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Borja MG, Martinez-Legazpi P, Nguyen C, Flores O, Kahn AM, Bermejo J, Del Álamo JC. Deriving phenotype-representative left ventricular flow patterns by reduced-order modeling and classification. Comput Biol Med 2024; 179:108760. [PMID: 38944903 DOI: 10.1016/j.compbiomed.2024.108760] [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: 12/06/2023] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Extracting phenotype-representative flow patterns and their associated numerical metrics is a bottleneck in the clinical translation of advanced cardiac flow imaging modalities. We hypothesized that reduced-order models (ROMs) are a suitable strategy for deriving simple and interpretable clinical metrics of intraventricular flow suitable for further assessments. Combined with machine learning (ML) flow-based ROMs could provide new insight to help diagnose and risk-stratify patients. METHODS We analyzed 2D color-Doppler echocardiograms of 81 non-ischemic dilated cardiomyopathy (DCM) patients, 51 hypertrophic cardiomyopathy (HCM) patients, and 77 normal volunteers (Control). We applied proper orthogonal decomposition (POD) to build patient-specific and cohort-specific ROMs of LV flow. Each ROM aggregates a low number of components representing a spatially dependent velocity map modulated along the cardiac cycle by a time-dependent coefficient. We tested three classifiers using deliberately simple ML analyses of these ROMs with varying supervision levels. In supervised models, hyperparameter grid search was used to derive the ROMs that maximize classification power. The classifiers were blinded to LV chamber geometry and function. We ran vector flow mapping on the color-Doppler sequences to help visualize flow patterns and interpret the ML results. RESULTS POD-based ROMs stably represented each cohort through 10-fold cross-validation. The principal POD mode captured >80 % of the flow kinetic energy (KE) in all cohorts and represented the LV filling/emptying jets. Mode 2 represented the diastolic vortex and its KE contribution ranged from <1 % (HCM) to 13 % (DCM). Semi-unsupervised classification using patient-specific ROMs revealed that the KE ratio of these two principal modes, the vortex-to-jet (V2J) energy ratio, is a simple, interpretable metric that discriminates DCM, HCM, and Control patients. Receiver operating characteristic curves using V2J as classifier had areas under the curve of 0.81, 0.91, and 0.95 for distinguishing HCM vs. Control, DCM vs. Control, and DCM vs. HCM, respectively. CONCLUSIONS Modal decomposition of cardiac flow can be used to create ROMs of normal and pathological flow patterns, uncovering simple interpretable flow metrics with power to discriminate disease states, and particularly suitable for further processing using ML.
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Affiliation(s)
- María Guadalupe Borja
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA
| | - Pablo Martinez-Legazpi
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED and CIBERCV, Madrid, Spain
| | - Cathleen Nguyen
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Oscar Flores
- Department of Aerospace Engineering, Universidad Carlos III de Madrid, Leganés, Spain
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain
| | - Juan C Del Álamo
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, CA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA.
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Wang W, Wang Y, Bai H, Chen X, Gao Z, Wang F, Liu S, Du H. The incremental value of left ventricular energy loss in predicting adverse events in chronic kidney disease patients with preserved ejection fraction. Int J Cardiol 2024; 415:132360. [PMID: 39111372 DOI: 10.1016/j.ijcard.2024.132360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 05/23/2024] [Accepted: 07/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Vector flow mapping (VFM) is a new echocardiographic technology that can effectively evaluate systolic and diastolic hemodynamic function. However, little is known about the prognostic value of VFM-related parameters. In this paper we aimed to investigate whether left ventricular energy loss (EL) parameters as assessed by VFM enhance prediction of adverse events in patients with chronic kidney disease with preserved ejection fraction. METHODS One hundred thirty-nine prospectively recruited patients (66% male, 58% on dialysis) with CKD stage 3-5 with normal left ventricular ejection fraction (LVEF) made up the study cohort. Global longitudinal strain (GLS) was calculated using 2-dimensional speckle tracking, and the LV EL during one cardiac cycle for each period was measured using VFM technology. Participants were followed for 4.17 ± 1.58 years for the primary end point of overall mortality and major adverse cardiovascular events (MACE). RESULTS Forty-five (32%) patients had a primary endpoint event. The EL during each period especially during the ejection stage (Ej-EL) was significantly higher in patients with adverse events than in those without, meanwhile the LV GLS were lower. The Ej-EL (HR: 1.11; 95% CI: 1.06-1.15) and LV GLS (HR: 0.87; 95% CI: 0.81-0.94) (all P < .001) were independent predictors for the primary end point. Increased Ej-EL (≥6.13, 10-3 J/m s) and impaired GLS (<15.52, %) were associated with a higher risk of overall mortality death and MACE (log rank χ2 = 26.94, 7.19; P < .001, =0.007), and DeLong tests showed that Ej-EL (AUC = 0.823) has a slight advantage in predicting adverse events compared to GLS (AUC = 0.681). Furthermore, the addition of Ej-EL to a model with conventional parameters did more to improve the model's discrimination compared to GLS. CONCLUSIONS Increased Ej-EL as determined by VFM is associated with a higher risk of overall death and MACE in CKD patients with preserved EF.
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Affiliation(s)
- Wei Wang
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China
| | - Yueheng Wang
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China.
| | - Hui Bai
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China
| | - Xiaoxue Chen
- Department of Ultrasound, First Hospital of Qinhuangdao, No.258, Wenhua Road, Qinhuangdao 066000, Hebei, China
| | - Ze Gao
- Physical Examination Center, Hebei People's Hospital, No.348, Hepingxi Road, Shijiazhuang 050051, Hebei, China
| | - Feng Wang
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China
| | - Shanshan Liu
- Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China
| | - Honghui Du
- Department of Ultrasound, Xingtai People's Hospital, No.148, Shunde Road, Xingtai 054001, Hebei, China
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Riva A, Saitta S, Sturla F, Disabato G, Tondi L, Camporeale A, Giese D, Castelvecchio S, Menicanti L, Redaelli A, Lombardi M, Votta E. Left ventricle diastolic vortex ring characterization in ischemic cardiomyopathy: insight into atrio-ventricular interplay. Med Biol Eng Comput 2024:10.1007/s11517-024-03154-4. [PMID: 38954265 DOI: 10.1007/s11517-024-03154-4] [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: 11/29/2023] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
Diastolic vortex ring (VR) plays a key role in the blood-pumping function exerted by the left ventricle (LV), with altered VR structures being associated with LV dysfunction. Herein, we sought to characterize the VR diastolic alterations in ischemic cardiomyopathy (ICM) patients with systo-diastolic LV dysfunction, as compared to healthy controls, in order to provide a more comprehensive understanding of LV diastolic function. 4D Flow MRI data were acquired in ICM patients (n = 15) and healthy controls (n = 15). The λ2 method was used to extract VRs during early and late diastolic filling. Geometrical VR features, e.g., circularity index (CI), orientation (α), and inclination with respect to the LV outflow tract (ß), were extracted. Kinetic energy (KE), rate of viscous energy loss ( EL ˙ ), vorticity (W), and volume (V) were computed for each VR; the ratios with the respective quantities computed for the entire LV were derived. At peak E-wave, the VR was less circular (p = 0.032), formed a smaller α with the LV long-axis (p = 0.003) and a greater ß (p = 0.002) in ICM patients as compared to controls. At peak A-wave, CI was significantly increased (p = 0.034), while α was significantly smaller (p = 0.016) and β was significantly increased (p = 0.036) in ICM as compared to controls. At both peak E-wave and peak A-wave,EL ˙ VR / EL ˙ LV , WVR/WLV, and VVR/VLV significantly decreased in ICM patients vs. healthy controls. KEVR/VVR showed a significant decrease in ICM patients with respect to controls at peak E-wave, while VVR remained comparable between normal and pathologic conditions. In the analyzed ICM patients, the diastolic VRs showed alterations in terms of geometry and energetics. These derangements might be attributed to both structural and functional alterations affecting the infarcted wall region and the remote myocardium.
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Affiliation(s)
- Alessandra Riva
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Simone Saitta
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy.
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy.
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Radiology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Daniel Giese
- Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS, Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico Di Milano, Milan, Italy
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Ngiam JN, Liong TS, Pramotedham T, Sia CH, Jou E, Kong WKF, Poh KK. Left ventricular vortex formation time: emerging clinical applications and limitations. Singapore Med J 2023:389617. [PMID: 38037777 DOI: 10.4103/singaporemedj.smj-2022-132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Vortex formation during left ventricular diastolic filling may provide clinically useful insights into cardiac health. In recent years, there has been growing interest in the measurement of vortex formation time (VFT), especially because it is derived noninvasively. There are important applications of VFT in valvular heart disease, athletic physiology, heart failure and hypertrophic cardiomyopathy. The formation of the vortex as fluid propagates into the left ventricle from the left atrium is important for efficient fluid transport. Quantifying VFT may thus help in evaluating and understanding disease and pathophysiological processes.
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Affiliation(s)
| | - Tze Sian Liong
- Department of Medicine, National University Health System, Singapore
| | | | - Ching-Hui Sia
- Department of Medicine; Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Eric Jou
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - William Kok-Fai Kong
- Department of Medicine; Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | - Kian-Keong Poh
- Department of Medicine; Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
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Kim IC, Yoo BS. Multidimensional Approach of Heart Failure Diagnosis and Prognostication Utilizing Cardiac Imaging with Biomarkers. Diagnostics (Basel) 2022; 12:1366. [PMID: 35741176 PMCID: PMC9221556 DOI: 10.3390/diagnostics12061366] [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: 02/13/2022] [Revised: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 02/01/2023] Open
Abstract
Heart failure (HF) is a clinical syndrome caused by various etiologies that results in systolic and diastolic cardiac dysfunction with congestion. While evaluating HF and planning for treatment, physicians utilize various laboratory tests, including electrocardiography, diverse imaging tests, exercise testing, invasive hemodynamic evaluation, or endomyocardial biopsy. Among these, cardiac imaging modalities and biomarkers are the mainstays during HF diagnosis and treatment. Recent developments in non-invasive imaging modalities, such as echocardiography, computed tomography, magnetic resonance imaging, and nuclear imaging, have helped us understand the etiology, pathophysiology, and hemodynamics of HF, and determine treatment options and predict the outcomes. Due to the convenience of their use and potential impact on HF management, biomarkers are increasingly adopted in our clinical practice as well as research purpose. Natriuretic peptide is the most widely used biomarker for the diagnosis of HF, evaluation of treatment response, and prediction of future outcomes. Other cardiac biomarkers to evaluate the pathophysiological mechanisms of HF include myocardial injury, oxidative stress, inflammation, fibrosis, hypertrophy, and neurohormonal activation. Because HF results from complex cardiac disorders, it is essential to assess the disease status multidimensionally. The proper utilization of multimodality imaging and cardiac biomarkers can improve the quality of patient management and predict clinical outcomes in HF in the era of personalized medicine.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu 42601, Korea;
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
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Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application. Diagnostics (Basel) 2021; 11:diagnostics11050892. [PMID: 34067703 PMCID: PMC8156791 DOI: 10.3390/diagnostics11050892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.
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7
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Pewowaruk RJ, Barton GP, Johnson C, Ralphe JC, Francois CJ, Lamers L, Roldán-Alzate A. Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model. J Cardiovasc Magn Reson 2021; 23:13. [PMID: 33627121 PMCID: PMC7905680 DOI: 10.1186/s12968-021-00709-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. METHODS 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. RESULTS 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). CONCLUSION These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.
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MESH Headings
- Animals
- Computed Tomography Angiography
- Disease Models, Animal
- Endovascular Procedures/instrumentation
- Magnetic Resonance Imaging, Cine
- Myocardial Contraction
- Myocardial Perfusion Imaging
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/physiopathology
- Recovery of Function
- Stenosis, Pulmonary Artery/diagnostic imaging
- Stenosis, Pulmonary Artery/physiopathology
- Stenosis, Pulmonary Artery/therapy
- Stents
- Sus scrofa
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/therapy
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Ryan J Pewowaruk
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Gregory P Barton
- University of Wisconsin-Madison, Madison, WI, USA
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Cody Johnson
- University of Wisconsin-Madison, Madison, WI, USA
| | - J Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Division of Cardiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher J Francois
- University of Wisconsin-Madison, Madison, WI, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Division of Cardiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Madison, WI, USA
- Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Di Labbio G, Ben Assa E, Kadem L. Experimental Investigation of the Effect of Heart Rate on Flow in the Left Ventricle in Health and Disease-Aortic Valve Regurgitation. J Biomech Eng 2020; 142:051005. [PMID: 31701119 DOI: 10.1115/1.4045400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Indexed: 11/08/2022]
Abstract
There is much debate in the literature surrounding the effects of heart rate on aortic regurgitation (AR). Despite the contradictory information, it is still widely believed that an increase in heart rate is beneficial due to the disproportionate shortening of the duration of diastole relative to systole, permitting less time for the left ventricle to fill from regurgitation. This in vitro work investigates how a change in heart rate affects the left ventricular fluid dynamics in the absence and presence of acute AR. The experiments are performed on a novel double-activation left heart simulator previously used for the study of chronic AR. The intraventricular velocity fields are acquired via time-resolved planar particle image velocimetry (PIV) in a clinically relevant plane. Considering fluid dynamic factors, an increase in heart rate was observed to have a limited benefit in the case of mild AR and a detrimental effect for more severe AR. With increasing heart rate, mild AR was associated with a decrease in regurgitant volume, a negligible change in regurgitant volume per diastolic second, and a limited reduction in the fraction of retained regurgitant inflow. More severe AR was accompanied by an increase in both regurgitant volume and the fraction of retained regurgitant inflow, implying a less effective pumping efficiency and a longer relative residence time of blood in the ventricle. Globally, the left ventricle's capacity to compensate for the increase in energy dissipation associated with an increase in heart rate diminishes considerably with severity, a phenomenon which may be exploited further as a method of noninvasive assessment of the severity of AR. These findings may affect the clinical belief that tachycardia is preferred in acute AR and should be investigated further in the clinical setting.
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Affiliation(s)
- Giuseppe Di Labbio
- Department of Mechanical, Industrial & Aerospace Engineering, Concordia University, 1455 Blvd. De Maisonneuve W., Montréal, QC H3G 1M8, Canada
| | - Eyal Ben Assa
- Cardiology Division, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv 6997801, Israel; Institute for Medical Engineering and Science, Massachusetts Institute of Technology,77 Massachusetts Avenue, Cambridge, MA 02139
| | - Lyes Kadem
- Department of Mechanical, Industrial & Aerospace Engineering, Concordia University, 1455 Blvd. De Maisonneuve W., Montréal, QC H3G 1M8, Canada
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Diagnostic and prognostic significance of cardiovascular vortex formation. J Cardiol 2019; 74:403-411. [DOI: 10.1016/j.jjcc.2019.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
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10
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Waal K, Crendal E, Boyle A. Left ventricular vortex formation in preterm infants assessed by blood speckle imaging. Echocardiography 2019; 36:1364-1371. [DOI: 10.1111/echo.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022] Open
Affiliation(s)
- Koert Waal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle Newcastle New South Wales Australia
| | - Edward Crendal
- John Hunter Children's Hospital Department of Neonatology and University of Newcastle Newcastle New South Wales Australia
- John Hunter Hospital Department of Cardiology and University of Newcastle Newcastle New South Wales Australia
| | - Andrew Boyle
- John Hunter Hospital Department of Cardiology and University of Newcastle Newcastle New South Wales Australia
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Jia D, Jeon B, Park HB, Chang HJ, Zhang LT. Image-Based Flow Simulations of Pre- and Post-left Atrial Appendage Closure in the Left Atrium. Cardiovasc Eng Technol 2019; 10:225-241. [PMID: 30953246 DOI: 10.1007/s13239-019-00412-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients with atrial fibrillation, the left atrial appendage (LAA) is often the site of thrombus formation due to low atrial ejection fraction that triggers strokes and other thromboembolic events. Recently introduced percutaneous LAA occlusion procedure is known to reduce LAA-induced strokes. Despite having the procedure, there are still 11% of the patients who continue to suffer from future strokes or transient ischemic attacks, not accounting for the procedural related complications. The high failure rate is largely due to the variabilities in LAA's shape, size, and contractility which may result in ineffectiveness of this procedure. To correctly identify the candidates and evaluate the effectiveness of the procedure, we rely on patient-specific CT scans which provides the exact LA and LAA geometries and predictive hemodynamic analysis to assist in evaluating quantitative flow parameters pre- and post-LAA occlusion procedures. Hemodynamic parameters are critical to predict adverse hemodynamic flow patterns in LAA as well as the effectiveness of LAA closure in individual patient. The aim of this paper is to establish an image-based patient-specific computational fluid dynamic (CFD) simulation framework specific to the prediction of treatment outcomes of LAA closure with atrial fibrillation. This framework utilizes automated LA/LAA image segmentation which yields significant reduction in image processing. One set of patient data with successful procedure outcome is used to illustrate the potential of the proposed framework. METHODS The proposed LAA occlusion simulation framework is composed of several components: (1) a novel image segmentation procedure, which is fully-automated to identify LA/LAA geometries from CT images, (2) a finite-element mesh generation procedure which transforms the surface geometry into a 3-D volume mesh and properly identified boundary planes, (3) performing CFD simulations with atrial fibrillation flow boundary conditions, and (4) analyzing flow characteristics (velocity, flow patterns, streamlines, vortices) within the LA for before and after LAA closure. RESULTS Based on the LA/LAA segmentation of a 65 year old female patient with chronic atrial fibrillation, a CFD analysis was pursued to examine flow characteristics upon LAA closure. The results showed that the flow velocity magnitudes were significantly reduced by a maximum factor of 2.21, flow streamlines were greatly stabilized, and mitral outflow appeared to be more organized. Vortices were dramatically reduced in size, number, intensity, as well as duration. During diastole, the peak vortex diameter was reduced from 2.8 to 1.5 cm, while the vortex duration was reduced from 0.210 to 0.135 s. These flow characteristics all indicated a reduced risk in future thrombus formation and strokes based on the established relationship between flow and thrombus formation. For the patient case under study, the effectiveness of the procedure is predicted and found to be consistent with the actual procedural outcome. CONCLUSIONS This framework successfully predicted patient-specific outcome of a LAA closure procedure for one patient with atrial fibrillation. It can be further developed into a useful tool for pre-procedural planning and candidate selection. More patient data are necessary for further validation studies.
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Affiliation(s)
- Dongjie Jia
- Department of Mechanical, Aerospace & Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Byunghwan Jeon
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
| | - Hyung-Bok Park
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Hyuk-Jae Chang
- Yonsei-Cedars Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University Health System, Seoul, South Korea
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Lucy T Zhang
- Department of Mechanical, Aerospace & Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA.
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Abstract
Patients with heart failure show myocardial, valvular, and electrical dysfunction, which results in enlarged cardiac chambers and increased intracardiac volume and pressure. Intracardiac flow analysis can provide information regarding the shape and wall properties, chamber dimensions, and flow efficiency throughout the cardiac cycle. There is increasing interest in vortex flow analysis for patients with heart failure to overcome limitations of conventional parameters. In conjunction with the conventional structural and functional parameters, vortex flow analysis-guided treatment in heart failure might be a novel option for cardiac physicians.
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Affiliation(s)
- In-Cheol Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, 56 Dalsung-ro Jung-gu, Daegu 41931, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodae mun-gu, Seoul 03722, Republic of Korea.
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Mele D, Smarrazzo V, Pedrizzetti G, Capasso F, Pepe M, Severino S, Luisi GA, Maglione M, Ferrari R. Intracardiac Flow Analysis: Techniques and Potential Clinical Applications. J Am Soc Echocardiogr 2019; 32:319-332. [DOI: 10.1016/j.echo.2018.10.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 01/20/2023]
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