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Taconne M, Le Rolle V, Panis V, Hubert A, Auffret V, Galli E, Hernandez A, Donal E. How myocardial work could be relevant in patients with an aortic valve stenosis? Eur Heart J Cardiovasc Imaging 2022; 24:119-129. [PMID: 35297488 DOI: 10.1093/ehjci/jeac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Myocardial work (MW) calculation is an attractive method to assess left ventricular (LV) myocardial function. In case of aortic stenosis (AS), assessment of work indices is challenging because it requires an accurate evaluation of LV-pressure curves. We sought to evaluate the performances of two distinct methods and to provide a quantitative comparison with invasive data. METHODS AND RESULTS Model-based and template-based methods were defined and applied for the evaluation of LV-pressures on 67 AS-patient. Global Constructive (GCW), Wasted (GWW), Positive (GPW), Negative (GNW) MW and Global Work Efficiency (GWE), and Index (GWI) parameters were calculated using the available software computing the indices using brachial blood-pressure and trans-aortic mean pressure gradient (MPG) for estimating the LV-pressures vs. using a model-based and homemade software. A complete comparison was performed with invasive measurements. Patients were characterized by MPG of 49.8 ± 14.8 mmHg, the global longitudinal strain (GLS) was -15.0 ± 4.04%, GCW was 2107 ± 800 mmHg.% (model-based) and 2483 ± 1068 mmHg.% (template-based). The root mean square error (RMSE) and correlation were calculated for each patient and pressure estimation methods. The mean RMSE are 33.9 mmHg and 40.4 mmHg and the mean correlation coefficients are 0.81 and 0.72 for the model-based and template-based methods, respectively. The two methods present correlation coefficient r2 >0.75 for all the indices. CONCLUSION The two non-invasive methods of LV pressure estimation and work indices computation correlate with invasive measurements. Although the model-based approach requires less information and is associated with slightly better performances, the implementation of template-based method is easier and is appropriate for clinical practice.
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Affiliation(s)
- Marion Taconne
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Virginie Le Rolle
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Vasileios Panis
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Arnaud Hubert
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Vincent Auffret
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Elena Galli
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Alfredo Hernandez
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
| | - Erwan Donal
- Service de Cardiologie CCPCHU de Rennes, University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Pontchaillou F-35000 Rennes, France
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Duport O, Le Rolle V, Galli E, Danan D, Darrigrand E, Donal E, Hernández A. Model-based analysis of myocardial contraction patterns in ischemic heart disease. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guerrero G, Le Rolle V, Loiodice C, Amblard A, Pepin JL, Hernandez A. Modeling patient-specific desaturation patterns in sleep apnea. IEEE Trans Biomed Eng 2021; 69:1502-1511. [PMID: 34665719 DOI: 10.1109/tbme.2021.3121170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The physiological mechanisms involved in cardio-respiratory responses to sleep apnea events are not yet fully elucidated. A model-based approach is proposed to analyse the acute desaturation response to obstructive apneas. METHODS An integrated model of cardio-respiratory interactions was proposed and parameters were identified, using an evolutionary algorithm, on a database composed of 107 obstructive apneas acquired from 10 patients (HYPNOS clinical study). Unsupervised clustering was applied to the identified parameters in order to characterize the phenotype of each response to obstructive apneas. RESULTS A close match was observed between simulated oxygen saturation (SaO2) and experimental SaO2 in all identifications (median RMSE = 1.3892%). Two clusters of parameters, associated with different dynamics related to sleep apnea and periodic breathing were obtained. CONCLUSION AND SIGNIFICANCE The proposed patient and event-specific model-based analysis provides understanding on specific desaturation patterns, consequent to apnea events, with potential applications for personalized diagnosis and treatment.
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Parametric Analysis of an Integrated Model of Cardio-respiratory Interactions in Adults in the Context of Obstructive Sleep Apnea. Ann Biomed Eng 2021; 49:3374-3387. [PMID: 34467512 DOI: 10.1007/s10439-021-02828-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
An original integrated model of cardio-respiratory interactions is presented in this paper with the objective of studying the acute physiological responses evoked by obstructive sleep apnea events in adults. A comprehensive sensitivity analysis of the model is proposed during the simulation of a 20 s obstructive apnea episode using the Morris' screening method and local sensitivity analysis. The more relevant parameters are related to the following mechanisms of the physiology: (i) the fraction of oxygen in inspired air, (ii) metabolic rates (oxygen consumption rate, CO2 production rate); (iii) chemoreflex (gains and time constants) (iv) respiratory mechanics (lung compliance and unstressed volume of air in the alveoli). These results highlight significant physiological variables that may be particularly useful for the development of novel diagnostic and therapeutic strategies, integrating a virtual patient approach.
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Owashi KP, Hubert A, Galli E, Donal E, Hernández AI, Le Rolle V. Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PLoS One 2020; 15:e0229609. [PMID: 32126071 PMCID: PMC7053724 DOI: 10.1371/journal.pone.0229609] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/10/2020] [Indexed: 11/18/2022] Open
Abstract
This paper proposes a model-based estimation of left ventricular (LV) pressure for the evaluation of constructive and wasted myocardial work of patients with aortic stenosis (AS). A model of the cardiovascular system is proposed, including descriptions of i) cardiac electrical activity, ii) elastance-based cardiac cavities, iii) systemic and pulmonary circulations and iv) heart valves. After a sensitivity analysis of model parameters, an identification strategy was implemented using a Monte-Carlo cross-validation approach. Parameter identification procedure consists in two steps for the estimation of LV pressures: step 1) from invasive, intraventricular measurements and step 2) from non-invasive data. The proposed approach was validated on data obtained from 12 patients with AS. The total relative errors between estimated and measured pressures were on average 11.9% and 12.27% and mean R2 were equal to 0.96 and 0.91, respectively for steps 1 and 2 of parameter identification strategy. Using LV pressures obtained from non-invasive measurements (step 2) and patient-specific simulations, Global Constructive (GCW), Wasted (GWW) myocardial Work and Global Work Efficiency (GWE) parameters were calculated. Correlations between measures and model-based estimations were 0.88, 0.80, 0.91 respectively for GCW, GWW and GWE. The main contributions concern the proposal of the parameter identification procedure, applied on an integrated cardiovascular model, able to reproduce LV pressure specifically to each AS patient, by non-invasive procedures, as well as a new method for the non-invasive estimation of constructive, wasted myocardial work and work efficiency in AS.
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Affiliation(s)
| | - Arnaud Hubert
- Univ Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Elena Galli
- Univ Rennes, Inserm, LTSI - UMR 1099, Rennes, France
| | - Erwan Donal
- Univ Rennes, Inserm, LTSI - UMR 1099, Rennes, France
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