Left ventricular geometry as a major determinant of left ventricular ejection fraction: physiological considerations and clinical implications

Triposkiadis, Filippos; Giamouzis, Grigorios; Boudoulas, Konstantinos Dean; Karagiannis, Georgios; Skoularigis, John; Boudoulas, Harisios; Parissis, John

doi:10.1002/ejhf.1055

Cited by 41 publications

(40 citation statements)

References 67 publications

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“…In the failing LV, however, where alterations in afterload have a profound influence on LV performance, while changes in preload have minimal effect (Fig. 1), this relationship may represent an ideal measure of LV performance, but studies in this group of patients are limited [2]. The evaluation of LV performance has been a research subject for more than a century.…”

Section: Pressure or Stress: LV Volume Relationshipmentioning

confidence: 99%

“…"The whole is greater than the sum of its parts" -Aristotle LV ejection fraction has been used extensively in clinical practice to stratify patients with different diseases in high or low risk groups, classify patients with heart failure, and to assess the effect of therapeutic interventions [2]. LV ejection fraction, however, depends not only on the contractility of the cardiomyocytes, but also on the geometry of the LV chamber.…”

Section: Geometrymentioning

confidence: 99%

“…With this degree of myocardial shortening and thickening, an ejection fraction of 60% or greater cannot be achieved without an appropriate orientation of cardiomyocytes in the wall of the LV cavity. From multiple studies, it has been shown that the most effective orientation of cardiomyocytes to provide an optimal ejection fraction is the helical or spiral formation [2].…”

Section: Geometrymentioning

confidence: 99%

“…Among others, loading conditions, neurohumoral activation (especially sympathetic nervous system), and LV geometry play an important role [1,2]. The effects of these factors on LV function are briefly discussed.…”

Section: Factors Affecting LV Performance With Emphasis On Armentioning

confidence: 99%

“…

Indices used to evaluate left ventricular (LV) performance in clinical practice (cardiac output, ejection fraction, other) are usually affected by many other factors such as preload, afterload, intrinsic or extrinsic inotropic effects, and LV geometry, just to mention a few [1,2]. In chronic aortic regurgitation (AR), preload, afterload and LV geometry are affected and for this reason, these factors should be taken into consideration when evaluating LV performance in these patients.

Hemodynamics in Chronic AR

AR is a unique condition; it is an isolated valve disease that results in both an increase in preload and afterload.

…”

mentioning

confidence: 99%

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Evaluation of Left Ventricular Performance: Is There a Gold Standard?

2018

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Section: Pressure or Stress: LV Volume Relationshipmentioning

confidence: 99%

Section: Geometrymentioning

confidence: 99%

Section: Geometrymentioning

confidence: 99%

Section: Factors Affecting LV Performance With Emphasis On Armentioning

confidence: 99%

“…

Hemodynamics in Chronic AR

AR is a unique condition; it is an isolated valve disease that results in both an increase in preload and afterload.

…”

mentioning

confidence: 99%

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Evaluation of Left Ventricular Performance: Is There a Gold Standard?

2018

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Programming Cellular Alignment in Engineered Cardiac Tissue via Bioprinting Anisotropic Organ Building Blocks

et al. 2022

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To date, several methods have been developed to induce alignment in engineered cardiac tissues. [7][8][9][10][11] One common approach is to seed cardiomyocytes onto micro-or nanopatterned surfaces that contain topographical cues, which guide cellular alignment. [12,13] Another approach is to seed cells onto anisotropic polymer scaffolds [14][15][16] or decellularized matrices [17] that guide tissue alignment. In addition, cell-laden hydrogels seeded into molds of varying geometry can self-assemble into aligned cardiac rods, rings, bundles, and sheets. [18][19][20][21][22][23][24] Unfortunately, these methods are typically confined to thin cardiac tissues (≤100 µm thick) with either linear or radial alignment. By contrast, extrusionbased bioprinting offers broad flexibility to control tissue composition and architecture. Recently, we and others have demonstrated that synthetic and biological fibers exhibit shear-induced alignment during printing, opening the possibility to program tissue alignment via cell templating. [25][26][27][28][29][30][31][32][33][34] However, programming the architecture of human tissues by directly aligning anisotropic tissue building blocks has yet to be explored.Here, we report the fabrication of engineered cardiac tissue with programmable alignment via bioprinting of anisotropic organ building blocks (aOBBs) (Figure 1). These aOBBs are elongated microtissues composed of cellular aligned hiPSC-CMs that can be modularly assembled into a printable bioink (Figure 1a). Individual aOBBs within this bioink align along the print path due to the same shear and extensional forces that orient acellular fibers upon extrusion through a tapered nozzle (Figure 1b). [35] Using this method, we fabricated cardiac tissues with high cellular density and programmed alignment across multiple length scales; ranging from individual aOBBs to the sarcomeric machinery that drives their contractile function (Figure 1c). Results and DiscussionThe first step in creating our cardiac bioink is to fabricate scalable micropillar arrays by stereolithography (SLA). These micropillar arrays are used to generate tens of thousands of aOBBs with controlled aspect ratio and cellular composition. After optimizing these parameters, we employed a sequential transfer micromolding process to create a single contiguousThe ability to replicate the 3D myocardial architecture found in human hearts is a grand challenge. Here, the fabrication of aligned cardiac tissues via bioprinting anisotropic organ building blocks (aOBBs) composed of human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CMs) is reported. A bioink composed of contractile cardiac aOBBs is first generated and aligned cardiac tissue sheets with linear, spiral, and chevron features are printed. Next, aligned cardiac macrofilaments are printed, whose contractile force and conduction velocity increase over time and exceed the performance of spheroid-based cardiac tissues. Finally, the ability to spatially control the magnitude and direction of contractile force...

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Bioprinting‐Assisted Tissue Assembly for Structural and Functional Modulation of Engineered Heart Tissue Mimicking Left Ventricular Myocardial Fiber Orientation

Hwang,

Choi,

Yong

et al. 2024

Advanced Materials

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Left ventricular twist is influenced by the unique oriented structure of myocardial fibers. Replicating this intricate structural‐functional relationship in an in vitro heart model remains challenging, mainly due to the difficulties in achieving a complex structure with synchrony between layers. This study introduces a novel approach through the utilization of bioprinting‐assisted tissue assembly (BATA)—a synergistic integration of bioprinting and tissue assembly strategies. By flexibly manufacturing tissue modules and assembly platforms, BATA can create structures that traditional methods find difficult to achieve. This approach integrates engineered heart tissue (EHT) modules, each with intrinsic functional and structural characteristics, into a layered, multi‐oriented tissue in a controlled manner. EHTs assembled in different orientations exhibit various contractile forces and electrical signal patterns. The BATA is capable of constructing complex myocardial fiber orientations within a chamber‐like structure (MoCha). MoCha replicates the native cardiac architecture by exhibiting three layers and three alignment directions, and it reproduces the left ventricular twist by exhibiting synchronized contraction between layers and mimicking the native cardiac architecture. The potential of BATA extends to engineering tissues capable of constructing and functioning as complete organs on a large scale. This advancement holds the promise of realizing future organ‐on‐demand technology.This article is protected by copyright. All rights reserved

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Left ventricular geometry as a major determinant of left ventricular ejection fraction: physiological considerations and clinical implications

Cited by 41 publications

References 67 publications

Evaluation of Left Ventricular Performance: Is There a Gold Standard?

Evaluation of Left Ventricular Performance: Is There a Gold Standard?

Programming Cellular Alignment in Engineered Cardiac Tissue via Bioprinting Anisotropic Organ Building Blocks

Bioprinting‐Assisted Tissue Assembly for Structural and Functional Modulation of Engineered Heart Tissue Mimicking Left Ventricular Myocardial Fiber Orientation

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