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Manchester EL, Pirola S, Pirola S, Mastroiacovo G, Polvani G, Pontone G, Xu XY. Aortic valve neocuspidization and bioprosthetic valves: Evaluating turbulence haemodynamics. Comput Biol Med 2024; 171:108123. [PMID: 38354498 DOI: 10.1016/j.compbiomed.2024.108123] [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] [Received: 09/12/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Aortic valve disease is often treated with bioprosthetic valves. An alternative treatment is aortic valve neocuspidization which is a relatively new reparative procedure whereby the three aortic cusps are replaced with patient pericardium or bovine tissues. Recent research indicates that aortic blood flow is disturbed, and turbulence effects have yet to be evaluated in either bioprosthetic or aortic valve neocuspidization valve types in patient-specific settings. The aim of this study is to better understand turbulence production in the aorta and evaluate its effects on laminar and turbulent wall shear stress. Four patients with aortic valve disease were treated with either bioprosthetic valves (n=2) or aortic valve neocuspidization valvular repair (n=2). Aortic geometries were segmented from magnetic resonance images (MRI), and 4D flow MRI was used to derive physiological inlet and outlet boundary conditions. Pulsatile large-eddy simulations were performed to capture the full range of laminar, transitional and turbulence characteristics in the aorta. Turbulence was produced in all aortas with highest levels occurring during systolic deceleration. In the ascending aorta, turbulence production is attributed to a combination of valvular skew, valvular eccentricity, and ascending aortic dilation. In the proximal descending thoracic aorta, turbulence production is dependent on the type of arch-descending aorta connection (e.g., a narrowing or sharp bend) which induces flow separation. Laminar and turbulent wall shear stresses are of similar magnitude throughout late systolic deceleration and diastole, although turbulent wall shear stress magnitudes exceed laminar wall shear stresses between 27.3% and 61.1% of the cardiac cycle. This emphasises the significance of including turbulent wall shear stress to improve our comprehension of progressive arterial wall diseases. The findings of this study recommend that aortic valve treatments should prioritise minimising valvular eccentricity and skew in order to mitigate turbulence generation.
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Affiliation(s)
- Emily Louise Manchester
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of Fluids and Environment, The University of Manchester, Manchester, United Kingdom.
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands.
| | - Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom.
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Zoghbi WA, Jone PN, Chamsi-Pasha MA, Chen T, Collins KA, Desai MY, Grayburn P, Groves DW, Hahn RT, Little SH, Kruse E, Sanborn D, Shah SB, Sugeng L, Swaminathan M, Thaden J, Thavendiranathan P, Tsang W, Weir-McCall JR, Gill E. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024; 37:2-63. [PMID: 38182282 DOI: 10.1016/j.echo.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
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Affiliation(s)
- William A Zoghbi
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas.
| | - Pei-Ni Jone
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois
| | | | - Tiffany Chen
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Grayburn
- Baylor Scott & White Health, University of Texas Southwestern, Dallas, Texas
| | - Daniel W Groves
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | - Stephen H Little
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | | | - Sangeeta B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
| | - Madhav Swaminathan
- Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, North Carolina
| | | | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
| | | | - Edward Gill
- University of Colorado School of Medicine, Aurora, Colorado
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3
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Mansoor O, Garcia J. Clinical Use of Blood Flow Analysis through 4D-Flow Imaging in Aortic Valve Disease. J Cardiovasc Dev Dis 2023; 10:251. [PMID: 37367416 DOI: 10.3390/jcdd10060251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Bicuspid aortic valve (BAV), which affects 1% of the general population, results from the abnormal fusion of the cusps of the aortic valve. BAV can lead to the dilatation of the aorta, aortic coarctation, development of aortic stenosis (AS), and aortic regurgitation. Surgical intervention is usually recommended for patients with BAV and bicuspid aortopathy. This review aims to examine 4D-flow imaging as a tool in cardiac magnetic resonance imaging for assessing abnormal blood flow and its clinical application in BAV and AS. We present a historical clinical approach summarizing evidence of abnormal blood flow in aortic valve disease. We highlight how abnormal flow patterns can contribute to the development of aortic dilatation and novel flow-based biomarkers that can be used for a better understanding of the disease progression.
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Affiliation(s)
- Omer Mansoor
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Julio Garcia
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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4
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Nowak M, Divo E, Adamczyk WP. Multiscale model for blood flow after a bileaflet artificial aortic valve implantation. Comput Biol Med 2023; 158:106805. [PMID: 37019010 DOI: 10.1016/j.compbiomed.2023.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
Cardiovascular diseases are the leading cause of mortality in the world, mainly due to atherosclerosis and its consequences. The article presents the numerical model of the blood flow through artificial aortic valve. The overset mesh approach was applied to simulate the valve leaflets motion and to realize the moving mesh, in the aortic arch and the main branches of cardiovascular system. To capture the cardiac system's response and the effect of vessel compliance on the outlet pressure, the lumped parameter model has been also included within the solution procedure. Three different turbulence modeling approaches were used and compared - the laminar, k-ϵ and k-ω model. The simulation results were also compared with the model excluding the moving valve geometry and the importance of the lumped parameter model for the outlet boundary condition was analyzed. Proposed numerical model and protocol was found as suitable for performing the virtual operations on the real patient vasculature geometry. The time-efficient turbulence model and overall solving procedure allows to support the clinicians in making decisions about the patient treatment and to predict the results of the future surgery.
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Kazemi A, Padgett DA, Callahan S, Stoddard M, Amini AA. Relative pressure estimation from 4D flow MRI using generalized Bernoulli equation in a phantom model of arterial stenosis. MAGMA (NEW YORK, N.Y.) 2022; 35:733-748. [PMID: 35175449 DOI: 10.1007/s10334-022-01001-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Arterial stenosis is a significant cardiovascular disease requiring accurate estimation of the pressure gradients for determining hemodynamic significance. In this paper, we propose Generalized Bernoulli Equation (GBE) utilizing interpolated-based method to estimate relative pressures using streamlines and pathlines from 4D Flow MRI. METHODS 4D Flow MRI data in a stenotic phantom model and computational fluid dynamics simulated velocities generated under identical flow conditions were processed by Generalized Bernoulli Equation (GBE), Reduced Bernoulli Equations (RBE), as well as the Simple Bernoulli Equation (SBE) which is clinically prevalent. Pressures derived from 4D flow MRI and noise corrupted CFD velocities were compared with pressures generated directly with CFD as well as pressures obtained using Millar catheters under identical flow conditions. RESULTS It was found that SBE and RBE methods underestimated the relative pressure for lower flow rates while overestimating the relative pressure at higher flow rates. Specifically, compared to the reference pressure, SBE underestimated the maximum relative pressure by 22[Formula: see text] for a pulsatile flow data with peak flow rate [Formula: see text] and overestimated by around 40[Formula: see text] when [Formula: see text]. In contrast, for GBE method the relative pressure values were overestimated by 15[Formula: see text] with [Formula: see text]and around 10[Formula: see text] with [Formula: see text]. CONCLUSION GBE methods showed robust performance to additive image noise compared to other methods. Our findings indicate that GBE pressure estimation over pathlines attains the highest level of accuracy compared to GBE over streamlines, and the SBE and RBE methods.
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Affiliation(s)
- Amirkhosro Kazemi
- Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
- Robley Rex VA Medical Center, Louisville, KY, USA
| | | | - Sean Callahan
- Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
- Robley Rex VA Medical Center, Louisville, KY, USA
| | - Marcus Stoddard
- Cardiovascular Division, University of Louisville, Louisville, KY, USA
- Robley Rex VA Medical Center, Louisville, KY, USA
| | - Amir A Amini
- Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA.
- Robley Rex VA Medical Center, Louisville, KY, USA.
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Nolte D, Bertoglio C. Inverse problems in blood flow modeling: A review. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3613. [PMID: 35526113 PMCID: PMC9541505 DOI: 10.1002/cnm.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/29/2021] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Mathematical and computational modeling of the cardiovascular system is increasingly providing non-invasive alternatives to traditional invasive clinical procedures. Moreover, it has the potential for generating additional diagnostic markers. In blood flow computations, the personalization of spatially distributed (i.e., 3D) models is a key step which relies on the formulation and numerical solution of inverse problems using clinical data, typically medical images for measuring both anatomy and function of the vasculature. In the last years, the development and application of inverse methods has rapidly expanded most likely due to the increased availability of data in clinical centers and the growing interest of modelers and clinicians in collaborating. Therefore, this work aims to provide a wide and comparative overview of literature within the last decade. We review the current state of the art of inverse problems in blood flows, focusing on studies considering fully dimensional fluid and fluid-solid models. The relevant physical models and hemodynamic measurement techniques are introduced, followed by a survey of mathematical data assimilation approaches used to solve different kinds of inverse problems, namely state and parameter estimation. An exhaustive discussion of the literature of the last decade is presented, structured by types of problems, models and available data.
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Affiliation(s)
- David Nolte
- Bernoulli InstituteUniversity of GroningenGroningenThe Netherlands
- Center for Mathematical ModelingUniversidad de ChileSantiagoChile
- Department of Fluid DynamicsTechnische Universität BerlinBerlinGermany
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7
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Tasca G, Sturla F, Jaworek M, Giese D, Menicanti L, Vismara R, Lombardi M, Redaelli A. In vitro four-dimensional flow magnetic resonance analysis of the effect of pericardial valve design on aortic flow. J Med Eng Technol 2022; 46:209-219. [DOI: 10.1080/03091902.2022.2026505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Giordano Tasca
- Cardiac Surgery Department, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Sturla
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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8
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Geeraert P, Jamalidinan F, Burns F, Jarvis K, Bristow MS, Lydell C, Hidalgo Tobon SS, de Celis Alonso B, Fedak PWM, White JA, Garcia J. Hemodynamic Assessment in Bicuspid Aortic Valve Disease and Aortic Dilation: New Insights From Voxel-By-Voxel Analysis of Reverse Flow, Stasis, and Energetics. Front Bioeng Biotechnol 2022; 9:725113. [PMID: 35096784 PMCID: PMC8793887 DOI: 10.3389/fbioe.2021.725113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/27/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Clinical management decisions surrounding ascending aorta (AAo) dilation in bicuspid aortic valve (BAV) disease benefit from personalized predictive tools. 4D-flow MRI may provide patient-specific markers reflective of BAV-associated aortopathy. This study aims to explore novel 4D-flow MRI parametric voxel-by-voxel forward flow, reverse flow, kinetic energy and stasis in BAV disease. We hypothesize that novel parametric voxel-by-voxel markers will be associated with aortic dilation and referral for surgery and can enhance our understanding of BAV hemodynamics beyond standard metrics. Methods: A total of 96 subjects (73 BAV patients, 23 healthy controls) underwent MRI scan. Healthy controls had no known cardiovascular disease. Patients were clinically referred for AAo dilation assessment. Indexed diameters were obtained by dividing the aortic diameter by the patient’s body surface area. Patients were followed for the occurrence of aortic surgery. 4D-flow analysis was performed by a single observer in five regions: left ventricular outflow tract (LVOT), AAo, arch, proximal descending aorta (PDAo), and distal descending aorta (DDAo). In each region peak velocity, kinetic energy (KE), forward flow (FF), reverse flow (RF), and stasis were measured on a voxel-by-voxel basis. T-tests (or non-parametric equivalent) compared flow parameters between cohorts. Univariate and multivariate analyses explored associations between diameter and parametric voxel-by-voxel parameters. Results: Compared to controls, BAV patients showed reduced stasis (p < 0.01) and increased RF and FF (p < 0.01) throughout the aorta, and KE remained similar. In the AAo, indexed diameter correlated with age (R = 0.326, p = 0.01), FF (R = −0.648, p < 0.001), RF (R = −0.441, p < 0.001), and stasis (R = −0.288, p < 0.05). In multivariate analysis, FF showed a significant inverse association with AAo indexed diameter, independent of age. During a median 179 ± 180 days of follow-up, 23 patients (32%) required aortic surgery. Compared to patients not requiring surgery, they showed increased KE and peak velocity in the proximal aorta (p < 0.01), accompanied by increased RF and reduced stasis throughout the entire aorta (p < 0.01). Conclusion: Novel voxel-by-voxel reverse flow and stasis were altered in BAV patients and are associated with aortic dilation and surgical treatment.
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Affiliation(s)
- Patrick Geeraert
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fatemehsadat Jamalidinan
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Fiona Burns
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Kelly Jarvis
- Department of Radiology, Northwestern University, Chicago, IL, United States
| | - Michael S. Bristow
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Carmen Lydell
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Benito de Celis Alonso
- Faculty of Mathematical and Physical Sciences, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
| | - Paul W. M. Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - James A. White
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Julio Garcia,
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De Marinis D, Obrist D. Data Assimilation by Stochastic Ensemble Kalman Filtering to Enhance Turbulent Cardiovascular Flow Data From Under-Resolved Observations. Front Cardiovasc Med 2021; 8:742110. [PMID: 34796213 PMCID: PMC8594566 DOI: 10.3389/fcvm.2021.742110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
We propose a data assimilation methodology that can be used to enhance the spatial and temporal resolution of voxel-based data as it may be obtained from biomedical imaging modalities. It can be used to improve the assessment of turbulent blood flow in large vessels by combining observed data with a computational fluid dynamics solver. The methodology is based on a Stochastic Ensemble Kalman Filter (SEnKF) approach and geared toward pulsatile and turbulent flow configurations. We describe the observed flow fields by a mean value and its covariance. These flow fields are combined with forecasts obtained from a direct numerical simulation of the flow field. The method is validated against canonical pulsatile and turbulent flows. Finally, it is applied to a clinically relevant configuration, namely the flow downstream of a bioprosthetic valve in an aorta phantom. It is demonstrated how the 4D flow field obtained from experimental observations can be enhanced by the data assimilation algorithm. Results show that the presented method is promising for future use with in vivo data from 4D Flow Magnetic Resonance Imaging (4D Flow MRI). 4D Flow MRI returns spatially and temporally averaged flow fields that are limited by the spatial and the temporal resolution of the tool. These averaged flow fields and the associated uncertainty might be used as observation data in the context of the proposed methodology.
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Affiliation(s)
- Dario De Marinis
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Dipartimento di Meccanica, Matematica e Management and Centro di Eccellenza in Meccanica Computazionale, Politecnico di Bari, Bari, Italy
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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10
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Geeraert P, Jamalidinan F, Fatehi Hassanabad A, Sojoudi A, Bristow M, Lydell C, Fedak PW, White JA, Garcia J. Bicuspid aortic valve disease is associated with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta: A cross-sectional study. Medicine (Baltimore) 2021; 100:e26518. [PMID: 34190185 PMCID: PMC8257908 DOI: 10.1097/md.0000000000026518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 06/10/2021] [Indexed: 01/15/2023] Open
Abstract
Bicuspid aortic valve (BAV) disease has significant gaps in its clinical management practices. To highlight the potential utility of advanced hemodynamic biomarkers in strengthening BAV assessment, we used 4-dimentional flow magnetic resonance imaging to investigate altered hemodynamics in the ascending aorta (AAo).A total of 32 healthy controls and 53 age-matched BAV patients underwent cardiac magnetic resonance imaging at 3T, with cine imaging and 4D-flow. Analysis planes were placed along 3D-segmented aortas at the left ventricular outflow tract (LVOT), sinuses of Valsalva, mid-ascending aorta (MAA), and proximal to the first aortic branch. Locations were analyzed for aortic diameter (normalized to body surface area), pressure drop (PD), viscous energy loss (EL), and wall shear stress (WSS) sub-vectors (axial wall shear stress, circumferential wall shear stress [WSSC], magnitude wall shear stress). Student's t tests, or non-parametric equivalents, compared parameters between cohorts. Univariable and multivariable analyses explored the associations of AAo diameter with hemodynamics within the BAV cohort.Compared to control cohort, BAV patients showed significantly greater PD (MAA: 9.5 ± 8.0 vs 2.8 ± 2.4 mm Hg; P < .01), EL (from LVOT-AA1: 7.39 ± 4.57 mW vs 2.90 ± 1.07 mW; P < .01), and WSSC (MAA: 0.3 ± 0.1 vs 0.2 ± 0.06 Pa; P ≤ .01) throughout the AAo. Correlational analyses revealed an inverse association between AAo diameter and both magnitude wall shear stress and axial wall shear stress.BAV patients exhibited increased PD, EL, and WSSC in the AAo, and an inverse association between AAo diameter and WSS sub-vectors. This demonstrated the impact of PD, EL, and WSS in BAV disease and the importance of altered hemodynamics in aortic remodelling.
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Affiliation(s)
- Patrick Geeraert
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
| | - Fatemehsadat Jamalidinan
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
| | - Ali Fatehi Hassanabad
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
| | | | | | - Carmen Lydell
- Department of Cardiac Sciences
- Diagnostic Imaging, University of Calgary
| | | | - James A. White
- Department of Cardiac Sciences
- Stephenson Cardiac Imaging Centre, University of Calgary
| | - Julio Garcia
- Department of Cardiac Sciences
- Department of Radiology, University of Calgary, Calgary
- Stephenson Cardiac Imaging Centre, University of Calgary
- Libin Cardiovascular Institute
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
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11
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Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system. Sci Rep 2021; 11:2066. [PMID: 33483580 PMCID: PMC7822932 DOI: 10.1038/s41598-021-81845-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
The characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.
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12
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Dillinger H, Walheim J, Kozerke S. On the limitations of echo planar 4D flow MRI. Magn Reson Med 2020; 84:1806-1816. [PMID: 32212352 DOI: 10.1002/mrm.28236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare EPI and GRE readout in high-flow velocity regimes and evaluate their impact on measurement accuracy in silico and in vitro. THEORY AND METHODS Phase-contrast sequences for EPI and GRE were simulated using CFD velocity data to assess displacement artifacts as well as effective spatial resolution. In silico findings were validated experimentally using a steady flow phantom. RESULTS For EPI factor 5 and simulated stenotic flow with peak velocity of 2.2 m s - 1 , displacement artifacts resulted in misregistration of 7.3 mm at echo time and the effective resolution was locally reduced by factors 5 and 8 compared to GRE for flow along phase and frequency encoding directions, respectively. In vitro, a maximum velocity difference between EPI factor 5 and GRE of 0.97 m s - 1 was found. CONCLUSIONS Four-dimensional flow MRI using EPI readout results not only in considerable velocity misregistration but also in spatially varying degradation of resolution. The proposed work indicates that EPI is inferior to standard GRE for 4D flow MRI.
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Affiliation(s)
- Hannes Dillinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Jonas Walheim
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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Pressure drop mapping using 4D flow MRI in patients with bicuspid aortic valve disease: A novel marker of valvular obstruction. Magn Reson Imaging 2020; 65:175-182. [DOI: 10.1016/j.mri.2019.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/02/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
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14
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Walheim J, Dillinger H, Kozerke S. Multipoint 5D flow cardiovascular magnetic resonance - accelerated cardiac- and respiratory-motion resolved mapping of mean and turbulent velocities. J Cardiovasc Magn Reson 2019; 21:42. [PMID: 31331353 PMCID: PMC6647085 DOI: 10.1186/s12968-019-0549-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/05/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Volumetric quantification of mean and fluctuating velocity components of transient and turbulent flows promises a comprehensive characterization of valvular and aortic flow characteristics. Data acquisition using standard navigator-gated 4D Flow cardiovascular magnetic resonance (CMR) is time-consuming and actual scan times depend on the breathing pattern of the subject, limiting the applicability of the method in a clinical setting. We sought to develop a 5D Flow CMR framework which combines undersampled data acquisition including multipoint velocity encoding with low-rank image reconstruction to provide cardiac- and respiratory-motion resolved assessment of velocity maps and turbulent kinetic energy in fixed scan times. METHODS Data acquisition and data-driven motion state detection was performed using an undersampled Cartesian tiny Golden angle approach. Locally low-rank (LLR) reconstruction was implemented to exploit correlations among heart phases and respiratory motion states. To ensure accurate quantification of mean and turbulent velocities, a multipoint encoding scheme with two velocity encodings per direction was incorporated. Velocity-vector fields and turbulent kinetic energy (TKE) were obtained using a Bayesian approach maximizing the posterior probability given the measured data. The scan time of 5D Flow CMR was set to 4 min. 5D Flow CMR with acceleration factors of 19 .0 ± 0.21 (mean ± std) and velocity encodings (VENC) of 0.5 m/s and 1.5 m/s per axis was compared to navigator-gated 2x SENSE accelerated 4D Flow CMR with VENC = 1.5 m/s in 9 subjects. Peak velocities and peak flow were compared and magnitude images, velocity and TKE maps were assessed. RESULTS While net scan time of 5D Flow CMR was 4 min independent of individual breathing patterns, the scan times of the standard 4D Flow CMR protocol varied depending on the actual navigator gating efficiency and were 17.8 ± 3.9 min on average. Velocity vector fields derived from 5D Flow CMR in the end-expiratory state agreed well with data obtained from the navigated 4D protocol (normalized root-mean-square error 8.9 ± 2.1%). On average, peak velocities assessed with 5D Flow CMR were higher than for the 4D protocol (3.1 ± 4.4%). CONCLUSIONS Respiratory-motion resolved multipoint 5D Flow CMR allows mapping of mean and turbulent velocities in the aorta in 4 min.
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Affiliation(s)
- Jonas Walheim
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35 8092, Zurich, Switzerland
| | - Hannes Dillinger
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35 8092, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35 8092, Zurich, Switzerland
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