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Zhu W, Xia Z, Zhou C, Wan J, Wang J, Li Y, Zhang J, Henein M, Fang F, Zhang G. Prognostic implications of residual mild coarctation gradient after interventional repair. J Clin Hypertens (Greenwich) 2024. [PMID: 39073270 DOI: 10.1111/jch.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
There is limited data on the prognostic implications of residual mild coarctation (RMC) in patients with repaired native coarctation of the aorta (CoA). To explore the association of RMC with mid-term comorbidities in post-interventional patients, and the predictive value of the residual pressure gradient. The authors retrospectively analyzed 79 native CoA patients who received successful intervention at our hospital between October 2010 and June 2023. The outcomes of the study were late arterial hypertension (either raised blood pressure or commencement of hypotensive medications) only in normotensive patients at early follow-up and the composite mid-term comorbidities including new-onset aortic injury, re-stenosis, and re-intervention. At a median follow-up of 60 months, late hypertension and mid-term comorbidities occurred in 16 (28.1%) and nine (11.4%) patients, respectively. Multivariate Cox proportional hazard regression analysis identified invasive peak systolic CoA pressure gradient (PSPG) as the best independent predictor of both outcomes. The maximally selected rank statistics indicated 10 mm Hg as the best PSPG cut-off value for predicting late hypertension. Compared to patients with PSPG < 11 mm Hg, the cumulative event rates of both outcomes were higher in those with PSPG ≥ 11 mm Hg (log-rank test, p < .001 for both endpoints). PSPG ≥ 11 mm Hg was proved to be the independent predictor of late hypertension with a significantly increased risk. In patients with non-surgical CoA repair, the post-interventional RMC and PSPG ≥11 mm Hg are important predictors of clinical comorbidities at mid-term follow-up.
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Affiliation(s)
- Wenhao Zhu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhiyuan Xia
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Congcong Zhou
- School of Global Public Health, New York University, New York, New York, USA
| | - Junyi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyu Wang
- Key Laboratory of Cardiovascular Epidemiology and Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yihang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingnan Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Michael Henein
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Gejun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Khodaei S, Abdelkhalek M, Maftoon N, Emadi A, Keshavarz-Motamed Z. Early Detection of Risk of Neo-Sinus Blood Stasis Post-Transcatheter Aortic Valve Replacement Using Personalized Hemodynamic Analysis. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100180. [PMID: 37745677 PMCID: PMC10512011 DOI: 10.1016/j.shj.2023.100180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 09/26/2023]
Abstract
Background Despite the demonstrated benefits of transcatheter aortic valve replacement (TAVR), subclinical leaflet thrombosis and hypoattenuated leaflet thickening are commonly seen as initial indications of decreased valve durability and augmented risk of transient ischemic attack. Methods We developed a multiscale patient-specific computational framework to quantify metrics of global circulatory function, metrics of global cardiac function, and local cardiac fluid dynamics of the aortic root and coronary arteries. Results Based on our findings, TAVR might be associated with a high risk of blood stagnation in the neo-sinus region due to the lack of sufficient blood flow washout during the diastole phase (e.g., maximum blood stasis volume increased by 13, 8, and 2.7 fold in the left coronary cusp, right coronary cusp, and noncoronary cusp, respectively [N = 26]). Moreover, in some patients, TAVR might not be associated with left ventricle load relief (e.g., left ventricle load reduced only by 1.2 % [N = 26]) and diastolic coronary flow improvement (e.g., maximum coronary flow reduced by 4.94%, 15.05%, and 23.59% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively, [N = 26]). Conclusions The transvalvular pressure gradient amelioration after TAVR might not translate into adequate sinus blood washout, optimal coronary flow, and reduced cardiac stress. Noninvasive personalized computational modeling can facilitate the determination of the most effective revascularization strategy pre-TAVR and monitor leaflet thrombosis and coronary plaque progression post-TAVR.
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Affiliation(s)
- Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Mohamed Abdelkhalek
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ali Emadi
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- School of Computational Science and Engineering, McMaster University, Hamilton, Ontario, Canada
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Garber L, Khodaei S, Maftoon N, Keshavarz-Motamed Z. Impact of TAVR on coronary artery hemodynamics using clinical measurements and image-based patient-specific in silico modeling. Sci Rep 2023; 13:8948. [PMID: 37268642 PMCID: PMC10238523 DOI: 10.1038/s41598-023-31987-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 06/04/2023] Open
Abstract
In recent years, transcatheter aortic valve replacement (TAVR) has become the leading method for treating aortic stenosis. While the procedure has improved dramatically in the past decade, there are still uncertainties about the impact of TAVR on coronary blood flow. Recent research has indicated that negative coronary events after TAVR may be partially driven by impaired coronary blood flow dynamics. Furthermore, the current technologies to rapidly obtain non-invasive coronary blood flow data are relatively limited. Herein, we present a lumped parameter computational model to simulate coronary blood flow in the main arteries as well as a series of cardiovascular hemodynamic metrics. The model was designed to only use a few inputs parameters from echocardiography, computed tomography and a sphygmomanometer. The novel computational model was then validated and applied to 19 patients undergoing TAVR to examine the impact of the procedure on coronary blood flow in the left anterior descending (LAD) artery, left circumflex (LCX) artery and right coronary artery (RCA) and various global hemodynamics metrics. Based on our findings, the changes in coronary blood flow after TAVR varied and were subject specific (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). Additionally, valvular pressure gradient, left ventricle (LV) workload and maximum LV pressure decreased by 61.5%, 4.5% and 13.0% respectively, while mean arterial pressure and cardiac output increased by 6.9% and 9.9% after TAVR. By applying this proof-of-concept computational model, a series of hemodynamic metrics were generated non-invasively which can help to better understand the individual relationships between TAVR and mean and peak coronary flow rates. In the future, tools such as these may play a vital role by providing clinicians with rapid insight into various cardiac and coronary metrics, rendering the planning for TAVR and other cardiovascular procedures more personalized.
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Affiliation(s)
- Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Bahadormanesh N, Tomka B, Abdelkhalek M, Khodaei S, Maftoon N, Keshavarz-Motamed Z. A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement. Sci Rep 2023; 13:8033. [PMID: 37198194 PMCID: PMC10192526 DOI: 10.1038/s41598-023-33511-6] [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: 10/21/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Given the associated risks with transcatheter aortic valve replacement (TAVR), it is crucial to determine how the implant will affect the valve dynamics and cardiac function, and if TAVR will improve or worsen the outcome of the patient. Effective treatment strategies, indeed, rely heavily on the complete understanding of the valve dynamics. We developed an innovative Doppler-exclusive non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics in patients with aortic stenosis in both pre- and post-TAVR status. Clinical Doppler pressure was reduced by TAVR (52.2 ± 20.4 vs. 17.3 ± 13.8 [mmHg], p < 0.001), but it was not always accompanied by improvements in valve dynamics and left ventricle (LV) hemodynamics metrics. TAVR had no effect on LV workload in 4 patients, and LV workload post-TAVR significantly rose in 4 other patients. Despite the group level improvements in maximum LV pressure (166.4 ± 32.2 vs 131.4 ± 16.9 [mmHg], p < 0.05), only 5 of the 12 patients (41%) had a decrease in LV pressure. Moreover, TAVR did not always improve valve dynamics. TAVR did not necessarily result in a decrease (in 9 out of 12 patients investigated in this study) in major principal stress on the aortic valve leaflets which is one of the main contributors in valve degeneration and, consequently, failure of heart valves. Diastolic stresses increased significantly post-TAVR (34%, 109% and 81%, p < 0.001) for each left, right and non-coronary leaflets respectively. Moreover, we quantified the stiffness and material properties of aortic valve leaflets which correspond with the reduced calcified region average stiffness among leaflets (66%, 74% and 62%; p < 0.001; N = 12). Valve dynamics post-intervention should be quantified and monitored to ensure the improvement of patient conditions and prevent any further complications. Improper evaluation of biomechanical valve features pre-intervention as well as post-intervention may result in harmful effects post-TAVR in patients including paravalvular leaks, valve degeneration, failure of TAVR and heart failure.
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Affiliation(s)
- Nikrouz Bahadormanesh
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | - Benjamin Tomka
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | | | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, JHE-310, Hamilton, ON, L8S 4L7, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Hiremath G, Batlivala S, Callahan R, Thatte N, Rockefeller T, Nawaytou H, Reddy SV, Hussain T, Chabiniok R, Butts R, Vettukattil J, Aregullin EO, Aldweib N, Burkhoff D, Brener MI. Clinical Applications of Pressure-Volume Assessment in Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100599. [PMID: 39130717 PMCID: PMC11307813 DOI: 10.1016/j.jscai.2023.100599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 08/13/2024]
Abstract
Ventricular pressure-volume (PV) loops offer unique insights into cardiovascular mechanics. PV loops can be instrumental in improving our understanding of various congenital heart diseases, including single ventricular physiology, heart failure, and pulmonary hypertension, as well as guiding therapeutic interventions. This review focuses on the theoretical and practical foundations for the acquisition and interpretation of PV loops in congenital heart disease and discusses their clinical applications.
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Affiliation(s)
- Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children’s Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Sarosh Batlivala
- Division of Pediatric Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ryan Callahan
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nikhil Thatte
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Toby Rockefeller
- Interventional Pediatric Cardiology, University of Missouri-Kansas City School of Medicine, Children’s Mercy, Kansas City, Missouri
| | - Hythem Nawaytou
- Department of Pediatrics, UCSF Benioff Children’s Hospital and the University of California, San Francisco, California
| | | | - Tarique Hussain
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | | | - Ryan Butts
- Pediatric Cardiology, Children’s Medical Center, Dallas, Texas
| | - Joseph Vettukattil
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - E. Oliver Aregullin
- Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Nael Aldweib
- Division of Cardiovascular Medicine, Oregon Health Sciences University, Portland, Oregon
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Michael I. Brener
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York
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Bahadormanesh N, Tomka B, Kadem M, Khodaei S, Keshavarz-Motamed Z. An ultrasound-exclusive non-invasive computational diagnostic framework for personalized cardiology of aortic valve stenosis. Med Image Anal 2023; 87:102795. [PMID: 37060702 DOI: 10.1016/j.media.2023.102795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Aortic stenosis (AS) is an acute and chronic cardiovascular disease and If left untreated, 50% of these patients will die within two years of developing symptoms. AS is characterized as the stiffening of the aortic valve leaflets which restricts their motion and prevents the proper opening under transvalvular pressure. Assessments of the valve dynamics, if available, would provide valuable information about the patient's state of cardiac deterioration as well as heart recovery and can have incredible impacts on patient care, planning interventions and making critical clinical decisions with life-threatening risks. Despite remarkable advancements in medical imaging, there are no clinical tools available to quantify valve dynamics invasively or noninvasively. In this study, we developed a highly innovative ultrasound-based non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics (e.g. transient 3-D distribution of stress and displacement, 3-D deformed shape of leaflets, geometric orifice area and angular positions of leaflets) for patients with AS at no risk to the patients. Such a diagnostic tool considers the local valve dynamics and the global circulatory system to provide a platform for testing the intervention scenarios and evaluating their effects. We used clinical data of 12 patients with AS not only to validate the proposed framework but also to demonstrate its diagnostic abilities by providing novel analyses and interpretations of clinical data in both pre and post intervention states. We used transthoracic echocardiogram (TTE) data for the developments and transesophageal echocardiography (TEE) data for validation.
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Affiliation(s)
| | - Benjamin Tomka
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Mason Kadem
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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7
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Xiao HJ, Zhan AL, Huang QW, Huang RG, Lin WH. Evaluation of the aorta in infants with simple or complex coarctation of the aorta using CT angiography. Front Cardiovasc Med 2023; 9:1034334. [PMID: 36698954 PMCID: PMC9868234 DOI: 10.3389/fcvm.2022.1034334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To assess aortic dilatation and determine its related factors in infants with coarctation of the aorta (CoA) by using computed tomography angiography (CTA). Methods The clinical data of 55 infantile patients with CoA diagnosed by CTA were analyzed retrospectively. Aortic diameters were measured at six different levels and standardized as Z scores based on the square root of body surface area. The results of simple and complex CoA were compared. Univariate and multivariate logistic regression were used to analyze the effects of sex, age, hypertension, degree of coarctation, CoA type, bicuspid aortic valve (BAV), and other factors related to aortic dilatation. Results In total, 52 infant patients with CoA were analyzed, including 22 cases of simple CoA and 30 cases of complex CoA. The ascending aorta of the infants in the simple CoA group and the complex CoA group were dilated to different degrees, but the difference was not statistically significant (50.00% vs. 73.33%, P = 0.084, and 2.05 ± 0.40 vs. 2.22 ± 0.43 P = 0.143). The infants in the complex CoA group had more aortic arch hypoplasia than those in the simple CoA group (33.33% vs. 9.09%, P = 0.042). Compared to the ventricular septal defect (VSD) group, the Z score of the ascending aorta in the CoA group was significantly higher than that in the VSD group (P = 0.023 and P = 0.000). A logistic retrospective analysis found that an increased degree of coarctation (CDR value) was an independent predictor of ascending aortic dilatation (adjusted OR = 0.002; P = 0.034). Conclusion Infants with simple or complex CoA are at risk of ascending aortic dilatation, and the factors of ascending aortic dilatation depend on the degree of coarctation. The risk of aortic dilatation in infants with CoA can be identified by CTA.
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Khodaei S, Garber L, Bauer J, Emadi A, Keshavarz-Motamed Z. Long-term prognostic impact of paravalvular leakage on coronary artery disease requires patient-specific quantification of hemodynamics. Sci Rep 2022; 12:21357. [PMID: 36494362 PMCID: PMC9734172 DOI: 10.1038/s41598-022-21104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-structure interaction model to quantify metrics of global circulatory function, metrics of global cardiac function and local cardiac fluid dynamics in 6 patients. Based on our findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow during diastole phase (e.g., maximum coronary flow rate reduced by 21.73%, 21.43% and 21.43% in the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)). Moreover, PVL may increase the LV load (e.g., LV load increased by 17.57% (N = 6)) and decrease the coronary wall shear stress (e.g., maximum wall shear stress reduced by 20.62%, 21.92%, 22.28% and 25.66% in the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)), which could promote atherosclerosis development through loss of the physiological flow-oriented alignment of endothelial cells. This study demonstrated that a rigorously developed personalized image-based computational framework can provide vital insights into underlying mechanics of TAVR and CAD interactions and assist in treatment planning and patient risk stratification in patients.
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Affiliation(s)
- Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Julia Bauer
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Ali Emadi
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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Sadeghi R, Tomka B, Khodaei S, Daeian M, Gandhi K, Garcia J, Keshavarz-Motamed Z. Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling. Sci Rep 2022; 12:9718. [PMID: 35690596 PMCID: PMC9188592 DOI: 10.1038/s41598-022-12894-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/28/2023] Open
Abstract
Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn't change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.
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Affiliation(s)
- Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Benjamin Tomka
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - MohammadAli Daeian
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Krishna Gandhi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON
| | - Julio Garcia
- grid.489011.50000 0004 0407 3514Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Cardiac Sciences, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute, Calgary, AB Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, Canada ON ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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Bhatt AB, Lantin-Hermoso MR, Daniels CJ, Jaquiss R, Landis BJ, Marino BS, Rathod RH, Vincent RN, Keller BB, Villafane J. Isolated Coarctation of the Aorta: Current Concepts and Perspectives. Front Cardiovasc Med 2022; 9:817866. [PMID: 35694677 PMCID: PMC9174545 DOI: 10.3389/fcvm.2022.817866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Current management of isolated CoA, localized narrowing of the aortic arch in the absence of other congenital heart disease, is a success story with improved prenatal diagnosis, high survival and improved understanding of long-term complication. Isolated CoA has heterogenous presentations, complex etiologic mechanisms, and progressive pathophysiologic changes that influence outcome. End-to-end or extended end-to-end anastomosis are the favored surgical approaches for isolated CoA in infants and transcatheter intervention is favored for children and adults. Primary stent placement is the procedure of choice in larger children and adults. Most adults with treated isolated CoA thrive, have normal daily activities, and undergo successful childbirth. Fetal echocardiography is the cornerstone of prenatal counseling and genetic testing is recommended. Advanced 3D imaging identifies aortic complications and myocardial dysfunction and guides individualized therapies including re-intervention. Adult CHD program enrollment is recommended. Longer follow-up data are needed to determine the frequency and severity of aneurysm formation, myocardial dysfunction, and whether childhood lifestyle modifications reduce late-onset complications.
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Affiliation(s)
- Ami B. Bhatt
- Departments of Internal Medicine and Pediatrics and Division of Cardiology, Harvard Medical School, Boston, MA, United States
| | - Maria R. Lantin-Hermoso
- Section of Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Curt J. Daniels
- Departments of Pediatrics and Internal Medicine, The Ohio State University Medical Center, Columbus, OH, United States
| | - Robert Jaquiss
- Department of Cardiovascular and Thoracic Surgery and Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Benjamin John Landis
- Department of Pediatrics and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, United States
| | - Rahul H. Rathod
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert N. Vincent
- Department of Pediatrics, New York Medical College, Valhalla, NY, United States
| | - Bradley B. Keller
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Juan Villafane
- Cincinnati Children's Heart Institute and the Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
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11
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Sadeghi R, Tomka B, Khodaei S, Garcia J, Ganame J, Keshavarz‐Motamed Z. Reducing Morbidity and Mortality in Patients With Coarctation Requires Systematic Differentiation of Impacts of Mixed Valvular Disease on Coarctation Hemodynamics. J Am Heart Assoc 2022; 11:e022664. [PMID: 35023351 PMCID: PMC9238522 DOI: 10.1161/jaha.121.022664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Despite ongoing advances in surgical techniques for coarctation of the aorta (COA) repair, the long-term results are not always benign. Associated mixed valvular diseases (various combinations of aortic and mitral valvular pathologies) are responsible for considerable postoperative morbidity and mortality. We investigated the impact of COA and mixed valvular diseases on hemodynamics. Methods and Results We developed a patient-specific computational framework. Our results demonstrate that mixed valvular diseases interact with COA fluid dynamics and contribute to speed up the progression of the disease by amplifying the irregular flow patterns downstream of COA (local) and exacerbating the left ventricular function (global) (N=26). Velocity downstream of COA with aortic regurgitation alone was increased, and the situation got worse when COA and aortic regurgitation coexisted with mitral regurgitation (COA with normal valves: 5.27 m/s, COA with only aortic regurgitation: 8.8 m/s, COA with aortic and mitral regurgitation: 9.36 m/s; patient 2). Workload in these patients was increased because of the presence of aortic stenosis alone, aortic regurgitation alone, mitral regurgitation alone, and when they coexisted (COA with normal valves: 1.0617 J; COA with only aortic stenosis: 1.225 J; COA with only aortic regurgitation: 1.6512 J; COA with only mitral regurgitation: 1.3599 J; patient 1). Conclusions Not only the severity of COA, but also the presence and the severity of mixed valvular disease should be considered in the evaluation of risks in patients. The results suggest that more aggressive surgical approaches may be required, because regularly chosen current surgical techniques may not be optimal for such patients.
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Affiliation(s)
- Reza Sadeghi
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Benjamin Tomka
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Seyedvahid Khodaei
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Julio Garcia
- Stephenson Cardiac Imaging CentreLibin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada,Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada,Department of Cardiac SciencesUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children’s Hospital Research InstituteCalgaryAlbertaCanada
| | - Javier Ganame
- Division of CardiologyDepartment of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Zahra Keshavarz‐Motamed
- Department of Mechanical EngineeringMcMaster UniversityHamiltonOntarioCanada,School of Biomedical EngineeringMcMaster UniversityHamiltonOntarioCanada,School of Computational Science and EngineeringMcMaster UniversityHamiltonOntarioCanada,The Thrombosis & Atherosclerosis Research InstituteMcMaster UniversityHamiltonOntarioCanada
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12
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On Left Ventricle Stroke Work Efficiency in Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis. Pediatr Cardiol 2022; 43:45-53. [PMID: 34357415 DOI: 10.1007/s00246-021-02690-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
The optimal timing for management of pediatric patients with moderate aortic valve disease [moderate aortic stenosis (modAS) or moderate aortic regurgitation (modAR)] remains unknown and largely unexplored. Although usually asymptomatic, the risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated moderate conditions warrants clearer risk stratification for appropriate timely intervention. In this study, we explore the use of a patient-specific mathematical model to introduce a new evaluative parameter of LV performance in patients with moderate aortic valve disease. Synthetic patient data (N = 520) representing healthy patients, and patients with modAS or modAR were first generated. Then, data from twenty-five pediatric patients were included in this study (healthy = 9; moderate AS = 8; modAR = 8). The effect of modAS or modAR on LV performance was evaluated by LV stroke work (LVSW) efficiency, a new non-invasive parameter. The results demonstrate that healthy patients possess a very high LVSW efficiency (synthetic data: 91 ± 2%, in vivo data: 92 ± 3%). However, modAS patients have a significant reduction in LVSW efficiency (synthetic data: 78 ± 2%, in vivo data: 76 ± 5%, p < 0.05), whereas modAR patients had the lowest LVSW efficiency (synthetic data: 58 ± 3%, in vivo data: 66 ± 7%; p < 0.05). This highlights that patients with moderate aortic valve disease require careful myocardial assessment, regardless of onset of clinical symptoms as their LV performance is significantly reduced. The evaluation of LVSW efficiency offers a promising avenue for future stratification of mixed aortic valve disease for optimal timing of management and intervention.
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13
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Baiocchi M, Barsoum S, Khodaei S, de la Torre Hernandez JM, Valentino SE, Dunford EC, MacDonald MJ, Keshavarz-Motamed Z. Effects of Choice of Medical Imaging Modalities on a Non-invasive Diagnostic and Monitoring Computational Framework for Patients With Complex Valvular, Vascular, and Ventricular Diseases Who Undergo Transcatheter Aortic Valve Replacement. Front Bioeng Biotechnol 2021; 9:643453. [PMID: 34307316 PMCID: PMC8297508 DOI: 10.3389/fbioe.2021.643453] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Due to the high individual differences in the anatomy and pathophysiology of patients, planning individualized treatment requires patient-specific diagnosis. Indeed, hemodynamic quantification can be immensely valuable for accurate diagnosis, however, we still lack precise diagnostic methods for numerous cardiovascular diseases including complex (and mixed) valvular, vascular, and ventricular interactions (C3VI) which is a complicated situation made even more challenging in the face of other cardiovascular pathologies. Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. In a recent paper, we developed a non-invasive and Doppler-based diagnostic and monitoring computational mechanics framework for C3VI, called C3VI-DE that uses input parameters measured reliably using Doppler echocardiography. In the present work, we have developed another computational-mechanics framework for C3VI (called C3VI-CT). C3VI-CT uses the same lumped-parameter model core as C3VI-DE but its input parameters are measured using computed tomography and a sphygmomanometer. Both frameworks can quantify: (1) global hemodynamics (metrics of cardiac function); (2) local hemodynamics (metrics of circulatory function). We compared accuracy of the results obtained using C3VI-DE and C3VI-CT against catheterization data (gold standard) using a C3VI dataset (N = 49) for patients with C3VI who undergo TAVR in both pre and post-TAVR with a high variability. Because of the dataset variability and the broad range of diseases that it covers, it enables determining which framework can yield the most accurate results. In contrast with C3VI-CT, C3VI-DE tracks both the cardiac and vascular status and is in great agreement with cardiac catheter data.
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Affiliation(s)
- Melissa Baiocchi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Shirley Barsoum
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | | | | | - Emily C Dunford
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | | | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.,School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.,School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada
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14
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Khodaei S, Henstock A, Sadeghi R, Sellers S, Blanke P, Leipsic J, Emadi A, Keshavarz-Motamed Z. Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework. Sci Rep 2021; 11:10888. [PMID: 34035325 PMCID: PMC8149684 DOI: 10.1038/s41598-021-85500-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
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Affiliation(s)
- Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Alison Henstock
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Stephanie Sellers
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Philipp Blanke
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Jonathon Leipsic
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Ali Emadi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
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15
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Ghorbanniahassankiadeh A, Marks DS, LaDisa JF. Correlation of Computational Instantaneous Wave-Free Ratio With Fractional Flow Reserve for Intermediate Multivessel Coronary Disease. J Biomech Eng 2021; 143:051011. [PMID: 33454732 DOI: 10.1115/1.4049746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Indexed: 01/14/2023]
Abstract
This study computationally assesses the accuracy of an instantaneous wave-free ratio (iFR) threshold range compared to standard modalities such as fractional flow reserve (FFR) and coronary flow reserve (CFR) for multiple intermediate lesions near the left main (LM) coronary bifurcation. iFR is an adenosine-independent index encouraged for assessment of coronary artery disease (CAD), but different thresholds are debated. This becomes particularly challenging in cases of multivessel disease when sensitivity to downstream lesions is unclear. Idealized LM coronary arteries with 34 different intermediate stenoses were created and categorized (Medina) as single and multiple lesion groups. Computational fluid dynamics modeling was performed with physiologic boundary conditions using an open-source software (simvascular1) to solve the time-dependent Navier-Stokes equations. A strong linear relationship between iFR and FFR was observed among studied models, indicating computational iFR values of 0.92 and 0.93 are statistically equivalent to an FFR of 0.80 in single and multiple lesion groups, respectively. At the clinical FFR value (i.e., 0.8), a triple-lesion group had smaller CFR compared to the single and double lesion groups (e.g., triple = 3.077 versus single = 3.133 and double = 3.132). In general, the effect of additional intermediate downstream lesions (minimum lumen area > 3 mm2) was not statistically significant for iFR and CFR. A computational iFR of 0.92 best predicts an FFR of 0.80 and may be recommended as threshold criteria for computational assessment of LM stenosis following additional validation using patient-specific models.
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Affiliation(s)
- Arash Ghorbanniahassankiadeh
- Department of Biomedical Engineering, Medical College of Wisconsin and Marquette University, 8701 W Watertown Plank Road, Milwaukee, WI 53226
| | - David S Marks
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226
| | - John F LaDisa
- Department of Biomedical Engineering, Medical College of Wisconsin and Marquette University, 8701 W Watertown Plank Road, Milwaukee, WI 53226; Department of Physiology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226; Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI 53226
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16
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Panzer J, De Somer F, Segers P, De Wolf D, Bove T. Effect of aortic stiffness versus stenosis on ventriculo-arterial interaction in an experimental model of coarctation repair. Eur J Cardiothorac Surg 2020; 58:1206-1215. [PMID: 32862227 DOI: 10.1093/ejcts/ezaa241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the effect of short- versus long-segment aortic stiffness and stenosis on ventriculo-arterial interaction in a porcine model of coarctation repair. METHODS Short-long aortic stiffness was created by transection/suture [coarctation (CoA) suture, n = 6] and stenting (stent, n = 5) of the proximal descending aorta. Short-long aortic stenosis was achieved by wrapping a prosthetic graft around the aorta to 1/3-circumference reduction, over a segment length of 1 cm (CoA suture stenosis, n = 5) and 4.5 cm (stent stenosis, n = 6). After 3 months, aortic pressure-flow haemodynamics, aortic distensibility by intravascular ultrasound and left ventricular performance by pressure-volume loops were compared to a Sham group (n = 5) at baseline and during dobutamine administration. RESULTS The aortic impedance increased with 30.3 (12.6%) and 41.3 (20.9%) (P < 0.001) in CoA stenosis and stent stenosis during inotropic response. Impaired haemodynamic aortic compliance was associated with lower aortic distensibility by intravascular ultrasound, specifically in long-segment stenosis. The ventriculo-arterial coupling was disturbed in both groups with stenosis, with blunted contractile response [Sham 140.3 (19.8%), CoA suture 101.3 (14.5%), CoA suture stenosis 75.0 (8.4%), stent 115.5 (12.7%), stent stenosis 55.1 (14.6%), P < 0.001] and increased myocardial stiffness during dobutamine in the long-segment aortic stenosis group [Sham -26.0 (12.9%), CoA suture -27.5 (15.9%), CoA stenosis -9.5 (8.6%), stent -23.4 (4.8%), stent stenosis 19.9 (23.1%), P < 0.001]. CONCLUSIONS This animal study on the sequelae of coarctation repair demonstrated that aortic stiffness had little effect on aortic pressure-flow characteristics in the absence of stenosis. However, the negative chronic effect of stenosis on aortic haemodynamics-especially a longer segment-leads to the rapid impairment of ventriculo-arterial interaction, which is accentuated by inotropy. Therefore, therapeutical management needs to focus on improving aortic remodelling after coarctation repair, preferably by minimizing residual stenosis, even at the cost of inducing aortic stiffness.
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Affiliation(s)
- Joseph Panzer
- Experimental Research Laboratory of Cardiac Surgery and Circulatory Physiology, Faculty of Medical Sciences, Ghent University, Ghent, Belgium.,Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Filip De Somer
- Experimental Research Laboratory of Cardiac Surgery and Circulatory Physiology, Faculty of Medical Sciences, Ghent University, Ghent, Belgium.,Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Patrick Segers
- IBiTech-bioMMeda, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Thierry Bove
- Experimental Research Laboratory of Cardiac Surgery and Circulatory Physiology, Faculty of Medical Sciences, Ghent University, Ghent, Belgium.,Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
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17
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Aragão NFDDV, Borgo JNV, Jesus CAD, Davoglio T, Armstrong ADC, Barretto RBDM, Le Bihan D, Assef JE, Pedra CAC, Pedra SRFF. Myocardial strain pattern progress in patients with Coarctation of the Aorta undergoing aortic stenting. Echocardiography 2020; 38:64-71. [PMID: 33231891 DOI: 10.1111/echo.14937] [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: 05/09/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND AIM Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting. METHODS The study included 21 patients with CoA (median age: 15 years [8-39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm-leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested. RESULTS Before treatment, patients with CoA had lower LV GLS than the control group (-18.4% ± 1.96 vs -21.5% ± 1.37; P < .01), showing significant increase to -19.4% ± 2.1 at 6 months and -20.7% ± 2.19 at 1 year, P < .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = -0.571; P = .007). CONCLUSION Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.
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Affiliation(s)
| | | | | | - Tathiane Davoglio
- Division of Congenital Heart Disease, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | | | - David Le Bihan
- Echocardiography Laboratory, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Jorge Eduardo Assef
- Echocardiography Laboratory, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Carlos Augusto Cardoso Pedra
- Catheterization Laboratory for Congenital Heart Disease, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
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18
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Ben-Assa E, Brown J, Keshavarz-Motamed Z, de la Torre Hernandez JM, Leiden B, Olender M, Kallel F, Palacios IF, Inglessis I, Passeri JJ, Shah PB, Elmariah S, Leon MB, Edelman ER. Ventricular stroke work and vascular impedance refine the characterization of patients with aortic stenosis. Sci Transl Med 2020; 11:11/509/eaaw0181. [PMID: 31511424 DOI: 10.1126/scitranslmed.aaw0181] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/20/2019] [Accepted: 07/29/2019] [Indexed: 12/24/2022]
Abstract
Aortic stenosis (AS) management is classically guided by symptoms and valvular metrics. However, the natural history of AS is dictated by coupling of the left ventricle, aortic valve, and vascular system. We investigated whether metrics of ventricular and vascular state add to the appreciation of AS state above valve gradient alone. Seventy patients with severe symptomatic AS were prospectively followed from baseline to 30 days after transcatheter aortic valve replacement (TAVR). Quality of life (QOL) was assessed using the Kansas City Cardiomyopathy Questionnaire. Left ventricular stroke work (SWLV) and vascular impedance spectrums were calculated noninvasively using in-house models based on central blood pressure waveforms, along with hemodynamic parameters from echocardiograms. Patients with higher preprocedural SWLV and lower vascular impedance were more likely to experience improved QOL after TAVR. Patients fell into two categories: those who did and those who did not exhibit increase in blood pressure after TAVR. In patients who developed hypertension (19%), vascular impedance increased and SWLV remained unchanged (impedance at zeroth harmonic: Z 0, from 3964.4 to 4851.8 dyne·s/cm3, P = 0.039; characteristic impedance: Z c, from 376.2 to 603.2 dyne·s/cm3, P = 0.033). SWLV dropped only in patients who did not develop new hypertension after TAVR (from 1.58 to 1.26 J; P < 0.001). Reduction in valvular pressure gradient after TAVR did not predict change in SWLV (r = 0.213; P = 0.129). Reduction of SWLV after TAVR may be an important metric in management of AS, rather than relying solely on the elimination of transvalvular pressure gradients.
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Affiliation(s)
- Eyal Ben-Assa
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA. .,Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.,Cardiology Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv 6423906, Israel
| | - Jonathan Brown
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Zahra Keshavarz-Motamed
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA.,Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S4L7, Canada
| | - Jose M de la Torre Hernandez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA.,Hospital Universitario Marques de Valdecilla, IDIVAL, Santander 39008, Spain
| | - Benjamin Leiden
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Max Olender
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | | | - Igor F Palacios
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ignacio Inglessis
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jonathan J Passeri
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Pinak B Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Martin B Leon
- Columbia University Medical Center, New York-Presbyterian Hospital, NY 10032, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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19
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Sadeghi R, Khodaei S, Ganame J, Keshavarz-Motamed Z. Towards non-invasive computational-mechanics and imaging-based diagnostic framework for personalized cardiology for coarctation. Sci Rep 2020; 10:9048. [PMID: 32493936 PMCID: PMC7271217 DOI: 10.1038/s41598-020-65576-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
Coarctation of the aorta (COA) is a congenital narrowing of the proximal descending aorta. Although accurate and early diagnosis of COA hinges on blood flow quantification, proper diagnostic methods for COA are still lacking because fluid-dynamics methods that can be used for accurate flow quantification are not well developed yet. Most importantly, COA and the heart interact with each other and because the heart resides in a complex vascular network that imposes boundary conditions on its function, accurate diagnosis relies on quantifications of the global hemodynamics (heart-function metrics) as well as the local hemodynamics (detailed information of the blood flow dynamics in COA). In this study, to enable the development of new non-invasive methods that can quantify local and global hemodynamics for COA diagnosis, we developed an innovative fast computational-mechanics and imaging-based framework that uses Lattice Boltzmann method and lumped-parameter modeling that only need routine non-invasive clinical patient data. We used clinical data of patients with COA to validate the proposed framework and to demonstrate its abilities to provide new diagnostic analyses not possible with conventional diagnostic methods. We validated this framework against clinical cardiac catheterization data, calculations using the conventional finite-volume method and clinical Doppler echocardiographic measurements. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
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Affiliation(s)
- Reza Sadeghi
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada
| | - Javier Ganame
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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20
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Keshavarz-Motamed Z. A diagnostic, monitoring, and predictive tool for patients with complex valvular, vascular and ventricular diseases. Sci Rep 2020; 10:6905. [PMID: 32327673 PMCID: PMC7181740 DOI: 10.1038/s41598-020-63728-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/31/2020] [Indexed: 01/03/2023] Open
Abstract
Hemodynamics quantification is critically useful for accurate and early diagnosis, but we still lack proper diagnosticmethods for many cardiovascular diseases. Furthermore, as most interventions intend to recover the healthy condition, the ability to monitor and predict hemodynamics following interventions can have significant impacts on saving lives. Predictive methods are rare, enabling prediction of effects of interventions, allowing timely and personalized interventions and helping critical clinical decision making about life-threatening risks based on quantitative data. In this study, an innovative non-invasive imaged-based patient-specific diagnostic, monitoring and predictive tool (called C3VI-CMF) was developed, enabling quantifying (1) details of physiological flow and pressures through the heart and circulatory system; (2) heart function metrics. C3VI-CMF also predicts the breakdown of the effects of each disease constituents on the heart function. Presently, neither of these can be obtained noninvasively in patients and when invasive procedures are undertaken, the collected metrics cannot be by any means as complete as the ones C3VI-CMF provides. C3VI-CMF purposefully uses a limited number of noninvasive input parameters all of which can be measured using Doppler echocardiography and sphygmomanometer. Validation of C3VI-CMF, against cardiac catheterization in forty-nine patients with complex cardiovascular diseases, showed very good agreement with the measurements.
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Affiliation(s)
- Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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21
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Keshavarz-Motamed Z, Khodaei S, Rikhtegar Nezami F, Amrute JM, Lee SJ, Brown J, Ben-Assa E, Garcia Camarero T, Ruano Calvo J, Sellers S, Blanke P, Leipsic J, de la Torre Hernandez JM, Edelman ER. Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based Patient-Specific In Silico Modeling. J Am Heart Assoc 2020; 9:e015063. [PMID: 32106747 PMCID: PMC7335548 DOI: 10.1161/jaha.119.015063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Mixed valvular disease (MVD), mitral regurgitation (MR) from pre‐existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre‐existing MVD, PVL, LV, and post‐TAVR recovery is meager. Methods and Results We quantified the effects of MVD on valvular‐ventricular hemodynamics using an image‐based patient‐specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P<0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post‐TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post‐TAVR. MR worsened in 32 patients post‐TAVR and did not improve in 18 other patients. Conclusions PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post‐TAVR, most MVD patients (75% of N=72; P<0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre‐existing MR condition (60% of N=48; P<0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.
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Affiliation(s)
- Zahra Keshavarz-Motamed
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada.,Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering McMaster University Hamilton Ontario Canada
| | - Farhad Rikhtegar Nezami
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Junedh M Amrute
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Division of Biology and Biological Engineering California Institute of Technology Pasadena CA
| | | | - Jonathan Brown
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA
| | - Eyal Ben-Assa
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiology Division Massachusetts General Hospital
| | | | | | - Stephanie Sellers
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Philipp Blanke
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jonathon Leipsic
- St. Paul's Hospital Vancouver British Columbia Canada.,Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Jose M de la Torre Hernandez
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Hospital Universitario Marques de Valdecilla IDIVAL Santander Spain
| | - Elazer R Edelman
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA.,Cardiovascular Division Brigham and Women's Hospital
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22
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Patient-specific non-invasive estimation of pressure gradient across aortic coarctation using magnetic resonance imaging. J Cardiol 2019; 73:544-552. [PMID: 30709715 DOI: 10.1016/j.jjcc.2018.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/05/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Non-invasive estimation of the pressure gradient in aortic coarctation has much clinical importance in assisting the diagnosis and treatment of the disease. Previous researchers applied computational fluid dynamics for the prediction of the pressure gradient in aortic coarctation. The accuracy of the prediction was satisfactory but the procedure was time-consuming and resource-demanding. METHOD In this research a magnetic resonance imaging (MRI)-based non-invasive modeling procedure is implemented to predict the pressure gradient in 14 patient cases of aortic coarctation. Multi-cycle patient flow and pressure data are processed to produce the flow and pressure conditions in the patient cases. Bernoulli equation-based friction loss model combined with the inertial effect of the blood flow in the vessel segments are applied to model the pressure gradient in the aortic coarctation. The model-predicted pressure gradient data are then compared with the catheter in vivo measurement data for validation. RESULTS The MRI-based model prediction technique produces results that are consistent with those from the catheter measurement, based on the criteria of both the cycle-averaged instantaneous pressure gradient and the peak-to-peak pressure gradient. CONCLUSION This study suggests that the MRI-based non-invasive modeling procedure has much potential to be applied in clinical practice for the prediction of the pressure gradient in aortic coarctation patients.
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Krishnamurthy Y, Stefanescu Schmidt AC, Bittner DO, Scholtz JE, Bui A, Reddy R, Youniss MA, Donohoe K, Flannery LD, Fahed AC, Ghoshhajra BB, DeFaria Yeh D, Bhatt AB. Subclinical Burden of Coronary Artery Calcium in Patients With Coarctation of the Aorta. Am J Cardiol 2019; 123:323-328. [PMID: 30424867 DOI: 10.1016/j.amjcard.2018.10.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 12/20/2022]
Abstract
Coronary computed tomography (CT) angiography is often performed in adults with coarctation of the aorta (CoA) for anatomic assessment. As this population ages, assessment of atherosclerotic cardiovascular disease burden is important. Thus, quantitative and qualitative coronary artery calcium (CAC) scores were assessed for patients with CoA ≥16 years of age, who were seen at a referral center. CoA patients had either coronary CT angiography or chest CT with interpretable coronary information performed for clinical indications (follow-up, preoperative, or for symptoms) from 2004 to 2017. Qualitative CAC was determined based on low-dose CT and lung cancer screening protocols. Quantitative CAC scores were compared with an age- and gender-matched control cohort of patients chosen from an emergency department database of patients who received coronary CT angiography for chest pain evaluation. Atherosclerotic cardiovascular disease 10-year predicted risk scores were calculated for both cohorts. Out of 131 patients with CoA (mean age 46.1 ± 15.3 years), 22 patients (17%) had multivessel atherosclerotic disease on qualitative assessment. In the subgroup of patients ≥40 years, those with CoA were more likely to have a quantitative CAC score ≥400 compared with those without CoA (14% vs 4%, p = 0.02). Median atherosclerotic cardiovascular disease risk score was 8% (interquartile range 2% to 12%) for CoA patients ≥40 years, and 5% (interquartile range 2% to 9%) for patient without CoA ≥40 years. In conclusion, we determined that CoA patients have subclinical atherosclerosis identifiable on CT in high rates when compared with patients without CoA. Atherosclerotic cardiovascular disease should be assessed in these patients for prevention and treatment.
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Affiliation(s)
| | - Ada C Stefanescu Schmidt
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel O Bittner
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Jan-Erik Scholtz
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Bui
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajesh Reddy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mohamed A Youniss
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kendall Donohoe
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura D Flannery
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Akl C Fahed
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Doreen DeFaria Yeh
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Ami B Bhatt
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Abstract
Computational cardiology is the scientific field devoted to the development of methodologies that enhance our mechanistic understanding, diagnosis and treatment of cardiovascular disease. In this regard, the field embraces the extraordinary pace of discovery in imaging, computational modeling, and cardiovascular informatics at the intersection of atherogenesis and vascular biology. This paper highlights existing methods, practices, and computational models and proposes new strategies to support a multidisciplinary effort in this space. We focus on the means by that to leverage and coalesce these multiple disciplines to advance translational science and computational cardiology. Analyzing the scientific trends and understanding the current needs we present our perspective for the future of cardiovascular treatment.
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25
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Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e348-e392. [DOI: 10.1161/cir.0000000000000535] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
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