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Gill H, Fernandes JF, Nio A, Dockerill C, Shah N, Ahmed N, Raymond J, Wang S, Sotelo J, Urbina J, Uribe S, Rajani R, Rhode K, Lamata P. Aortic Stenosis: Haemodynamic Benchmark and Metric Reliability Study. J Cardiovasc Transl Res 2023; 16:862-873. [PMID: 36745287 PMCID: PMC10480252 DOI: 10.1007/s12265-022-10350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 02/07/2023]
Abstract
Aortic stenosis is a condition which is fatal if left untreated. Novel quantitative imaging techniques which better characterise transvalvular pressure drops are being developed but require refinement and validation. A customisable and cost-effective workbench valve phantom circuit capable of replicating valve mechanics and pathology was created. The reproducibility and relationship of differing haemodynamic metrics were assessed from ground truth pressure data alongside imaging compatibility. The phantom met the requirements to capture ground truth pressure data alongside ultrasound and magnetic resonance image compatibility. The reproducibility was successfully tested. The robustness of three different pressure drop metrics was assessed: whilst the peak and net pressure drops provide a robust assessment of the stenotic burden in our phantom, the peak-to-peak pressure drop is a metric that is confounded by non-valvular factors such as wave reflection. The peak-to-peak pressure drop is a metric that should be reconsidered in clinical practice. The left panel shows manufacture of low cost, functional valves. The central section demonstrates circuit layout, representative MRI and US images alongside gross valve morphologies. The right panel shows the different pressure drop metrics that were assessed for reproducibility.
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Affiliation(s)
- Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK.
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK.
| | - Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Amanda Nio
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Cameron Dockerill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Nili Shah
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Naajia Ahmed
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | | | - Shu Wang
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
| | - Jesus Urbina
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
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Mascolini MV, Fontanella CG, Berardo A, Carniel EL. Influence of transurethral catheters on urine pressure-flow relationships in males: A computational fluid-dynamics study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107594. [PMID: 37207463 DOI: 10.1016/j.cmpb.2023.107594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE In the field of urology, the pressure-flow study (PFS) is an essential urodynamics practise which requires the patient's transurethral catheterization during the voiding phase of micturition to evaluate the functionality of the lower urinary tract (LUT) and reveal the pathophysiology of its dysfunctionality. However, the literature evidences confusion regarding the interference of the catheterization on the urethral pressure-flow behaviour. METHODS The present research study represents the first Computational Fluid-Dynamics (CFD) approach to this urodynamics issue, analysing the influence of a catheter in the male LUT through case studies which included the inter-individual and intra-individual dependence. A set of four three dimensional (3D) models of the male LUT, different in urethral diameters, and a set of three 3D models of the transurethral catheter, diverse in calibre, were developed leading to 16 CFD non-catheterized either catheterized configurations, to describe the typical micturition scenario considering both urethra and catheter characteristics. RESULTS The developed CFD simulations showed that the urine flow field during micturition was influenced by the urethral cross-sectional area and each catheter determined a specific decrease in flow rate if compared to the relative free uroflow. CONCLUSIONS In-silico methods allow to analyse relevant urodynamics aspects, which could not be investigated in vivo, and may support the clinical PFS to reduce uncertainty on urodynamic diagnosis.
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Affiliation(s)
- Maria Vittoria Mascolini
- Department of Industrial Engineering, University of Padova, Padova, Italy; Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Padova, Italy; Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Alice Berardo
- Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy; Department of Civil, Environmental and Architectural Engineering, University of Padova, Padova, Italy; Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy; Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
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Haslund LE, Jorgensen LT, Bo Stuart M, Traberg MS, Jensen JA. Precise Estimation of Intravascular Pressure Gradients. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:393-405. [PMID: 37028315 DOI: 10.1109/tuffc.2023.3255791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This study presents a method for noninvasive pressure gradient estimation, which allows the detection of small pressure differences with higher precision compared to invasive catheters. It combines a new method for estimating the temporal acceleration of the flowing blood with the Navier-Stokes equation. The acceleration estimation is based on a double cross-correlation approach, which is hypothesized to minimize the influence of noise. Data are acquired using a 256-element, 6.5-MHz GE L3-12-D linear array transducer connected to a Verasonics research scanner. A synthetic aperture (SA) interleaved sequence with 2 ×12 virtual sources evenly distributed over the aperture and permuted in emission order is used in combination with recursive imaging. This enables a temporal resolution between correlation frames equal to the pulse repetition time at a frame rate of half the pulse repetition frequency. The accuracy of the method is evaluated against a computational fluid dynamic simulation. Here, the estimated total pressure difference complies with the CFD reference pressure difference, which yields an R -square of 0.985 and an RMSE of 3.03 Pa. The precision of the method is tested on experimental data, measured on a carotid phantom of the common carotid artery. The volume profile used during measurement was set to mimic flow in the carotid artery with a peak flow rate of 12.9 mL/s. The experimental setup showed that the measured pressure difference changes from -59.4 to 31 Pa throughout a single pulse cycle. This was estimated with a precision of 5.44% (3.22 Pa) across ten pulse cycles. The method was also compared to invasive catheter measurements in a phantom with a 60% cross-sectional area reduction. The ultrasound method detected a maximum pressure difference of 72.3 Pa with a precision of 3.3% (2.22 Pa). The catheters measured a maximum pressure difference of 105 Pa with a precision of 11.2% (11.4 Pa). This was measured over the same constriction and with a peak flow rate of 12.9 mL/s. The double cross-correlation approach revealed no improvement compared to a normal differential operator. The method's strength, thus, lies primarily in the ultrasound sequence, which allows precise and accurate velocity estimations, at which acceleration and pressure differences can be acquired.
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Kourouklis AP, Wahlsten A, Stracuzzi A, Martyts A, Paganella LG, Labouesse C, Al-Nuaimi D, Giampietro C, Ehret AE, Tibbitt MW, Mazza E. Control of hydrostatic pressure and osmotic stress in 3D cell culture for mechanobiological studies. BIOMATERIALS ADVANCES 2023; 145:213241. [PMID: 36529095 DOI: 10.1016/j.bioadv.2022.213241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Hydrostatic pressure (HP) and osmotic stress (OS) play an important role in various biological processes, such as cell proliferation and differentiation. In contrast to canonical mechanical signals transmitted through the anchoring points of the cells with the extracellular matrix, the physical and molecular mechanisms that transduce HP and OS into cellular functions remain elusive. Three-dimensional cell cultures show great promise to replicate physiologically relevant signals in well-defined host bioreactors with the goal of shedding light on hidden aspects of the mechanobiology of HP and OS. This review starts by introducing prevalent mechanisms for the generation of HP and OS signals in biological tissues that are subject to pathophysiological mechanical loading. We then revisit various mechanisms in the mechanotransduction of HP and OS, and describe the current state of the art in bioreactors and biomaterials for the control of the corresponding physical signals.
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Affiliation(s)
- Andreas P Kourouklis
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland.
| | - Adam Wahlsten
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Alberto Stracuzzi
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Anastasiya Martyts
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Lorenza Garau Paganella
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Celine Labouesse
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Dunja Al-Nuaimi
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Costanza Giampietro
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Alexander E Ehret
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Mark W Tibbitt
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Edoardo Mazza
- Institute for Mechanical Systems, Department of Mechanical and Process Engineering, ETH Zurich, Leonhardstrasse 21, 8092 Zurich, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600 Dübendorf, Switzerland
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5
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Fernandes JF, Gill H, Nio A, Faraci A, Galli V, Marlevi D, Bissell M, Ha H, Rajani R, Mortier P, Myerson SG, Dyverfeldt P, Ebbers T, Nordsletten DA, Lamata P. Non-invasive cardiovascular magnetic resonance assessment of pressure recovery distance after aortic valve stenosis. J Cardiovasc Magn Reson 2023; 25:5. [PMID: 36717885 PMCID: PMC9885657 DOI: 10.1186/s12968-023-00914-3] [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: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Decisions in the management of aortic stenosis are based on the peak pressure drop, captured by Doppler echocardiography, whereas gold standard catheterization measurements assess the net pressure drop but are limited by associated risks. The relationship between these two measurements, peak and net pressure drop, is dictated by the pressure recovery along the ascending aorta which is mainly caused by turbulence energy dissipation. Currently, pressure recovery is considered to occur within the first 40-50 mm distally from the aortic valve, albeit there is inconsistency across interventionist centers on where/how to position the catheter to capture the net pressure drop. METHODS We developed a non-invasive method to assess the pressure recovery distance based on blood flow momentum via 4D Flow cardiovascular magnetic resonance (CMR). Multi-center acquisitions included physical flow phantoms with different stenotic valve configurations to validate this method, first against reference measurements and then against turbulent energy dissipation (respectively n = 8 and n = 28 acquisitions) and to investigate the relationship between peak and net pressure drops. Finally, we explored the potential errors of cardiac catheterisation pressure recordings as a result of neglecting the pressure recovery distance in a clinical bicuspid aortic valve (BAV) cohort of n = 32 patients. RESULTS In-vitro assessment of pressure recovery distance based on flow momentum achieved an average error of 1.8 ± 8.4 mm when compared to reference pressure sensors in the first phantom workbench. The momentum pressure recovery distance and the turbulent energy dissipation distance showed no statistical difference (mean difference of 2.8 ± 5.4 mm, R2 = 0.93) in the second phantom workbench. A linear correlation was observed between peak and net pressure drops, however, with strong dependences on the valvular morphology. Finally, in the BAV cohort the pressure recovery distance was 78.8 ± 34.3 mm from vena contracta, which is significantly longer than currently accepted in clinical practise (40-50 mm), and 37.5% of patients displayed a pressure recovery distance beyond the end of the ascending aorta. CONCLUSION The non-invasive assessment of the distance to pressure recovery is possible by tracking momentum via 4D Flow CMR. Recovery is not always complete at the ascending aorta, and catheterised recordings will overestimate the net pressure drop in those situations. There is a need to re-evaluate the methods that characterise the haemodynamic burden caused by aortic stenosis as currently clinically accepted pressure recovery distance is an underestimation.
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Affiliation(s)
- Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Amanda Nio
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alessandro Faraci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - David Marlevi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Malenka Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Korea
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - David A Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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6
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Gill H, Fernandes J, Chehab O, Prendergast B, Redwood S, Chiribiri A, Nordsletten D, Rajani R, Lamata P. Evaluation of aortic stenosis: From Bernoulli and Doppler to Navier-Stokes. Trends Cardiovasc Med 2023; 33:32-43. [PMID: 34920129 DOI: 10.1016/j.tcm.2021.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023]
Abstract
Uni-dimensional Doppler echocardiography data provide the mainstay of quantative assessment of aortic stenosis, with the transvalvular pressure drop a key indicator of haemodynamic burden. Sophisticated methods of obtaining velocity data, combined with improved computational analysis, are facilitating increasingly robust and reproducible measurement. Imaging modalities which permit acquisition of three-dimensional blood velocity vector fields enable angle-independent valve interrogation and calculation of enhanced measures of the transvalvular pressure drop. This manuscript clarifies the fundamental principles of physics that underpin the evaluation of aortic stenosis and explores modern techniques that may provide more accurate means to grade aortic stenosis and inform appropriate management.
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Affiliation(s)
- Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Joao Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Omar Chehab
- Cardiology Department, Guy's and St. Thomas's Hospital NHS Foundation Trust, London, UK
| | - Bernard Prendergast
- Cardiology Department, Guy's and St. Thomas's Hospital NHS Foundation Trust, London, UK
| | - Simon Redwood
- Cardiology Department, Guy's and St. Thomas's Hospital NHS Foundation Trust, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Surgery and Biomedical Engineering, University of Michigan, 2800 Plymouth Rd, 48109, Ann Arbor, MI, USA
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Cardiology Department, Guy's and St. Thomas's Hospital NHS Foundation Trust, London, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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7
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Gusseva M, Castellanos DA, Greer JS, Hussein MA, Hasbani K, Greil G, Veeram Reddy SR, Hussain T, Chapelle D, Chabiniok R. Time-Synchronization of Interventional Cardiovascular Magnetic Resonance Data Using a Biomechanical Model for Pressure-Volume Loop Analysis. J Magn Reson Imaging 2023; 57:320-323. [PMID: 35567583 DOI: 10.1002/jmri.28216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Maria Gusseva
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Daniel A Castellanos
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joshua S Greer
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mohamed Abdelghafar Hussein
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Pediatric Department, Kafrelsheikh University, Kafr Elsheikh, Egypt
| | - Keren Hasbani
- Division of Pediatric Cardiology, Department of Pediatrics, Dell Medical School, UT Austin, Texas, USA
| | - Gerald Greil
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Surendranath R Veeram Reddy
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dominique Chapelle
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France
| | - Radomír Chabiniok
- Inria, Palaiseau, France.,LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Palaiseau, France.,Division of Pediatric Cardiology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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8
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Brito J, Raposo L, Teles RC. Invasive assessment of aortic stenosis in contemporary practice. Front Cardiovasc Med 2022; 9:1007139. [PMID: 36531706 PMCID: PMC9751012 DOI: 10.3389/fcvm.2022.1007139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/08/2022] [Indexed: 11/20/2023] Open
Abstract
The authors review the current role of cardiac catheterization in the characterization of aortic stenosis, its main clinical applications, its pitfalls, and its additional value to the information provided by echocardiography. Discrepancies that may arise between these two modalities are discussed and further explained. Hemodynamic variables besides transvalvular pressure drop are described, and emphasis is given to an integrative approach to aortic stenosis assessment, that includes invasive and noninvasive evaluation.
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Affiliation(s)
- João Brito
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
| | - Luís Raposo
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
| | - Rui Campante Teles
- Cardiovascular Intervention Unit, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Interventional Cardiology Center, Hospital da Luz, Lisbon, Portugal
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9
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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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10
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Shima H, Nakaya T, Tsujino I, Nakamura J, Sugimoto A, Sato T, Watanabe T, Ohira H, Suzuki M, Kato M, Yokota I, Konno S. Accuracy of Swan‒Ganz catheterization‐based assessment of right ventricular function: Validation study using high‐fidelity micromanometry‐derived values as reference. Pulm Circ 2022; 12:e12078. [PMID: 35514782 PMCID: PMC9063972 DOI: 10.1002/pul2.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
Right ventricular (RV) function critically affects the outcomes of patients with pulmonary hypertension (PH). Pressure wave analysis using Swan‒Ganz catheterization (SG‐cath) allows for the calculation of indices of RV function. However, the accuracy of these indices has not been validated. In the present study, we calculated indices of systolic and diastolic RV functions using SG‐cath‐derived pressure recordings in patients with suspected or confirmed PH. We analyzed and validated the accuracies of three RV indices having proven prognostic values, that is, end‐systolic elastance (Ees)/arterial elastance (Ea), β (stiffness constant), and end‐diastolic elastance (Eed), using high‐fidelity micromanometry‐derived data as reference. We analyzed 73 participants who underwent SG‐cath for the diagnosis or evaluation of PH. In this study, Ees/Ea was calculated via the single‐beat pressure method using [1.65 × (mean pulmonary arterial pressure) − 7.79] as end‐systolic pressure. SG‐cath‐derived Ees/Ea, β, and Eed were 0.89 ± 0.69 (mean ± standard deviation), 0.027 ± 0.002, and 0.16 ± 0.02 mmHg/ml, respectively. The mean differences (limits of agreement) between SG‐cath and micromanometry‐derived data were 0.13 (0.99, −0.72), 0.002 (0.020, −0.013), and 0.04 (0.20, −0.12) for Ees/Ea, β, and Eed, respectively. The intraclass correlation coefficients of the indices derived from the two catheterizations were 0.76, 0.71, and 0.57 for Ees/Ea, β, and Eed, respectively. In patients with confirmed or suspected PH, SG‐cath‐derived RV indices, especially Ees/Ea and β, exhibited a good correlation with micromanometry‐derived reference values.
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Affiliation(s)
- Hideki Shima
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Toshitaka Nakaya
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
- Division of Respiratory and Cardiovascular Innovative Research Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Ayako Sugimoto
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
- Division of Respiratory and Cardiovascular Innovative Research Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Taku Watanabe
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine Hokkaido University Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University Sapporo Japan
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Nguyen TQ, Traberg MS, Olesen JB, Moshavegh R, Møller-Sørensen PH, Lönn L, Jensen JA, Nielsen MB, Hansen KL. Pressure Difference Estimation in Non-stenotic Carotid Bifurcation Phantoms Using Vector Flow Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:346-357. [PMID: 34763906 DOI: 10.1016/j.ultrasmedbio.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Local pressure differences estimated using vector flow imaging (VFI) and direct catheterization in seven carotid bifurcation phantoms were compared with simulated pressure fields. VFI correlated strongly with simulated peak pressure differences (r = 0.99, p < 0.00001), with an average overestimation of 12.3 Pa (28.6%). The range between the lowest and highest pressure difference of VFI underestimated simulations by 4.6 Pa (8.06%; r = 0.99, p < 0.0001). The catheter method exhibited no correlation (r = -0.09, p = 0.85). Ten repeated measurements on one phantom revealed a small standard deviation (SD) for VFI (SD = 8.4%, mean estimated SD = 11.5%), but not for the catheter method (SD = 785.6%). An in vivo peak systolic pressure difference of 97.9 Pa (estimated SD = 30%) was measured using VFI in one healthy individual. This study indicates that VFI pressure difference estimation is feasible in phantoms and in vivo and realistic estimates of the SD can be attained from the data.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Marie Sand Traberg
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | | | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Michael Bachmann Nielsen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kristoffer Lindskov Hansen
- Center for Fast Ultrasound Imaging, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
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Farahmand M, Mirinejad H, Scully CG. Model-based approach to investigate equipment-induced error in pressure-waveform derived hemodynamic measurements. Physiol Meas 2021; 42:10.1088/1361-6579/ac38be. [PMID: 34763325 PMCID: PMC8757537 DOI: 10.1088/1361-6579/ac38be] [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: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 12/30/2022]
Abstract
Objective.Advanced hemodynamic monitoring systems have provided less invasive methods for estimating pressure-derived measurements such as pressure-derived cardiac output (CO) measurements. These devices apply algorithms to arterial pressure waveforms recorded via pressure recording components that transmit the pressure signal to a pressure monitor. While standards have been developed for pressure monitoring equipment, it is unclear how the equipment-induced error can affect secondary measurements from pressure waveforms. We propose an approach for modelling different components of a pressure monitoring system and use this model-based approach to investigate the effect of different pressure recording configurations on pressure-derived hemodynamic measurements.Approach.The proposed model-based approach is a three step process. (1) Modelling the response of pressure recording components using bench tests; (2) verifying the identified models through nonparametric equivalence tests; and (3) assessing the effects of pressure recording components on pressure-derived measurements. To delineate the application of this approach, we performed a series of model-based analyses to quantify the combined effect of a wide range of tubing configurations with various damping ratios and natural frequencies and monitors with different bandwidths on pressure waveforms and CO measurements by six pulse contour algorithms.Results.Model-based results show the error in pressure-derived CO measurements because of tubing configurations with different natural frequencies and damping ratios. Tubing configurations with low natural frequencies (<23 Hz) altered characteristics of pressure waveforms in a way that affected the CO measurement, some by as much as 20%.Significance.Our method can serve as a tool to quantify the performance of pressure recording systems with different dynamic properties. This approach can be applied to investigate the effects of physiologic signal recording configurations on various pressure-derived hemodynamic measurements.
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Affiliation(s)
- Masoud Farahmand
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, United States of America
| | - Hossein Mirinejad
- College of Aeronautics and Engineering, Kent State University, Kent, OH 44242, United States of America
| | - Christopher G Scully
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, United States of America
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Chemla D, Millasseau S, Hamzaoui O, Teboul JL, Monnet X, Michard F, Jozwiak M. New Method to Estimate Central Systolic Blood Pressure From Peripheral Pressure: A Proof of Concept and Validation Study. Front Cardiovasc Med 2021; 8:772613. [PMID: 34977186 PMCID: PMC8714848 DOI: 10.3389/fcvm.2021.772613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The non-invasive estimation of central systolic blood pressure (cSBP) is increasingly performed using new devices based on various pulse acquisition techniques and mathematical analyses. These devices are most often calibrated assuming that mean (MBP) and diastolic (DBP) BP are essentially unchanged when pressure wave travels from aorta to peripheral artery, an assumption which is evidence-based. We tested a new empirical formula for the direct central blood pressure estimation of cSBP using MBP and DBP only (DCBP = MBP2/DBP). Methods and Results: First, we performed a post-hoc analysis of our prospective invasive high-fidelity aortic pressure database (n = 139, age 49 ± 12 years, 78% men). The cSBP was 146.0 ± 31.1 mmHg. The error between aortic DCBP and cSBP was −0.9 ± 7.4 mmHg, and there was no bias across the cSBP range (82.5–204.0 mmHg). Second, we analyzed 64 patients from two studies of the literature in whom invasive high-fidelity pressures were simultaneously obtained in the aorta and brachial artery. The weighed mean error between brachial DCBP and cSBP was 1.1 mmHg. Finally, 30 intensive care unit patients equipped with fluid-filled catheter in the radial artery were prospectively studied. The cSBP (115.7 ± 18.2 mmHg) was estimated by carotid tonometry. The error between radial DCBP and cSBP was −0.4 ± 5.8 mmHg, and there was no bias across the range. Conclusion: Our study shows that cSBP could be reliably estimated from MBP and DBP only, provided BP measurement errors are minimized. DCBP may have implications for assessing cardiovascular risk associated with cSBP on large BP databases, a point that deserves further studies.
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Affiliation(s)
- Denis Chemla
- Service d'explorations fonctionnelles multidisciplinaires bi-site Antoine Béclère - Kremlin Bicêtre, GHU Paris Sud, AP-HP, Le Kremlin-Bicêtre, France
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- *Correspondence: Denis Chemla
| | | | - Olfa Hamzaoui
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Jean-Louis Teboul
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Mathieu Jozwiak
- Equipe 2 CARRES, UR2CA - Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur UCA, Nice and Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet, Nice, France
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Liao CH, Cheng CT, Chen CC, Wang YH, Chiu HT, Peng CC, Jow UM, Lai YL, Chen YC, Ho DR. Systematic Review of Diagnostic Sensors for Intra-Abdominal Pressure Monitoring. SENSORS 2021; 21:s21144824. [PMID: 34300564 PMCID: PMC8309748 DOI: 10.3390/s21144824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/28/2022]
Abstract
Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. Elevated IAP has been implicated in many medical complications. This article reviews the current state-of-the-art in innovative sensors for the measurement of IAP. A systematic review was conducted on studies on the development and application of IAP sensors. Publications from 2010 to 2021 were identified by performing structured searches in databases, review articles, and major textbooks. Sixteen studies were eligible for the final systematic review. Of the 16 articles that describe the measurement of IAP, there were 5 in vitro studies (31.3%), 7 in vivo studies (43.7%), and 4 human trials (25.0%). In addition, with the advancement of wireless communication technology, an increasing number of wireless sensing systems have been developed. Among the studies in this review, five presented wireless sensing systems (31.3%) to monitor IAP. In this systematic review, we present recent developments in different types of intra-abdominal pressure sensors and discuss their inherent advantages due to their small size, remote monitoring, and multiplexing.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Chih-Chi Chen
- Department of Rehabilitation and Physical Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33328, Taiwan;
| | - Yu-Hsin Wang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Hsin-Tzu Chiu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Cheng-Chun Peng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Uei-Ming Jow
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Yen-Liang Lai
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Ya-Chuan Chen
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taipei 10547, Taiwan; (C.-H.L.); (C.-T.C.); (Y.-H.W.); (H.-T.C.); (C.-C.P.); (U.-M.J.); (Y.-L.L.); (Y.-C.C.)
| | - Dong-Ru Ho
- Department of Urology, Chiayi Chang Gung Memorial Hospital, Chang Gung University, Chiayi 613016, Taiwan
- Correspondence: ; Tel.: +886-975-353-211
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16
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Chemla D, Millasseau S. A systematic review of invasive, high-fidelity pressure studies documenting the amplification of blood pressure from the aorta to the brachial and radial arteries. J Clin Monit Comput 2020; 35:1245-1252. [PMID: 33037525 DOI: 10.1007/s10877-020-00599-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
It is commonly accepted that systolic blood pressure (SBP) is significantly higher in the brachial/radial artery than in the aorta while mean (MBP) and diastolic (DBP) pressures remain unchanged. This may have implications for outcome studies and for non-invasive devices calibration. We performed a systematic review of invasive high-fidelity pressure studies documenting BP in the aorta and brachial/radial artery. We selected articles published prior to July 2015. Pressure amplification (Amp = peripheral minus central pressure) was calculated (weighted mean). The six studies retained (n = 294, 76.5% male, mean age 63.5 years) mainly involved patients with suspected coronary artery disease (CAD). In two studies at the aortic/brachial level (n = 64), MBP and DBP were unchanged (MPAmp = 0.1 mmHg, DPAmp = -1.3 mmHg), while SBP increased (SPAmp = 4.2 mmHg; relative amplification = 3.1%). In four studies in which MBP was not documented (n = 230), brachial DBP remained unchanged and SBP increased (SPAmp = 6.6 mmHg; 4.9%). One of these four studies also reported radial SBP and DBP, not MBP (n = 12). Few high-fidelity pressure studies were found, and they have been performed mainly in elderly male patients with suspected CAD. Counter to expectations, the mean amplification of SBP from the aorta to brachial artery was < 5%. Further studies on SPAmp phenotypes (positive, null, negative) are advocated. Non-invasive device calibration assumptions were confirmed, namely unchanged MBP and DBP from the aorta to the brachial artery. Data did not allow for firm conclusions on the amount of BP changes from the aorta to the radial artery, and from the aorta to the brachial/radial arteries in other populations.
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Affiliation(s)
- Denis Chemla
- Service d'explorations Fonctionnelles Multidisciplinaires bi-Site Antoine Béclère - Kremlin Bicêtre, Hôpital Marie Lannelongue, APHP.Université Paris Saclay. DMU4-CORREVE and INSERM UMR_S 999, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
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17
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Qananwah Q, Al-Zyoud W, Al-Zaben A. Biomedical invasive pressure sensor coatings: calibration and waveform perspectives. J Med Eng Technol 2020; 44:203-209. [PMID: 32500765 DOI: 10.1080/03091902.2020.1759710] [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: 01/11/2023]
Abstract
The biocompatibility of invasive biomedical sensors is a fundamental issue in the design of implanted sensors. Therefore, the unique packaging of the sensor is a crucial design procedure that must be performed and evaluated correctly. Under steady-state measurements, the sensor calibration can be done quickly, and the corresponding errors and loss in the sensor's sensitivity, because of the packaging material, can be compensated easily. This paper investigates the effect of the presence and absence of biocompatible silicone paste as packaging material on the catheter sensor's output waveform morphology, and the sensor's response time under dynamic measurements. The procedure to calibrate the sensor during the design is presented to compensate for the effect of packaging material in terms of state-space formulation. In conclusion, errors in peak pressure and waveform shape in the catheter sensor can be significantly reduced by the geometry and the packaging materials of the catheter sensor. At last, we believe that using biocompatible silicone paste as packaging material on the catheter sensor is scalable.
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Affiliation(s)
- Q Qananwah
- Biomedical Systems and Medical Informatics Department, Hijjawi College for Engineering Technology, Yarmouk University, Irbid, Jordan
| | - W Al-Zyoud
- Biomedical Engineering Department, School of Applied Medical Sciences, German Jordanian University, Amman, Jordan
| | - A Al-Zaben
- Biomedical Systems and Medical Informatics Department, Hijjawi College for Engineering Technology, Yarmouk University, Irbid, Jordan
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Grønlykke L, Couture EJ, Haddad F, Amsallem M, Ravn HB, Raymond M, Beaubien-Souligny W, Demers P, Rochon A, Sarabi ME, Lamarche Y, Desjardins G, Denault AY. Preliminary Experience Using Diastolic Right Ventricular Pressure Gradient Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:2116-2125. [PMID: 32037274 DOI: 10.1053/j.jvca.2019.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/31/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Right ventricular (RV) dysfunction in cardiac surgery is associated with increased mortality and morbidity and difficult separation from cardiopulmonary bypass (DSB). The primary objective of the present study was to describe the prevalence and characteristics of patients with abnormal RV diastolic pressure gradient (PG). The secondary objective was to explore the association among abnormal diastolic PG and DSB, postoperative complications, high central venous pressure (CVP), and high RV end-diastolic pressure (RVEDP). DESIGN Retrospective and prospective validation study. SETTING Tertiary care cardiac institute. PARTICIPANTS Cardiac surgical patients (n=374) from a retrospective analysis (n=259) and a prospective validation group (n=115). INTERVENTION RV pressure waveforms were obtained using a pulmonary artery catheter with a pacing port opened at 19 cm distal to the tip of the catheter. Abnormal RV diastolic PG was defined as >4 mmHg. Both elevated RVEDP and high CVP were defined as >16 mmHg. MEASUREMENTS AND MAIN RESULTS From the retrospective and validation cohorts, 42.5% and 48% of the patients had abnormal RV diastolic PG before cardiac surgery, respectively. Abnormal RV diastolic PG before cardiac surgery was associated with higher EuroSCORE II (odds ratio 2.29 [1.10-4.80] v 1.62 [1.10-3.04]; p = 0.041), abnormal hepatic venous flow (45% v 29%; p = 0.038), higher body mass index (28.9 [25.5-32.5] v 27.0 [24.9-30.5]; p = 0.022), pulmonary hypertension (48% v 37%; p = 0.005), and more frequent DSB (32% v 19%; p = 0.023). However, RV diastolic PG was not an independent predictor of DSB, whereas RVEDP (odds ratio 1.67 [1.09-2.55]; p = 0.018) was independently associated with DSB. In addition, RV pressure monitoring indices were superior to CVP in predicting DSB. CONCLUSION Abnormal RV diastolic PG is common before cardiac surgery and is associated with a higher proportion of known preoperative risk factors. However, an abnormal RV diastolic PG gradient is not an independent predictor of DSB in contrast to RVEDP.
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Affiliation(s)
- Lars Grønlykke
- Department of Cardiothoracic Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Etienne J Couture
- Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Francois Haddad
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Meggie Raymond
- Department of Cardiothoracic Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Demers
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mahsa Elmi Sarabi
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- Cardiac Surgical Intensive Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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Evaluation of 4D flow MRI-based non-invasive pressure assessment in aortic coarctations. J Biomech 2019; 94:13-21. [PMID: 31326119 DOI: 10.1016/j.jbiomech.2019.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022]
Abstract
Severity of aortic coarctation (CoA) is currently assessed by estimating trans-coarctation pressure drops through cardiac catheterization or echocardiography. In principle, more detailed information could be obtained non-invasively based on space- and time-resolved magnetic resonance imaging (4D flow) data. Yet the limitations of this imaging technique require testing the accuracy of 4D flow-derived hemodynamic quantities against other methodologies. With the objective of assessing the feasibility and accuracy of this non-invasive method to support the clinical diagnosis of CoA, we developed an algorithm (4DF-FEPPE) to obtain relative pressure distributions from 4D flow data by solving the Poisson pressure equation. 4DF-FEPPE was tested against results from a patient-specific fluid-structure interaction (FSI) simulation, whose patient-specific boundary conditions were prescribed based on 4D flow data. Since numerical simulations provide noise-free pressure fields on fine spatial and temporal scales, our analysis allowed to assess the uncertainties related to 4D flow noise and limited resolution. 4DF-FEPPE and FSI results were compared on a series of cross-sections along the aorta. Bland-Altman analysis revealed very good agreement between the two methodologies in terms of instantaneous data at peak systole, end-diastole and time-averaged values: biases (means of differences) were +0.4 mmHg, -1.1 mmHg and +0.6 mmHg, respectively. Limits of agreement (2 SD) were ±0.978 mmHg, ±1.06 mmHg and ±1.97 mmHg, respectively. Peak-to-peak and maximum trans-coarctation pressure drops obtained with 4DF-FEPPE differed from FSI results by 0.75 mmHg and -1.34 mmHg respectively. The present study considers important validation aspects of non-invasive pressure difference estimation based on 4D flow MRI, showing the potential of this technology to be more broadly applied to the clinical practice.
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Reduced-order modeling of blood flow for noninvasive functional evaluation of coronary artery disease. Biomech Model Mechanobiol 2019; 18:1867-1881. [DOI: 10.1007/s10237-019-01182-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/04/2019] [Indexed: 11/27/2022]
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Rüschen D, Rimke M, Gesenhues J, Leonhardt S, Walter M. Online cardiac output estimation during transvalvular left ventricular assistance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 171:87-97. [PMID: 27609634 DOI: 10.1016/j.cmpb.2016.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/09/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Sufficient cardiac output is one of the main goals of ventricular assist device therapy. To date, there is no adequate method to estimate the combined amount of blood the native heart and a continuous-flow assist device pump through the circulatory system. This paper presents an approach to estimate total cardiac output based on the signals provided by optical pressure sensors mounted on the inlet and outlet of an Abiomed Impella CP pump. METHODS Two Kalman filters were used in parallel for joint estimation of the aortic flow rate and the hydraulic resistance of the aortic valve. The filters utilized a third order nonlinear state-space representation of the cardiovascular system with two nominal parameter sets, one for ovine and another for human subjects. The accuracy of the estimated cardiac output has been investigated in a hybrid mock circulatory loop and an animal study involving two sheep with experimentally induced acute ischaemic heart disease supported by a transvalvular left ventricular assist device. RESULTS The in vitro accuracy of the cardiac output estimation is ±3.64%. In an ovine model, the comparison of the estimated cardiac output with an ultrasonic flow measurement in the pulmonary artery showed 95% limits of agreement of -0.004 ± 0.897 L min-1. The estimation errors were comparable to the accuracy of the measurement (±10%), which is the gold standard in research for invasive blood flow diagnostics. CONCLUSIONS The online estimation of total cardiac output may give the treating physician a direct and physiologically meaningful feedback on the pump speed setting. One promising possible application of our method is physiological control, where the cardiac output can be used as the control variable for closed-loop ventricular assist device therapy.
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Affiliation(s)
- Daniel Rüschen
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
| | - Miriam Rimke
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Jonas Gesenhues
- Institute of Automatic Control, RWTH Aachen University, Aachen, Germany
| | - Steffen Leonhardt
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Marian Walter
- Philips Chair for Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Marlevi D, Ruijsink B, Balmus M, Dillon-Murphy D, Fovargue D, Pushparajah K, Bertoglio C, Colarieti-Tosti M, Larsson M, Lamata P, Figueroa CA, Razavi R, Nordsletten DA. Estimation of Cardiovascular Relative Pressure Using Virtual Work-Energy. Sci Rep 2019; 9:1375. [PMID: 30718699 PMCID: PMC6362021 DOI: 10.1038/s41598-018-37714-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022] Open
Abstract
Many cardiovascular diseases lead to local increases in relative pressure, reflecting the higher costs of driving blood flow. The utility of this biomarker for stratifying the severity of disease has thus driven the development of methods to measure these relative pressures. While intravascular catheterisation remains the most direct measure, its invasiveness limits clinical application in many instances. Non-invasive Doppler ultrasound estimates have partially addressed this gap; however only provide relative pressure estimates for a range of constricted cardiovascular conditions. Here we introduce a non-invasive method that enables arbitrary interrogation of relative pressures throughout an imaged vascular structure, leveraging modern phase contrast magnetic resonance imaging, the virtual work-energy equations, and a virtual field to provide robust and accurate estimates. The versatility and accuracy of the method is verified in a set of complex patient-specific cardiovascular models, where relative pressures into previously inaccessible flow regions are assessed. The method is further validated within a cohort of congenital heart disease patients, providing a novel tool for probing relative pressures in-vivo.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Bram Ruijsink
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Maximilian Balmus
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Desmond Dillon-Murphy
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Daniel Fovargue
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - Kuberan Pushparajah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Cristóbal Bertoglio
- Bernoulli Institute, University of Groningen, Groningen, The Netherlands
- Center for Mathematical Modeling, Universidad de Chile, Santiago, Chile
| | - Massimiliano Colarieti-Tosti
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
| | - C Alberto Figueroa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, USA
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - David A Nordsletten
- Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, United Kingdom.
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Nguyen TQ, Hansen KL, Bechsgaard T, Lönn L, Jensen JA, Nielsen MB. Non-Invasive Assessment of Intravascular Pressure Gradients: A Review of Current and Proposed Novel Methods. Diagnostics (Basel) 2018; 9:diagnostics9010005. [PMID: 30597993 PMCID: PMC6468662 DOI: 10.3390/diagnostics9010005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022] Open
Abstract
Invasive catheterization is associated with a low risk of serious complications. However, although it is the gold standard for measuring pressure gradients, it induces changes to blood flow and requires significant resources. Therefore, non-invasive alternatives are urgently needed. Pressure gradients are routinely estimated non-invasively in clinical settings using ultrasound and calculated with the simplified Bernoulli equation, a method with several limitations. A PubMed literature search on validation of non-invasive techniques was conducted, and studies were included if non-invasively estimated pressure gradients were compared with invasively measured pressure gradients in vivo. Pressure gradients were mainly estimated from velocities obtained with Doppler ultrasound or magnetic resonance imaging. Most studies used the simplified Bernoulli equation, but more recent studies have employed the expanded Bernoulli and Navier⁻Stokes equations. Overall, the studies reported good correlation between non-invasive estimation of pressure gradients and catheterization. Despite having strong correlations, several studies reported the non-invasive techniques to either overestimate or underestimate the invasive measurements, thus questioning the accuracy of the non-invasive methods. In conclusion, more advanced imaging techniques may be needed to overcome the shortcomings of current methods.
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Affiliation(s)
- Tin-Quoc Nguyen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Thor Bechsgaard
- Department of Radiology, Odense University Hospital Svendborg Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark.
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Jørgen Arendt Jensen
- Center for Fast Ultrasound Imaging, DTU Elektro, Technical University of Denmark, Ørsteds Plads Building 349, 2800 Lyngby, Denmark.
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
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24
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Dalvi B, Jain S, Pinto R. Device closure of atrial septal defect with severe pulmonary hypertension in adults: Patient selection with early and intermediate term results. Catheter Cardiovasc Interv 2018; 93:309-315. [DOI: 10.1002/ccd.27853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/28/2018] [Accepted: 08/04/2018] [Indexed: 11/05/2022]
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25
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Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis 2018; 10:S2890-S2898. [PMID: 30305949 DOI: 10.21037/jtd.2018.07.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients having atrial septal defect (ASD) with moderate and more importantly severe pulmonary arterial hypertension (PAH) pose a clinical dilemma. Closing ASD in those with irreversible PAH and not closing it when the PAH is reversible can cost patients dearly, both in terms of quality of life and longevity. In our experience, there is no single parameter that can help in decision making in this difficult subset of patients and therefore we recommend a multi-dimensional approach, which takes into consideration clinical, radiological, electrocardiographic and hemodynamic variables as a whole. ASD with restrictive left ventricular (LV) physiology can lead to pulmonary venous hypertension, which can manifest as life threatening acute pulmonary edema following device closure. All high-risk candidates prone to having this combination should be prepared with diuretics and vasodilators prior to bringing them to catheterization laboratory and should be assessed with temporary balloon/device occlusion prior to permanent closure of the defect. In those cases of ASD with borderline operability either due to severe PAH or LV restrictive physiology, perforated device may be helpful in preventing acute or long-term complications of complete closure.
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Affiliation(s)
- Shreepal Jain
- Department of Pediatric Cardiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Glenmark Cardiac Center, Mumbai, Maharashtra, India
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26
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Olesen JB, Villagomez-Hoyos CA, Moller ND, Ewertsen C, Hansen KL, Nielsen MB, Bech B, Lonn L, Traberg MS, Jensen JA. Noninvasive Estimation of Pressure Changes Using 2-D Vector Velocity Ultrasound: An Experimental Study With In Vivo Examples. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:709-719. [PMID: 29733275 DOI: 10.1109/tuffc.2018.2808328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A noninvasive method for estimating intravascular pressure changes using 2-D vector velocity is presented. The method was first validated on computational fluid dynamic (CFD) data and with catheter measurements on phantoms. Hereafter, the method was tested in vivo at the carotid bifurcation and at the aortic valve of two healthy volunteers. Ultrasound measurements were performed using the experimental scanner SARUS, in combination with an 8 MHz linear array transducer for experimental scans and a carotid scan, whereas a 3.5-MHz phased array probe was employed for a scan of an aortic valve. Measured 2-D fields of angle-independent vector velocities were obtained using synthetic aperture imaging. Pressure drops from simulated steady flow through six vessel geometries spanning different degrees of diameter narrowing, running from 20%-70%, showed relative biases from 0.35% to 12.06%, depending on the degree of constriction. Phantom measurements were performed on a vessel with the same geometry as the 70% constricted CFD model. The derived pressure drops were compared to pressure drops measured by a clinically used 4F catheter and to a finite-element model. The proposed method showed peak systolic pressure drops of -3 kPa ± 57 Pa, while the catheter and the simulation model showed -5.4 kPa ± 52 Pa and -2.9 kPa, respectively. An in vivo acquisition of 10 s was made at the carotid bifurcation. This produced eight cardiac cycles from where pressure gradients of -227 ± 15 Pa were found. Finally, the aortic valve measurement showed a peak pressure drop of -2.1 kPa over one cardiac cycle. In conclusion, pressure gradients from convective flow changes are detectable using 2-D vector velocity ultrasound.
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Spazzapan M, Sastry P, Dunning J, Nordsletten D, de Vecchi A. The Use of Biophysical Flow Models in the Surgical Management of Patients Affected by Chronic Thromboembolic Pulmonary Hypertension. Front Physiol 2018; 9:223. [PMID: 29593574 PMCID: PMC5859070 DOI: 10.3389/fphys.2018.00223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/28/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from progressive thrombotic occlusion of the pulmonary arteries. It is treated by surgical removal of the occlusion, with success rates depending on the degree of microvascular remodeling. Surgical eligibility is influenced by the contributions of both the thrombus occlusion and microvasculature remodeling to the overall vascular resistance. Assessing this is challenging due to the high inter-individual variability in arterial morphology and physiology. We investigated the potential of patient-specific computational flow modeling to quantify pressure gradients in the pulmonary arteries of CTEPH patients to assist the decision-making process for surgical eligibility. Methods: Detailed segmentations of the pulmonary arteries were created from postoperative chest Computed Tomography scans of three CTEPH patients. A focal stenosis was included in the original geometry to compare the pre- and post-surgical hemodynamics. Three-dimensional flow simulations were performed on each morphology to quantify velocity-dependent pressure changes using a finite element solver coupled to terminal 2-element Windkessel models. In addition to transient flow simulations, a parametric modeling approach based on constant flow simulations is also proposed as faster technique to estimate relative pressure drops through the proximal pulmonary vasculature. Results: An asymmetrical flow split between left and right pulmonary arteries was observed in the stenosed models. Removing the proximal obstruction resulted in a reduction of the right-left pressure imbalance of up to 18%. Changes were also observed in the wall shear stresses and flow topology, where vortices developed in the stenosed model while the non-stenosed retained a helical flow. The predicted pressure gradients from constant flow simulations were consistent with the ones measured in the transient flow simulations. Conclusion: This study provides a proof of concept that patient-specific computational modeling can be used as a noninvasive tool for assisting surgical decisions in CTEPH based on hemodynamics metrics. Our technique enables determination of the proximal relative pressure, which could subsequently be compared to the total pressure drop to determine the degree of distal and proximal vascular resistance. In the longer term this approach has the potential to form the basis for a more quantitative classification system of CTEPH types.
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Affiliation(s)
- Martina Spazzapan
- King's College London, GKT School of Medical Education, London, United Kingdom
| | - Priya Sastry
- Cardiothoracic Surgery Unit, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - John Dunning
- Cardiothoracic Surgery Unit, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - David Nordsletten
- King's College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, United Kingdom
| | - Adelaide de Vecchi
- King's College London, School of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, London, United Kingdom
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28
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de Boer SW, Heinen SGH, van den Heuvel DAF, van de Vosse FN, de Vries JPPM. How to define the hemodynamic significance of an equivocal iliofemoral artery stenosis: Review of literature and outcomes of an international questionnaire. Vascular 2017; 25:598-608. [DOI: 10.1177/1708538117700751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose The goal of the study was to review current literature regarding the diagnosis of equivocal (50–70%) iliofemoral artery stenosis and compare these findings with the daily practice of an international panel of endovascular experts. Methods The Medline Database was searched for relevant publications, and an electronic survey was sent to experts in the field covering the following topics: definition of an equivocal iliofemoral artery stenosis, angiographic visualization and investigation protocols of an equivocal stenosis, intra-arterial pressure measurements, and definition of hemodynamic significance of an equivocal iliofemoral artery stenosis using a physiologic measure. Results Of the 37 invited endovascular experts, 21 (53.8%) agreed to participate in the survey. Analysis of existing literature shows that the level of evidence for diagnosing equivocal iliofemoral artery stenosis is mediocre and is not being implemented by experts in the field. Conclusion Studies have shown that a stenosis of between 50% and 70% iliofemoral lumen diameter reduction shows a wide range of trans-stenotic pressure gradients. Equivocal iliofemoral artery stenosis can best be identified using three-dimensional quantitative vascular analysis software. Although evidence for a clear hemodynamic cutoff point is weak, performing trans-lesion intra-arterial pressure measurements at rest and during maximal hyperemia is preferred. Diagnosing iliofemoral artery stenosis solely on lumen diameter reduction is inadequate.
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Affiliation(s)
- SW de Boer
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - SGH Heinen
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - DAF van den Heuvel
- Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - FN van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - JPPM de Vries
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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29
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Donati F, Myerson S, Bissell MM, Smith NP, Neubauer S, Monaghan MJ, Nordsletten DA, Lamata P. Beyond Bernoulli: Improving the Accuracy and Precision of Noninvasive Estimation of Peak Pressure Drops. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005207. [PMID: 28093412 PMCID: PMC5265685 DOI: 10.1161/circimaging.116.005207] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transvalvular peak pressure drops are routinely assessed noninvasively by echocardiography using the Bernoulli principle. However, the Bernoulli principle relies on several approximations that may not be appropriate, including that the majority of the pressure drop is because of the spatial acceleration of the blood flow, and the ejection jet is a single streamline (single peak velocity value). METHODS AND RESULTS We assessed the accuracy of the Bernoulli principle to estimate the peak pressure drop at the aortic valve using 3-dimensional cardiovascular magnetic resonance flow data in 32 subjects. Reference pressure drops were computed from the flow field, accounting for the principles of physics (ie, the Navier-Stokes equations). Analysis of the pressure components confirmed that the spatial acceleration of the blood jet through the valve is most significant (accounting for 99% of the total drop in stenotic subjects). However, the Bernoulli formulation demonstrated a consistent overestimation of the transvalvular pressure (average of 54%, range 5%-136%) resulting from the use of a single peak velocity value, which neglects the velocity distribution across the aortic valve plane. This assumption was a source of uncontrolled variability. CONCLUSIONS The application of the Bernoulli formulation results in a clinically significant overestimation of peak pressure drops because of approximation of blood flow as a single streamline. A corrected formulation that accounts for the cross-sectional profile of the blood flow is proposed and adapted to both cardiovascular magnetic resonance and echocardiographic data.
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Affiliation(s)
- Fabrizio Donati
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Saul Myerson
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Malenka M Bissell
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Nicolas P Smith
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Stefan Neubauer
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Mark J Monaghan
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - David A Nordsletten
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.)
| | - Pablo Lamata
- From the King's College London, Division of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, The Rayne Institute, United Kingdom (F.D., N.P.S., D.A.N., P.L.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (S.M., M.M.B., S.N.); University of Auckland, New Zealand (N.P.S.); and Department of Non Invasive Cardiology, King's College Hospital, London, United Kingdom (M.J.M.).
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30
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Donati F, Nordsletten DA, Smith NP, Lamata P. Pressure mapping from flow imaging: enhancing computation of the viscous term through velocity reconstruction in near-wall regions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:5097-100. [PMID: 25571139 DOI: 10.1109/embc.2014.6944771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although being small compared to inertial acceleration, viscous component of the pressure gradient has recently emerged as a potential biomarker for aortic disease conditions including aortic valve stenosis. However, as it involves the computation of second order derivatives and viscous dissipation is locally higher in the near-wall region of the larger vessels, where the lowest local signal-to-noise ratios are encountered, the estimation process from medical image velocity data through mathematical models is highly challenging. We propose a fully automatic framework to recover the laminar viscous pressure gradient through reconstruction of the velocity vector field in the aortic boundary region. An in-silico study is conducted and the pressure drop is computed solving a Poisson problem on pressure using both a reconstructed and non-reconstructed velocity profile near the vessel walls, showing a global improvement of performance with the enhanced method.
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31
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Donati F, Figueroa CA, Smith NP, Lamata P, Nordsletten DA. Non-invasive pressure difference estimation from PC-MRI using the work-energy equation. Med Image Anal 2015; 26:159-72. [PMID: 26409245 PMCID: PMC4686008 DOI: 10.1016/j.media.2015.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/21/2015] [Accepted: 08/31/2015] [Indexed: 01/15/2023]
Abstract
Pressure difference is an accepted clinical biomarker for cardiovascular disease conditions such as aortic coarctation. Currently, measurements of pressure differences in the clinic rely on invasive techniques (catheterization), prompting development of non-invasive estimates based on blood flow. In this work, we propose a non-invasive estimation procedure deriving pressure difference from the work-energy equation for a Newtonian fluid. Spatial and temporal convergence is demonstrated on in silico Phase Contrast Magnetic Resonance Image (PC-MRI) phantoms with steady and transient flow fields. The method is also tested on an image dataset generated in silico from a 3D patient-specific Computational Fluid Dynamics (CFD) simulation and finally evaluated on a cohort of 9 subjects. The performance is compared to existing approaches based on steady and unsteady Bernoulli formulations as well as the pressure Poisson equation. The new technique shows good accuracy, robustness to noise, and robustness to the image segmentation process, illustrating the potential of this approach for non-invasive pressure difference estimation.
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Affiliation(s)
- Fabrizio Donati
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
| | - C Alberto Figueroa
- University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48105, United States.
| | - Nicolas P Smith
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Auckland, Engineering School Block 1, Level 5, 20 Symonds St, Auckland 101, New Zealand.
| | - Pablo Lamata
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom; University of Oxford, Department of Computer Science, Wolfson Building, Parks Road, Oxford OX1 3QD, United Kingdom.
| | - David A Nordsletten
- King's College London, Department of Biomedical Engineering and Imaging Sciences, St. Thomas' Hospital, 4th floor Lambeth Wing, The Rayne Institute, London SE1 7EH, United Kingdom.
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32
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Rüschen D, Rimke M, Gesenhues J, Leonhardt S, Walter M. Continuous Cardiac Output Estimation Under Left Ventricular Assistance. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ifacol.2015.10.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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