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Jian J, Zhang L, Zhang Y, Jian C, Wang T, Xie M, Wu W, Liang B, Xiong X. A dynamic nomogram for predicting in-hospital major adverse cardiovascular and cerebrovascular events in patients with both coronary artery disease and atrial fibrillation: a multicenter retrospective study. Coron Artery Dis 2024:00019501-990000000-00242. [PMID: 38836650 DOI: 10.1097/mca.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Patients with both coronary artery disease (CAD) and atrial fibrillation (AF) are at a high risk of major adverse cardiovascular and cerebrovascular events (MACCE) during hospitalization. Accurate prediction of MACCE can help identify high-risk patients and guide treatment decisions. This study was to elaborate and validate a dynamic nomogram for predicting the occurrence of MACCE during hospitalization in Patients with CAD combined with AF. METHODS A total of 3550 patients with AF and CAD were collected. They were randomly assigned to a training group and a validation group in a ratio of 7 : 3. Univariate and multivariate analyses were utilized to identify risk factors (P < 0.05). To avoid multicollinearity and overfit of the model, the least absolute shrinkage and selection operator was conducted to further screen the risk factors. Calibration curves, receiver operating characteristic curves, and decision curve analyses are employed to assess the nomogram. For external validation, a cohort consisting of 249 patients was utilized from the Medical Information Mart for Intensive Care IV Clinical Database, version 2.2. RESULTS Eight indicators with statistical differences were screened by univariate analysis, multivariate analysis, and the least absolute shrinkage and selection operator method (P < 0.05). The prediction model based on eight risk factors demonstrated good prediction performance in the training group, with an area under the curve (AUC) of 0.838. This performance was also maintained in the internal validation group (AUC = 0.835) and the external validation group (AUC = 0.806). Meanwhile, the calibration curve indicates that the nomogram was well-calibrated, and decision curve analysis revealed that the nomogram exhibited good clinical utility. CONCLUSION The nomogram we constructed may aid in stratifying the risk and predicting the prognosis for patients with CAD and AF.
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Affiliation(s)
- Jie Jian
- College of Medical Informatics
- Medical Data Science Academy, Chongqing Medical University
| | - Lingqin Zhang
- Equipment and Supplies Department, Bishan Hospital of Chongqing Medical University
| | - Yang Zhang
- College of Medical Informatics
- Medical Data Science Academy, Chongqing Medical University
| | - Chang Jian
- College of Medical Informatics
- Medical Data Science Academy, Chongqing Medical University
| | - Tingting Wang
- College of Medical Informatics
- Medical Data Science Academy, Chongqing Medical University
| | | | - Wenjuan Wu
- Department of Medical Services, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gonzalo A, Augustin CM, Bifulco SF, Telle Å, Chahine Y, Kassar A, Guerrero-Hurtado M, Durán E, Martínez-Legazpi P, Flores O, Bermejo J, Plank G, Akoum N, Boyle PM, Del Alamo JC. Patient-specific multi-physics simulations of fibrotic changes in left atrial tissue mechanics impact on hemodynamics. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.29.596526. [PMID: 38853952 PMCID: PMC11160719 DOI: 10.1101/2024.05.29.596526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Stroke is a leading cause of death and disability worldwide. Atrial myopathy, including fibrosis, is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association are poorly understood. Fibrosis modifies myocardial structure, impairing electrical propagation and tissue biomechanics, and creating stagnant flow regions where clots could form. Fibrosis can be mapped non-invasively using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, fibrosis maps are not currently incorporated into stroke risk calculations or computational electro-mechano-fluidic models. We present multi-physics simulations of left atrial (LA) myocardial motion and hemodynamics using patient-specific anatomies and fibrotic maps from LGE-MRI. We modify tissue stiffness and active tension generation in fibrotic regions and investigate how these changes affect LA flow for different fibrotic burdens. We find that fibrotic regions and, to a lesser extent, non-fibrotic regions experience reduced myocardial strain, resulting in decreased LA emptying fraction consistent with clinical observations. Both fibrotic tissue stiffening and hypocontractility independently reduce LA function, but together, these two alterations cause more pronounced effects than either one alone. Fibrosis significantly alters flow patterns throughout the atrial chamber, and particularly, the filling and emptying jets of the left atrial appendage (LAA). The effects of fibrosis in LA flow are largely captured by the concomitant changes in LA emptying fraction except inside the LAA, where a multi-factorial behavior is observed. This work illustrates how high-fidelity, multi-physics models can be used to study thrombogenesis mechanisms in a patient-specific manner, shedding light onto the link between atrial fibrosis and ischemic stroke. Key points Left atrial (LA) fibrosis is associated with arrhythmogenesis and increased risk of ischemic stroke; its extent and pattern can be quantified on a patient-specific basis using late gadolinium enhancement magnetic resonance imaging.Current stroke risk prediction tools have limited personalization, and their accuracy could be improvedfib by incorporating patient-specific information like fibrotic maps and hemodynamic patterns.We present the first electro-mechano-fluidic multi-physics computational simulations of LA flow, including fibrosis and anatomies from medical imaging.Mechanical changes in fibrotic tissue impair global LA motion, decreasing LA and left atrial appendage (LAA) emptying fractions, especially in subjects with higher fibrosis burdens.Fibrotic-mediated LA motion impairment alters LA and LAA flow near the endocardium and the whole cavity, ultimately leading to more stagnant blood regions in the LAA.
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Zingaro A, Ahmad Z, Kholmovski E, Sakata K, Dede' L, Morris AK, Quarteroni A, Trayanova NA. A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data. Sci Rep 2024; 14:9515. [PMID: 38664464 PMCID: PMC11045804 DOI: 10.1038/s41598-024-59997-2] [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: 01/26/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like theCHA 2 DS 2 -VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.
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Affiliation(s)
- Alberto Zingaro
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA.
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
- ELEM Biotech S.L., Pier07, Via Laietana, 26, 08003, Barcelona, Spain.
| | - Zan Ahmad
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, 100 Wyman Park Dr, Baltimore, MD, 21211, USA
| | - Eugene Kholmovski
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
- Department of Radiology, University of Utah, 30 N Mario Capecchi Dr., Salt Lake City, UT, 84112, USA
| | - Kensuke Sakata
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
| | - Luca Dede'
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Alan K Morris
- Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr., Salt Lake City, UT, 84112, USA
| | - Alfio Quarteroni
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, 1015, Lausanne, Switzerland
| | - Natalia A Trayanova
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD, 21218, USA
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Ahmad Z, Yin M, Sukurdeep Y, Rotenberg N, Kholmovski E, Trayanova NA. Elastic shape analysis computations for clustering left atrial appendage geometries of atrial fibrillation patients. ARXIV 2024:arXiv:2403.08685v1. [PMID: 38560740 PMCID: PMC10980091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Morphological variations in the left atrial appendage (LAA) are associated with different levels of ischemic stroke risk for patients with atrial fibrillation (AF). Studying LAA morphology can elucidate mechanisms behind this association and lead to the development of advanced stroke risk stratification tools. However, current categorical descriptions of LAA morphologies are qualitative and inconsistent across studies, which impedes advancements in our understanding of stroke pathogenesis in AF. To mitigate these issues, we introduce a quantitative pipeline that combines elastic shape analysis with unsupervised learning for the categorization of LAA morphology in AF patients. As part of our pipeline, we compute pairwise elastic distances between LAA meshes from a cohort of 20 AF patients, and leverage these distances to cluster our shape data. We demonstrate that our method clusters LAA morphologies based on distinctive shape features, overcoming the innate inconsistencies of current LAA categorization systems, and paving the way for improved stroke risk metrics using objective LAA shape groups.
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Affiliation(s)
- Zan Ahmad
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore MD 21210, USA
- Department of Biomedical Engineering, Alliance for Cardiovascular Diagnostics and Treatment Innovation (ADVANCE), Baltimore, MD, 21210, USA
| | - Minglang Yin
- Department of Biomedical Engineering, Alliance for Cardiovascular Diagnostics and Treatment Innovation (ADVANCE), Baltimore, MD, 21210, USA
| | - Yashil Sukurdeep
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore MD 21210, USA
| | - Noam Rotenberg
- Department of Biomedical Engineering, Alliance for Cardiovascular Diagnostics and Treatment Innovation (ADVANCE), Baltimore, MD, 21210, USA
| | - Eugene Kholmovski
- Department of Biomedical Engineering, Alliance for Cardiovascular Diagnostics and Treatment Innovation (ADVANCE), Baltimore, MD, 21210, USA
| | - Natalia A Trayanova
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore MD 21210, USA
- Department of Biomedical Engineering, Alliance for Cardiovascular Diagnostics and Treatment Innovation (ADVANCE), Baltimore, MD, 21210, USA
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Zingaro A, Ahmad Z, Kholmovski E, Sakata K, Dede’ L, Morris AK, Quarteroni A, Trayanova NA. A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.11.575156. [PMID: 38293150 PMCID: PMC10827064 DOI: 10.1101/2024.01.11.575156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the CHA2DS2-VASc score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.
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Affiliation(s)
- Alberto Zingaro
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- ELEM Biotech S.L., Pier07, Via Laietana, 26, 08003, Barcelona, Spain
| | - Zan Ahmad
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, 100 Wyman Park Dr, 21211, Baltimore, MD, USA
| | - Eugene Kholmovski
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
- Department of Radiology, University of Utah, 30 N Mario Capecchi Dr., 84112, Salt Lake City, UT, USA
| | - Kensuke Sakata
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
| | - Luca Dede’
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Alan K. Morris
- Scientific Computing and Imaging Institute, University of Utah, 72 Central Campus Dr., 84112, Salt Lake City, UT, USA
| | - Alfio Quarteroni
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Station 8, Av. Piccard, CH-1015 Lausanne, Switzerland (Professor Emeritus)
| | - Natalia A. Trayanova
- ADVANCE, Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St., 21218, Baltimore, MD, USA
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