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Strocchi M, Rodero C, Roney CH, Mendonca Costa C, Plank G, Lamata P, Niederer SA. A Semi-automatic Pipeline for Generation of Large Cohorts of Four-Chamber Heart Meshes. Methods Mol Biol 2024; 2735:117-127. [PMID: 38038846 DOI: 10.1007/978-1-0716-3527-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Computational models for cardiac electro-mechanics have been increasingly used to further understand heart function. Small cohort and single patient computational studies provide useful insight into cardiac pathophysiology and response to therapy. However, these smaller studies have limited capability to capture the high level of anatomical variability seen in cardiology patients. Larger cohort studies are, on the other hand, more representative of the study population, but building several patient-specific anatomical meshes can be time-consuming and requires access to larger datasets of imaging data, image processing software to label anatomical structures and tools to create high fidelity anatomical meshes. Limited access to these tools and data might limit advances in this area of research. In this chapter, we present our semi-automatic pipeline to build patient-specific four-chamber heart meshes from CT imaging datasets, including ventricular myofibers and a set of universal ventricular and atrial coordinates. This pipeline was applied to CT images from both heart failure patients and healthy controls to generate cohorts of tetrahedral meshes suitable for electro-mechanics simulations. Both cohorts were made publicly available in order to promote computational studies employing large virtual cohorts.
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Affiliation(s)
- Marina Strocchi
- Department of Biomedical Engineering, King's College London, London, UK
| | - Cristobal Rodero
- Department of Biomedical Engineering, King's College London, London, UK
| | - Caroline H Roney
- Department of Biomedical Engineering, King's College London, London, UK
| | | | | | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, King's College London, London, UK.
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2
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Munoz C, Fotaki A, Hua A, Hajhosseiny R, Kunze KP, Ismail TF, Neji R, Pushparajah K, Botnar RM, Prieto C. Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease. J Magn Reson Imaging 2023; 58:1110-1122. [PMID: 36757267 PMCID: PMC10946808 DOI: 10.1002/jmri.28613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. PURPOSE To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). STUDY TYPE Prospective. POPULATION A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). FIELD STRENGTH/SEQUENCE 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. ASSESSMENT iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. STATISTICAL TESTS Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland-Altman analysis. A P value < 0.05 was considered statistically significant. RESULTS Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. DATA CONCLUSION iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Camila Munoz
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Anastasia Fotaki
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Alina Hua
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Reza Hajhosseiny
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Karl P. Kunze
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Tevfik F. Ismail
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- MR Research CollaborationsSiemens Healthcare LimitedFrimleyUK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - René M. Botnar
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Escuela de Ingeniería, Pontificia Universidad Católica de ChileSantiagoChile
- Instituto de Ingeniería Biológica y Médica, Pontificia Universidad Católica de ChileSantiagoChile
- Millenium Institute for Intelligent Healthcare Engineering iHEALTHSantiagoChile
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Strocchi M, Longobardi S, Augustin CM, Gsell MAF, Petras A, Rinaldi CA, Vigmond EJ, Plank G, Oates CJ, Wilkinson RD, Niederer SA. Cell to whole organ global sensitivity analysis on a four-chamber heart electromechanics model using Gaussian processes emulators. PLoS Comput Biol 2023; 19:e1011257. [PMID: 37363928 DOI: 10.1371/journal.pcbi.1011257] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Cardiac pump function arises from a series of highly orchestrated events across multiple scales. Computational electromechanics can encode these events in physics-constrained models. However, the large number of parameters in these models has made the systematic study of the link between cellular, tissue, and organ scale parameters to whole heart physiology challenging. A patient-specific anatomical heart model, or digital twin, was created. Cellular ionic dynamics and contraction were simulated with the Courtemanche-Land and the ToR-ORd-Land models for the atria and the ventricles, respectively. Whole heart contraction was coupled with the circulatory system, simulated with CircAdapt, while accounting for the effect of the pericardium on cardiac motion. The four-chamber electromechanics framework resulted in 117 parameters of interest. The model was broken into five hierarchical sub-models: tissue electrophysiology, ToR-ORd-Land model, Courtemanche-Land model, passive mechanics and CircAdapt. For each sub-model, we trained Gaussian processes emulators (GPEs) that were then used to perform a global sensitivity analysis (GSA) to retain parameters explaining 90% of the total sensitivity for subsequent analysis. We identified 45 out of 117 parameters that were important for whole heart function. We performed a GSA over these 45 parameters and identified the systemic and pulmonary peripheral resistance as being critical parameters for a wide range of volumetric and hemodynamic cardiac indexes across all four chambers. We have shown that GPEs provide a robust method for mapping between cellular properties and clinical measurements. This could be applied to identify parameters that can be calibrated in patient-specific models or digital twins, and to link cellular function to clinical indexes.
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Affiliation(s)
- Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Stefano Longobardi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | | | | | - Argyrios Petras
- Johann Radon Institute for Computational and Applied Mathematics (RICAM), Linz, Austria
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Edward J Vigmond
- University of Bordeaux, CNRS, Bordeaux, Talence, France
- IHU Liryc, Bordeaux, Talence, France
| | - Gernot Plank
- Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Chris J Oates
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Alan Turing Institute, London, United Kingdom
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Lin S, Morgant MC, Marín-Castrillón DM, Walker PM, Glélé LSA, Boucher A, Presles B, Bouchot O, Lalande A. Aortic local biomechanical properties in ascending aortic aneurysms. Acta Biomater 2022; 149:40-50. [PMID: 35714897 DOI: 10.1016/j.actbio.2022.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
Ascending aortic aneurysm (AsAA) is a high-risk cardiovascular disease with an increased incidence over years. In this study, we compare different risk factors based on the pre-failure behavior (from a biomechanical point of view) obtained ex-vivo from an equi-biaxial tensile test. A total of 100 patients (63 ± 12 years, 72 males) with AsAA replacement, were recruited. Equi-biaxial tensile tests of AsAA walls were performed on freshly sampled aortic wall tissue after ascending aortic replacement. The aneurysmal aortic walls were divided into four quadrants (medial, anterior, lateral, and posterior) and two directions (longitudinal and circumferential) were considered. The stiffness was represented by the maximum Young Modulus (MYM). Based on patient information, the following subgroups were considered: age, gender, hypertension, obesity, dyslipidemia, diabetes, smoking history, aortic insufficiency, aortic stenosis, coronary artery disease, aortic diameter and aortic valve type. In general, when the aortic diameter increased, the aortic wall became thicker. In terms of the MYM, the longitudinal direction was significantly higher than that in the circumferential direction. In the multivariant analysis, the impact factors of age (p = 0.07), smoking (p = 0.05), diabetes (p = 0.03), aortic stenosis (p = 0.02), coronary artery disease (p < 10-3), and aortic diameters (p = 0.02) were significantly influencing the MYM. There was no significant MYM difference when the patients presented arterial hypertension, dyslipidemia, obesity, or bicuspid aortic valve. To conclude, the pre-failure aortic stiffness is multi-factorial, according to our population of 100 patients with AsAA. STATEMENT OF SIGNIFICANCE: : Our research on the topic of "Aortic local biomechanical properties in case of ascending aortic aneurysms" is about the biomechanical properties on one hundred aortic samples according to the aortic wall quadrants and the direction. More than ten factors and risks which may impact ascending aortic aneurysms have been studied. According to our knowledge, so far, this article involved the largest population on this topic. It will be our pleasure to share this information with all the readers.
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Affiliation(s)
- Siyu Lin
- ImViA laboratory, University of Burgundy, Dijon, France.
| | - Marie Catherine Morgant
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | | | - Paul M Walker
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Medical Imaging, University Hospital of Dijon, Dijon, France
| | | | | | | | - Olivier Bouchot
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Alain Lalande
- ImViA laboratory, University of Burgundy, Dijon, France; Department of Medical Imaging, University Hospital of Dijon, Dijon, France
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Zeng W, Caudillo A, Mukherjee S, Lee SH, Panzer MB. Development and multi-level validation of a computational model to predict traumatic aortic injury. Comput Biol Med 2021; 136:104700. [PMID: 34352453 DOI: 10.1016/j.compbiomed.2021.104700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Traumatic aortic injury (TAI) is one of the leading causes of fatalities in blunt impact. However, there is no consensus on the injury mechanism of TAI in traffic accidents, mainly due to the complexity of occurrence scenarios and limited real-world crash data relevant to TAI. In this study, a computational model of the aorta with nonlinear mechanical characteristics and accurate morphology was developed and integrated within a thorax finite element model that included all major anatomical structures. To maximize the model's capability for predicting TAI, a multi-level process was presented to validate the model comprehensively. At the component level, the in vitro aortic pressurization testing was simulated to mimic the aortic burst pressure. Then, a sled test of a truncated cadaver was modeled to evaluate aorta response under posterior acceleration. The frontal chest pendulum impact was utilized to validate the performance of the aorta within full body model under direct chest compression. A parametric study was implemented to determine an injury tolerance for the aorta under these different loading conditions. The simulated peak pressure before aortic rupture was within the range of the experimental burst pressure. For the sled test, the simulated chest deflection and cross-sectional pressure of the aorta were correlated with the experimental measurement. No aorta injury was observed in simulated results of both sled test and chest pendulum impact, which matched the experimental findings. The present model will be a useful tool for understanding the TAI mechanisms, evaluating injury tolerance, and developing prevention strategies for aortic injuries.
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Affiliation(s)
- Wei Zeng
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA.
| | - Adrian Caudillo
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Sayak Mukherjee
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Sang-Hyun Lee
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Matthew B Panzer
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA.
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6
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Williamson PN, Docherty PD, Yazdi SG, Khanafer A, Kabaliuk N, Jermy M. PIV Analysis of Haemodynamics Distal to the Frozen Elephant Trunk Stent Surrogate. Cardiovasc Eng Technol 2021; 12:373-386. [PMID: 33675018 DOI: 10.1007/s13239-021-00521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The Frozen Elephant Trunk (FET) stent is a hybrid endovascular device that may be implemented in the event of an aneurysm or aortic dissection of the aortic arch or superior descending aorta. A Type 1B endoleak can lead to intrasaccular flow during systole and has been identified as a known failure of the FET stent graft. The purpose was to develop in-vitro modelling techniques to enable the investigation of the known failure. METHODS A silicone aortic phantom and 3D printed surrogate stent graft were manufactured to investigate the haemodynamics of a Type 1B endoleak. Physiological pulsatile flow dynamics distal to the surrogate stent graft were investigated in-vitro using Particle Image Velocimetry (PIV). RESULTS PIV captured recirculation zones and an endoleak distal to the surrogate stent graft. The endoleak was developed at the peak of systole and sustained until the onset of diastole. The endoleak was asymmetric, indicating a potential variation in the phantom artery wall thickness or stent alignment. Recirculation was identified on the posterior dorsal line during late systole. CONCLUSIONS The identification of the Type 1B endoleak proved that in-vitro modelling can be used to investigate complex compliance changes and wall motions. The recirculation may indicate the potential for long term intimal layer inflammatory issues such as atherosclerosis. These results may aid future remediation techniques or stent design. Further development of the methods used in this experiment may assist with the future testing of stents prior to animal or human trial.
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Affiliation(s)
- Petra N Williamson
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8041, New Zealand
| | - Paul D Docherty
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8041, New Zealand. .,Institute of Technical Medicine, Furtwangen University, Campus Villingen-Schwenningen, Jakob-Kienzle Strasse 17, 78054, Villingen-Schwenningen, Germany.
| | - Sina G Yazdi
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8041, New Zealand
| | - Adib Khanafer
- Vascular, Endovascular & Renal Transplant Unit, Christchurch Hospital, Canterbury District Health Board, Riccarton Avenue, Christchurch, 8053, New Zealand.,Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - Natalia Kabaliuk
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8041, New Zealand
| | - Mark Jermy
- Department of Mechanical Engineering, University of Canterbury, Private Bag 4800, Christchurch, 8041, New Zealand
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7
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Chong MY, Gu B, Chan BT, Ong ZC, Xu XY, Lim E. Effect of intimal flap motion on flow in acute type B aortic dissection by using fluid-structure interaction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3399. [PMID: 32862487 DOI: 10.1002/cnm.3399] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
A monolithic, fully coupled fluid-structure interaction (FSI) computational framework was developed to account for dissection flap motion in acute type B aortic dissection (TBAD). Analysis of results included wall deformation, pressure, flow, wall shear stress (WSS), von Mises stress and comparison of hemodynamics between rigid wall and FSI models. Our FSI model mimicked realistic wall deformation that resulted in maximum compression of the distal true lumen (TL) by 21.4%. The substantial movement of intimal flap mostly affected flow conditions in the false lumen (FL). Flap motion facilitated more flow entering the FL at peak systole, with the TL to FL flow split changing from 88:12 in the rigid model to 83:17 in the FSI model. There was more disturbed flow in the FL during systole (5.8% FSI vs 5.2% rigid) and diastole (13.5% FSI vs 9.8% rigid), via a λ2 -criterion. The flap-induced disturbed flow near the tears in the FSI model caused an increase of local WSS by up to 70.0% during diastole. This resulted in a significant reduction in the size of low time-averaged WSS (TAWSS) regions in the FL (113.11 cm2 FSI vs 177.44 cm2 rigid). Moreover, the FSI model predicted lower systolic pressure, higher diastolic pressure, and hence lower pulse pressure. Our results provided new insights into the possible impact of flap motion on flow in aortic dissections, which are particularly important when evaluating hemodynamics of acute TBAD. NOVELTY STATEMENT: Our monolithic fully coupled FSI computational framework is able to reproduce experimentally measured range of flap deformation in aortic dissection, thereby providing novel insights into the influence of physiological flap motion on the flow and pressure distributions. The drastic flap movement increases the flow resistance in the true lumen and causes more disturbed flow in the false lumen, as visualized through the λ2 criterion. The flap-induced luminal pressure is dampened, thereby affecting pressure measures, which may serve as potential prognostic indicators for late complications in acute uncomplicated TBAD patients.
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Affiliation(s)
- Mei Yan Chong
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Boram Gu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham, Nottingham, UK
| | - Zhi Chao Ong
- Department of Mechanical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Einly Lim
- Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
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Individual, expected diameters of the ascending aorta and prevalence of dilations in a study-population aged 60–74 years: a DANCAVAS substudy. Int J Cardiovasc Imaging 2020; 37:971-980. [DOI: 10.1007/s10554-020-02081-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/21/2020] [Indexed: 01/01/2023]
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Doyle B. Response to "Re Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm". Eur J Vasc Endovasc Surg 2020; 61:164. [PMID: 32703635 DOI: 10.1016/j.ejvs.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Barry Doyle
- The University of Western Australia, Perth, Australia.
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10
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Strocchi M, Augustin CM, Gsell MAF, Karabelas E, Neic A, Gillette K, Razeghi O, Prassl AJ, Vigmond EJ, Behar JM, Gould J, Sidhu B, Rinaldi CA, Bishop MJ, Plank G, Niederer SA. A publicly available virtual cohort of four-chamber heart meshes for cardiac electro-mechanics simulations. PLoS One 2020; 15:e0235145. [PMID: 32589679 PMCID: PMC7319311 DOI: 10.1371/journal.pone.0235145] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Computational models of the heart are increasingly being used in the development of devices, patient diagnosis and therapy guidance. While software techniques have been developed for simulating single hearts, there remain significant challenges in simulating cohorts of virtual hearts from multiple patients. To facilitate the development of new simulation and model analysis techniques by groups without direct access to medical data, image analysis techniques and meshing tools, we have created the first publicly available virtual cohort of twenty-four four-chamber hearts. Our cohort was built from heart failure patients, age 67±14 years. We segmented four-chamber heart geometries from end-diastolic (ED) CT images and generated linear tetrahedral meshes with an average edge length of 1.1±0.2mm. Ventricular fibres were added in the ventricles with a rule-based method with an orientation of -60° and 80° at the epicardium and endocardium, respectively. We additionally refined the meshes to an average edge length of 0.39±0.10mm to show that all given meshes can be resampled to achieve an arbitrary desired resolution. We ran simulations for ventricular electrical activation and free mechanical contraction on all 1.1mm-resolution meshes to ensure that our meshes are suitable for electro-mechanical simulations. Simulations for electrical activation resulted in a total activation time of 149±16ms. Free mechanical contractions gave an average left ventricular (LV) and right ventricular (RV) ejection fraction (EF) of 35±1% and 30±2%, respectively, and a LV and RV stroke volume (SV) of 95±28mL and 65±11mL, respectively. By making the cohort publicly available, we hope to facilitate large cohort computational studies and to promote the development of cardiac computational electro-mechanics for clinical applications.
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Affiliation(s)
- Marina Strocchi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
| | | | | | - Elias Karabelas
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
| | | | - Karli Gillette
- Institute of Biophysics, Medical University of Graz, Graz, Steiermark, Austria
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
| | - Anton J. Prassl
- Institute of Biophysics, Medical University of Graz, Graz, Steiermark, Austria
| | - Edward J. Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600 Pessac- Bordeaux, France
- University of Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Jonathan M. Behar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, City of London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, City of London, United Kingdom
| | - Baldeep Sidhu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, City of London, United Kingdom
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, City of London, United Kingdom
| | - Martin J. Bishop
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
| | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Steiermark, Austria
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, City of London, United Kingdom
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11
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Eslami P, Tran J, Jin Z, Karady J, Sotoodeh R, Lu MT, Hoffmann U, Marsden A. Effect of Wall Elasticity on Hemodynamics and Wall Shear Stress in Patient-Specific Simulations in the Coronary Arteries. J Biomech Eng 2020; 142:024503. [PMID: 31074768 PMCID: PMC7105147 DOI: 10.1115/1.4043722] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/24/2019] [Indexed: 11/08/2022]
Abstract
Wall shear stress (WSS) has been shown to be associated with myocardial infarction (MI) and progression of atherosclerosis. Wall elasticity is an important feature of hemodynamic modeling affecting WSS calculations. The objective of this study was to investigate the role of wall elasticity on WSS, and justify use of either rigid or elastic models in future studies. Digital anatomic models of the aorta and coronaries were created based on coronary computed tomography angiography (CCTA) in four patients. Hemodynamics was computed in rigid and elastic models using a finite element flow solver. WSS in five timepoints in the cardiac cycle and time averaged wall shear stress (TAWSS) were compared between the models at each 3 mm subsegment and 4 arcs in cross sections along the centerlines of coronaries. In the left main (LM), proximal left anterior descending (LAD), left circumflex (LCX), and proximal right coronary artery (RCA) of the elastic model, the mean percent radial increase 5.95 ± 1.25, 4.02 ± 0.97, 4.08 ± 0.94, and 4.84 ± 1.05%, respectively. WSS at each timepoint in the cardiac cycle had slightly different values; however, when averaged over the cardiac cycle, there were negligible differences between the models. In both the subsegments (n = 704) and subarc analysis, TAWSS in the two models were highly correlated (r = 0.99). In investigation on the effect of coronary wall elasticity on WSS in CCTA-based models, the results of this study show no significant differences in TAWSS justifying using rigid wall models for future larger studies.
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Affiliation(s)
- Parastou Eslami
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Justin Tran
- Department of Mechanical Engineering, Stanford
University, Stanford, CA 94305
| | - Zexi Jin
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Julia Karady
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Romina Sotoodeh
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Michael T. Lu
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General Hospital,
Harvard Medical School, Boston, MA
02114
| | - Alison Marsden
- Departments of Bioengineering and Pediatrics, Institute of
Computational and Mathematical Engineering, Stanford University,
Stanford, CA 94305
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12
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Rotzinger DC, Si-Mohamed SA, Shapira N, Douek PC, Meuli RA, Boussel L. "Dark-blood" dual-energy computed tomography angiography for thoracic aortic wall imaging. Eur Radiol 2019; 30:425-431. [PMID: 31332557 DOI: 10.1007/s00330-019-06336-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/23/2019] [Accepted: 06/21/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To assess the capability of a newly developed material decomposition method from contrast-enhanced dual-energy CT images, aiming to better visualize the aortic wall and aortic intramural hematoma (IMH), compared with true non-contrast (TNC) CT. MATERIALS AND METHODS Twenty-two patients (11 women; mean age, 61 ± 20 years) with acute chest pain underwent 25 dual-layer non-contrast and contrast-enhanced CT. CT-angiography images were retrospectively processed using two-material decomposition analysis, where we defined the first material as the content of a region of interest placed in the ascending aorta for each patient, and the second material as water. Two independent radiologists assessed the images from the second material termed "dark-blood" images and the TNC images regarding contrast-to-noise ratio (CNR) between the wall and the lumen, diagnostic quality regarding the presence of aortic wall thickening, and the inner/outer vessel wall conspicuity. RESULTS Diagnostic quality scores in normal aortic segments were 0.9 ± 0.3 and 2.7 ± 0.6 (p < 0.001) and wall conspicuity scores were 0.7 ± 0.5 and 1.8 ± 0.3 (p < 0.001) on TNC and dark-blood images, respectively. In aortic segments with IMH, diagnostic quality scores were 1.7 ± 0.5 and 2.4 ± 0.6 (p < 0.001) and wall conspicuity scores were 0.7 ± 0.7 and 1.8 ± 0.3 (p < 0.001) on TNC and dark-blood images, respectively. In normal aortic segments, CNRs were 0.3 ± 0.2 and 2.8 ± 0.9 on TNC and dark-blood images, respectively (p < 0.001). In aortic segments with IMH, CNRs were 0.3 ± 0.2 and 4.0 ± 1.0 on TNC and dark-blood images, respectively (p < 0.001). CONCLUSIONS Compared with true non-contrast CT, dark-blood material decomposition maps enhance quantitative and qualitative image quality for the assessment of normal aortic wall and IMH. KEY POINTS • Current dual-energy CT-angiography provides virtual non-contrast and bright-blood images. • Dark-blood images represent a new way to assess the vascular wall structure with dual-energy CT and can improve the lumen-to-wall contrast compared with true non-contrast CT. • This dual-energy CT material decomposition method is likely to improve contrast resolution in other applications as well, taking advantage of the high spatial resolution of CT.
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Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland. .,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Salim A Si-Mohamed
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
| | - Nadav Shapira
- CT/AMI Research and Development, Philips Medical Systems, Haifa, Israel
| | - Philippe C Douek
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Loïc Boussel
- Radiology Department, Hospices Civils de Lyon (HCL), Lyon, France.,University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, Lyon, France
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13
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Wei W, Evin M, Rapacchi S, Kober F, Bernard M, Jacquier A, Kahn CJF, Behr M. Investigating heartbeat-related in-plane motion and stress levels induced at the aortic root. Biomed Eng Online 2019; 18:19. [PMID: 30808342 PMCID: PMC6391796 DOI: 10.1186/s12938-019-0632-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/31/2019] [Indexed: 12/28/2022] Open
Abstract
Background The axial motion of aortic root (AR) due to ventricular traction was previously suggested to contribute to ascending aorta (AA) dissection by increasing its longitudinal stress, but AR in-plane motion effects on stresses have never been studied. The objective is to investigate the contribution of AR in-plane motion to AA stress levels. Methods The AR in-plane motion was assessed on magnetic resonance imagining data from 25 healthy volunteers as the movement of the AA section centroid. The measured movement was prescribed to the proximal AA end of an aortic finite element model to investigate its influences on aortic stresses. The finite element model was developed from a patient-specific geometry using LS-DYNA solver and validated against the aortic distensibility. Fluid–structure interaction (FSI) approach was also used to simulate blood hydrodynamic effects on aortic dilation and stresses. Results The AR in-plane motion was 5.5 ± 1.7 mm with the components of 3.1 ± 1.5 mm along the direction of proximal descending aorta (PDA) to AA centroid and 3.0 ± 1.3 mm perpendicularly under the PDA reference system. The AR axial motion elevated the longitudinal stress of proximal AA by 40% while the corresponding increase due to in-plane motion was always below 5%. The stresses at proximal AA resulted approximately 7% less in FSI simulation with blood flow. Conclusions The AR in-plane motion was comparable with the magnitude of axial motion. Neither axial nor in-plane motion could directly lead to AA dissection. It is necessary to consider the heterogeneous pressures related to blood hydrodynamics when studying aortic wall stress levels. Electronic supplementary material The online version of this article (10.1186/s12938-019-0632-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei Wei
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France.
| | - Morgane Evin
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
| | | | - Frank Kober
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Monique Bernard
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Alexis Jacquier
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Cyril J F Kahn
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
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14
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Legerer C, Almsherqi ZA, McLachlan CS. Over-Wrapping of the Aortic Wall with an Elastic Extra-Aortic Wrap Results in Luminal Creasing. J Cardiovasc Dev Dis 2018; 5:jcdd5030042. [PMID: 30103504 PMCID: PMC6162522 DOI: 10.3390/jcdd5030042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022] Open
Abstract
Elastic extra-aortic wrapping is a potential non-pharmacological way to improve aortic compliance and treat isolated systolic hypertension associated with a stiffened aorta. We aimed to use computer simulations to re-evaluate whether there is aortic shape distortion in aortic wrapping to achieve greater elasticity of the wrapped aortic segment. Non-linear transient numerical analysis based on an idealized hyper-elastic single-layered aorta model was performed to simulate the force/displacement regimes of external aortic wrapping. Pressure-displacement relationships were used to establish model aortic wall distensibilities of 4.3 and 5.5 (10−3 mmHg−1). A physiological pulsatile lumen pressure was employed to estimate the potential improvements in aortic distensibility by compression forces representing elastic aortic wrapping. In the less distensible model of the aortic wall there was increased systolic expansion in the wrapped segment. We found a risk of creasing of the aortic luminal wall with wrapping. Sufficient unloading of a thick and elastic aortic wall to induce increased compliance, as observed in elastic wrapping, is associated with the potential risk of over compression and folding (creasing) inside the lumen.
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Affiliation(s)
- Christian Legerer
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Zakaria A Almsherqi
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Craig S McLachlan
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
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15
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Feasibility of a 3D Printed Patient-Specific Model System to Determine Hemodynamic Energy Delivery During Extracorporeal Circulation. ASAIO J 2018; 64:309-317. [DOI: 10.1097/mat.0000000000000638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Rudenick PA, Segers P, Pineda V, Cuellar H, García-Dorado D, Evangelista A, Bijnens BH. False Lumen Flow Patterns and their Relation with Morphological and Biomechanical Characteristics of Chronic Aortic Dissections. Computational Model Compared with Magnetic Resonance Imaging Measurements. PLoS One 2017; 12:e0170888. [PMID: 28125720 PMCID: PMC5270334 DOI: 10.1371/journal.pone.0170888] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 01/12/2017] [Indexed: 11/30/2022] Open
Abstract
Aortic wall stiffness, tear size and location and the presence of abdominal side branches arising from the false lumen (FL) are key properties potentially involved in FL enlargement in chronic aortic dissections (ADs). We hypothesize that temporal variations on FL flow patterns, as measured in a cross-section by phase-contrast magnetic resonance imaging (PC-MRI), could be used to infer integrated information on these features. In 33 patients with chronic descending AD, instantaneous flow profiles were quantified in the FL at diaphragm level by PC-MRI. We used a lumped-parameter model to assess the changes in flow profiles induced by wall stiffness, tear size/location, and the presence of abdominal side branches arising from the FL. Four characteristic FL flow patterns were identified in 31/33 patients (94%) based on the direction of flow in systole and diastole: BA = systolic biphasic flow and primarily diastolic antegrade flow (n = 6); BR = systolic biphasic flow and primarily diastolic retrograde flow (n = 14); MA = systolic monophasic flow and primarily diastolic antegrade flow (n = 9); MR = systolic monophasic flow and primarily diastolic retrograde flow (n = 2). In the computational model, the temporal variation of flow directions within the FL was highly dependent on the position of assessment along the aorta. FL flow patterns (especially at the level of the diaphragm) showed their characteristic patterns due to variations in the cumulative size and the spatial distribution of the communicating tears, and the incidence of visceral side branches originating from the FL. Changes in wall stiffness did not change the temporal variation of the flows whereas it importantly determined intraluminal pressures. FL flow patterns implicitly codify morphological information on key determinants of aortic expansion in ADs. This data might be taken into consideration in the imaging protocol to define the predictive value of FL flows.
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Affiliation(s)
- Paula A. Rudenick
- Physense, Universitat Pompeu Fabra, Barcelona, Spain
- University Hospital and Research Institute Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Patrick Segers
- Biofluid, Tissue and Solid Mechanics for Medical Applications, Institute Biomedical Technology, Ghent University, Ghent, Belgium
| | - Victor Pineda
- University Hospital and Research Institute Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hug Cuellar
- University Hospital and Research Institute Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David García-Dorado
- University Hospital and Research Institute Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Evangelista
- University Hospital and Research Institute Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bart H. Bijnens
- Physense, Universitat Pompeu Fabra, Barcelona, Spain
- ICREA, Barcelona, Spain
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17
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Tan YJ, Tan X, Yeong WY, Tor SB. Additive Manufacturing of Patient-Customizable Scaffolds for Tubular Tissues Using the Melt-Drawing Method. MATERIALS (BASEL, SWITZERLAND) 2016; 9:E893. [PMID: 28774013 PMCID: PMC5457202 DOI: 10.3390/ma9110893] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
Polymeric fibrous scaffolds for guiding cell growth are designed to be potentially used for the tissue engineering (TE) of tubular organs including esophagi, blood vessels, tracheas, etc. Tubular scaffolds were fabricated via melt-drawing of highly elastic poly(l-lactide-co-ε-caprolactone) (PLC) fibers layer-by-layer on a cylindrical mandrel. The diameter and length of the scaffolds are customizable via 3D printing of the mandrel. Thickness of the scaffolds was varied by changing the number of layers of the melt-drawing process. The morphology and tensile properties of the PLC fibers were investigated. The fibers were highly aligned with a uniform diameter. Their diameters and tensile properties were tunable by varying the melt-drawing speeds. These tailorable topographies and tensile properties show that the additive-based scaffold fabrication technique is customizable at the micro- and macro-scale for different tubular tissues. The merits of these scaffolds in TE were further shown by the finding that myoblast and fibroblast cells seeded onto the scaffolds in vitro showed appropriate cell proliferation and distribution. Human mesenchymal stem cells (hMSCs) differentiated to smooth muscle lineage on the microfibrous scaffolds in the absence of soluble induction factors, showing cellular shape modulation and scaffold elasticity may encourage the myogenic differentiation of stem cells.
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Affiliation(s)
- Yu Jun Tan
- Singapore Centre for 3D Printing, School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore.
| | - Xipeng Tan
- Singapore Centre for 3D Printing, School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore.
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing, School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore.
| | - Shu Beng Tor
- Singapore Centre for 3D Printing, School of Mechanical & Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore.
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Reference Values for Cardiac and Aortic Magnetic Resonance Imaging in Healthy, Young Caucasian Adults. PLoS One 2016; 11:e0164480. [PMID: 27732640 PMCID: PMC5061387 DOI: 10.1371/journal.pone.0164480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/26/2016] [Indexed: 12/04/2022] Open
Abstract
Background Reference values for morphological and functional parameters of the cardiovascular system in early life are relevant since they may help to identify young adults who fall outside the physiological range of arterial and cardiac ageing. This study provides age and sex specific reference values for aortic wall characteristics, cardiac function parameters and aortic pulse wave velocity (PWV) in a population-based sample of healthy, young adults using magnetic resonance (MR) imaging. Materials and Methods In 131 randomly selected healthy, young adults aged between 25 and 35 years (mean age 31.8 years, 63 men) of the general-population based Atherosclerosis-Monitoring-and-Biomarker-measurements-In-The-YOuNg (AMBITYON) study, descending thoracic aortic dimensions and wall thickness, thoracic aortic PWV and cardiac function parameters were measured using a 3.0T MR-system. Age and sex specific reference values were generated using dedicated software. Differences in reference values between two age groups (25–30 and 30–35 years) and both sexes were tested. Results Aortic diameters and areas were higher in the older age group (all p<0.007). Moreover, aortic dimensions, left ventricular mass, left and right ventricular volumes and cardiac output were lower in women than in men (all p<0.001). For mean and maximum aortic wall thickness, left and right ejection fraction and aortic PWV we did not observe a significant age or sex effect. Conclusion This study provides age and sex specific reference values for cardiovascular MR parameters in healthy, young Caucasian adults. These may aid in MR guided pre-clinical identification of young adults who fall outside the physiological range of arterial and cardiac ageing.
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19
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Praveen Kumar G, Jafary-Zadeh M, Cui F. Deployment of a Bulk Metallic Glass-Based Self-Expandable Stent in a Patient-Specific Descending Aorta. ACS Biomater Sci Eng 2016; 2:1951-1958. [DOI: 10.1021/acsbiomaterials.6b00342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gideon Praveen Kumar
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
| | - Mehdi Jafary-Zadeh
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
| | - Fangsen Cui
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
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20
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Ittermann T, Lorbeer R, Dörr M, Schneider T, Quadrat A, Heßelbarth L, Wenzel M, Lehmphul I, Köhrle J, Mensel B, Völzke H. High levels of thyroid-stimulating hormone are associated with aortic wall thickness in the general population. Eur Radiol 2016; 26:4490-4496. [PMID: 26973144 DOI: 10.1007/s00330-016-4316-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/26/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our aim was to investigate the association of thyroid function defined by serum concentrations of thyroid-stimulating hormone (TSH) with thoracic aortic wall thickness (AWT) as a marker of atherosclerotic processes. METHODS We pooled data of 2,679 individuals from two independent population-based surveys of the Study of Health in Pomerania. Aortic diameter and AWT measurements were performed on a 1.5-T MRI scanner at the concentration of the right pulmonary artery displaying the ascending and the descending aorta. RESULTS TSH, treated as continuous variable, was significantly associated with descending AWT (β = 0.11; 95 % confidence interval (CI) 0.02-0.21), while the association with ascending AWT was not statistically significant (β = 0.20; 95 % CI -0.01-0.21). High TSH (>3.29 mIU/L) was significantly associated with ascending (β = 0.12; 95 % CI 0.02-0.23) but not with descending AWT (β = 0.06; 95 % CI -0.04-0.16). There was no consistent association between TSH and aortic diameters. CONCLUSIONS Our study demonstrated that AWT values increase with increasing serum TSH concentrations. Thus, a hypothyroid state may be indicative for aortic atherosclerosis. These results fit very well to the findings of previous studies pointing towards increased atherosclerotic risk in the hypothyroid state. KEY POINTS • Serum TSH concentrations are positively associated with aortic wall thickness. • Serum TSH concentrations are not associated with the aortic diameters. • Serum 3,5-diiodothyronine concentrations may be positively associated with aortic wall thickness.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany.
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
| | - Roberto Lorbeer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Marcus Dörr
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Schneider
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Quadrat
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Lydia Heßelbarth
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Michael Wenzel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Ina Lehmphul
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Josef Köhrle
- Institut für Experimentelle Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
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Lorbeer R, Schneider T, Quadrat A, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Mensel B. Cardiovascular risk factors and thoracic aortic wall thickness in a general population. J Vasc Interv Radiol 2015; 26:635-41. [PMID: 25704225 DOI: 10.1016/j.jvir.2014.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/10/2014] [Accepted: 12/14/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the association of cardiovascular risk factors with wall thickness of the ascending and descending thoracic aorta in the general population. MATERIALS AND METHODS The study included 1,176 individuals (523 women) 21-83 years old from the Study of Health in Pomerania without history of stroke or myocardial infarction. Aortic wall thickness (AWT) was determined by cine magnetic resonance imaging. The associations of AWT with the cardiovascular risk factors male sex, age, smoking, body mass index (BMI), systolic and diastolic blood pressure, hemoglobin A1c, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were assessed by multivariable linear regression models, and interaction effects were tested. RESULTS Male sex (β = .086, P < .001), age (β = .006, P < .001), and BMI (β = .013, P < .001) were positively associated with the AWT of the ascending aorta. Male sex (β = .105, P < .001), age (β = .006, P < .001), current smoker (β = .044, P = .010), BMI (β = .013, P < .001), and HDL-C (β = .057, P = .008) revealed a positive association with AWT of the descending aorta. LDL-C (β = -.024, P = .009; β = -.018, P = .010) was inversely associated with the AWT of the ascending and descending aorta, respectively. Triglyceride levels (β = .024, P = .027; β = .018, P = .024) showed a positive association with the AWT of the ascending and descending aorta, respectively, in men, but not in women. CONCLUSIONS Established cardiovascular risk factors, including male sex, older age, smoking, high BMI, and high triglyceride levels, were associated with increasing thoracic AWT of the ascending and descending aorta. High HDL-C and low LDL-C levels were correlated with AWT.
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Affiliation(s)
- Roberto Lorbeer
- Institute for Community Medicine, Section SHIP-KEF, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany.
| | - Tobias Schneider
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Alexander Quadrat
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, Section SHIP-KEF, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany; German Centre for Cardiovascular Research, Partner Site Greifswald, Greifswald, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian Albrechts University, Kiel, Germany
| | - Katrin Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
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Mensel B, Quadrat A, Schneider T, Kühn JP, Dörr M, Völzke H, Lieb W, Hegenscheid K, Lorbeer R. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol 2014; 24:2038-44. [PMID: 24816934 DOI: 10.1007/s00330-014-3188-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/13/2014] [Accepted: 04/14/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To provide age- and sex-specific reference values for MRI-derived wall thickness of the ascending and descending aorta in the general population. MATERIALS AND METHODS Data of 753 subjects (311 females) aged 21-81 years were analysed. MRI was used to determine the aortic wall thickness (AWT). Equations for reference value calculation according to age were established for females and males. RESULTS Median wall thickness of the ascending aorta was 1.46 mm (5th-95th range: 1.15-1.88 mm) for females and 1.56 mm (1.22-1.99 mm) for males. Median wall thickness of the descending aorta was 1.26 mm (0.97-1.58 mm) in females and 1.36 mm (1.04-1.75 mm) in males. While median and 5th and 95th percentiles for the ascending and descending aorta increased with age in both sexes, the association between age and median AWT was stronger in males than in females for both the ascending and descending aorta. CONCLUSIONS Reference values for the ascending and descending AWT are provided. In a healthy sample from the general population, the wall of the ascending aorta is thicker than the wall of the descending aorta, and both walls are thicker in males than females. The increase in wall thickness with age is greater in males. KEY POINTS Ascending aortic wall thickness is greater than descending aortic wall thickness. Ascending and descending aortic wall thickness is greater in males. Thoracic aortic wall thickness increases with age in both sexes. The age-related increase in aortic wall thickness is stronger in males.
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Affiliation(s)
- Birger Mensel
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany,
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Cardiovascular aging: Insights from local and regional measures of aortic stiffness using magnetic resonance imaging. Artery Res 2014. [DOI: 10.1016/j.artres.2014.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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