{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T10:55:33Z","timestamp":1705575333155},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"award":["\u00a0"]},{"award":["20PRE35210594"]},{"award":["\u00a0"]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Atrial fibrillation (AF) is a prevalent arrhythmia, that causes thrombus formation, ordinarily in the left atrial appendage (LAA). The conventional metric of stroke risk stratification, CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score, does not account for LAA morphology or hemodynamics. We showed in our previous study that residence time distribution (RTD) of blood-borne particles in the LAA and its associated calculated variables (i.e., mean residence time, <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic>, and asymptotic concentration, <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub>) have the potential to improve CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc score. The purpose of this research was to investigate the effects of the following potential confounding factors on LAA <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic> and <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub>: (1) pulmonary vein flow waveform pulsatility, (2) non-Newtonian blood rheology and hematocrit level, and (3) length of the simulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Subject-Specific data including left atrial (LA) and LAA cardiac computed tomography, cardiac output (CO), heart rate, and hematocrit level were gathered from 25 AF subjects. We calculated LAA <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic> and <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub> based on series of computational fluid dynamics (CFD) analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both LAA <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic> and <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub> are significantly affected by the CO, but not by temporal pattern of the inlet flow. Both LAA <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic> and <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub> increase with increasing hematocrit level and both calculated indices are higher for non-Newtonian blood rheology for a given hematocrit level. Further, at least 20,000\u2005s of CFD simulation is needed to calculate LAA <jats:italic>t<jats:sub>m<\/jats:sub><\/jats:italic> and <jats:italic>C<\/jats:italic><jats:sub>\u221e<\/jats:sub> values reliably.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Subject-specific LA and LAA geometries, CO, and hematocrit level are essential to quantify the subject-specific proclivity of blood cell tarrying inside LAA in terms of the RTD function.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1070498","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T04:46:20Z","timestamp":1678682780000},"update-policy":"http:\/\/dx.doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Subject-specific factors affecting particle residence time distribution of left atrial appendage in atrial fibrillation: A computational model-based 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