Proceeding

Publication Date

1-2026

Publication Title

Journal of Cardiac Failure

Abstract

Introduction: Despite advances in LVAD technology, RHF (right heart failure) continues to be an important cause of significant morbidity and mortality. Prior RHF risk models have poor discrimination with C-statistic value less than 0.7. We developed a novel patient-specific computational model (CM) framework to investigate the effects of the HeartMate 3 (HM3) on RH function.

Methods: A CM that couples finite element cardiac mechanics with systemic and pulmonary circulations in a closed loop system is developed (Fig. 1a). Patient-specific heart geometry from 9 patients is reconstructed based on CT images taken prior to HM3 implant (Fig. 1b). Using clinical measurements of RV pressure and volume waveforms taken before device implantation, the model is applied to simulate the effects of the HM3 using the pressure gradient-flow relationship (Fig. 1c-d). The effects of septal wall thickness and regional contractility of the HM3 on RV function was investigated, quantified by the change of RV end-systolic pressure-volume relationship (ESPVR) indexed by the volume intercept of ESPVR at RV pressure 60 mmHg, V60.

Results: The CM is first applied to simulate heart failure (HF) and the effects of HM3 operating at pump speed between 5-9k rpm (Fig. 2a-b). Operation of the HM3 causes the septum to shift into the LV, resulting in an increased RV cavity volume. The effects of septal wall thickness changing from 0.32 cm to 1.98 cm on the change of V60 at different pump speeds (0k, 5k-9k rpm) are predicted by the model (Fig. 2c). With the HM3 operating at 9k rpm, an increase in septal wall thickness led to a decrease in V60 with respect to the baseline HF case (i.e., 10% with thickness of 0.32 cm but 4% with thickness of 1.98 cm). The effects of regional myocardial contractility Tmax (in LVFW, septum, RVFW or LVF + septum) reducing from 100% to 40% of its value in the baseline case on RV systolic function with the HM3 are predicted by the model. The reduction of septal Tmax generates an increase of V60 (Fig. 2d).

Conclusion: This novel patient-specific CM demonstrates that the RV contractile function is reduced with an increase in HM3 pump speed, and this reduction is greater with a thinner septal wall or lower septal myocardial contractility. These findings may have important clinical implications in identifying LVAD patients who may suffer from RV failure.

Volume

32

Issue

1

First Page

174

Comments

Scientific Meeting of the Heart Failure Society of America (HFSA), Sep 26-29, 2025, Minneapolis, MN

Last Page

175

DOI

10.1016/j.cardfail.2025.11.014

ISSN

1071-9164

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