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Bäck S, Henriksson L, Bolger AF, Carlhäll CJ, Persson A, Karlsson M, Ebbers T. Assessment of transmitral and left atrial appendage flow rate from cardiac 4D-CT. COMMUNICATIONS MEDICINE 2023; 3:22. [PMID: 36774374 PMCID: PMC9922288 DOI: 10.1038/s43856-023-00252-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/30/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Cardiac time-resolved CT (4D-CT) acquisitions provide high quality anatomical images of the heart. However, some cardiac diseases require assessment of blood flow in the heart. Diastolic dysfunction, for instance, is diagnosed by measuring the flow through the mitral valve (MV), while in atrial fibrillation, the flow through the left atrial appendage (LAA) indicates the risk for thrombus formation. Accurate validated techniques to extract this information from 4D-CT have been lacking, however. METHODS To measure the flow rate though the MV and the LAA from 4D-CT, we developed a motion tracking algorithm that performs a nonrigid deformation of the surface separating the blood pool from the myocardium. To improve the tracking of the LAA, this region was deformed separately from the left atrium and left ventricle. We compared the CT based flow with 4D flow and short axis MRI data from the same individual in 9 patients. RESULTS For the mitral valve flow, good agreement was found for the time span between the early and late diastolic peak flow (bias: <0.1 s). The ventricular stroke volume is similar compared to short-axis MRI (bias 3 ml). There are larger differences in the diastolic peak flow rates, with a larger bias for the early flow rate than the late flow rate. The peak LAA outflow rate measured with both modalities matches well (bias: -6 ml/s). CONCLUSIONS Overall, the developed algorithm provides accurate tracking of dynamic cardiac geometries resulting in similar flow rates at the MV and LAA compared to 4D flow MRI.
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Affiliation(s)
- Sophia Bäck
- grid.5640.70000 0001 2162 9922Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Lilian Henriksson
- grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann F. Bolger
- grid.5640.70000 0001 2162 9922Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.266102.10000 0001 2297 6811Department of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Carl-Johan Carlhäll
- grid.5640.70000 0001 2162 9922Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Persson
- grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matts Karlsson
- grid.5640.70000 0001 2162 9922Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden ,grid.5640.70000 0001 2162 9922Department of Management and Engineering, Linköping university, Linköping, Sweden
| | - Tino Ebbers
- Unit of Cardiovascular Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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2
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Sekine T, Nakaza M, Matsumoto M, Ando T, Inoue T, Sakamoto SI, Maruyama M, Obara M, Leonowicz O, Usuda J, Kumita S. 4D Flow MR Imaging of the Left Atrium: What is Non-physiological Blood Flow in the Cardiac System? Magn Reson Med Sci 2022; 21:293-308. [PMID: 35185085 PMCID: PMC9680542 DOI: 10.2463/mrms.rev.2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 01/30/2024] Open
Abstract
Most cardiac diseases cause a non-physiological blood flow pattern known as turbulence around the heart and great vessels, which further worsen the disease itself. However, there is no consensus on how blood flow can be defined in disease conditions. Especially, in the left atrium, the fact that vortex flow already exists makes this debate more complicated. 3D time-resolved phase-contrast (4D flow) MRI is expected to be able to capture blood flow patterns from multiple aspects, such as blood flow velocity, stasis, and vortex quantification. Previous studies have confirmed that physiological vortex flow is predominantly induced by the higher-volume flow from the superior left pulmonary vein. In atrial fibrillation, 4D flow MRI reveals a non-physiological blood flow pattern, which information may add value to well-established clinical risk factors. Currently, the research target of LA analysis has also widened to lung surgeons, pulmonary vein stump thrombosis after left upper lobectomy. 4D flow MRI is expected to be utilized for many more variable diseases that are currently unimaginable.
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Affiliation(s)
- Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Masatoki Nakaza
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Mitsuo Matsumoto
- Department of Thoracic Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Takahiro Ando
- Department of Radiology, Nippon Medical School, Nagayama Hospital, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shun-Ichiro Sakamoto
- Department of Cardiovascular Surgery, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Mitsunori Maruyama
- Department of Cardiology, Nippon Medical School, Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan
| | | | | | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
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3
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Zhuang B, Sirajuddin A, Zhao S, Lu M. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives. Quant Imaging Med Surg 2021; 11:4193-4210. [PMID: 34476199 DOI: 10.21037/qims-20-1234] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/23/2021] [Indexed: 11/06/2022]
Abstract
Magnetic resonance imaging (MRI) four-dimensional (4D) flow is a type of phase-contrast (PC) MRI that uses blood flow encoded in 3 directions, which is resolved relative to 3 spatial and temporal dimensions of cardiac circulation. It can be used to simultaneously quantify and visualize hemodynamics or morphology disorders. 4D flow MRI is more comprehensive and accurate than two-dimensional (2D) PC MRI and echocardiography. 4D flow MRI provides numerous hemodynamic parameters that are not limited to the basic 2D parameters, including wall shear stress (WSS), pulse wave velocity (PWV), kinetic energy, turbulent kinetic energy (TKE), pressure gradient, and flow component analysis. 4D flow MRI is widely used to image many parts of the body, such as the neck, brain, and liver, and has a wide application spectrum to cardiac diseases and large vessels. This present review aims to summarize the hemodynamic parameters of 4D flow MRI technology and generalize their usefulness in clinical practice in relation to the cardiovascular system. In addition, we note the improvements that have been made to 4D flow MRI with the application of new technologies. The application of new technologies can improve the speed of 4D flow, which would benefit clinical applications.
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Affiliation(s)
- Baiyan Zhuang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China
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4
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Parés C, Berjano E, González-Suárez A. Effect of intracardiac blood flow pulsatility during radiofrequency cardiac ablation: computer modeling study. Int J Hyperthermia 2021; 38:316-325. [PMID: 33627008 DOI: 10.1080/02656736.2021.1890240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To assess the effect of intracardiac blood flow pulsatility on tissue and blood distributions during radiofrequency (RF) cardiac ablation (RFCA). METHODS A three-dimensional computer model was used to simulate constant power ablations with an irrigated-tip electrode and three possible catheter orientations (perpendicular, parallel and 45°). Continuous flow and three different pulsatile flow profiles were considered, with four average blood velocity values: 3, 5.5, 8.5 and 24.4 cm/s. The 50 °C contour was used to assess thermal lesion size. RESULTS The differences in lesion size between continuous flow and the different pulsatile flow profiles were always less than 1 mm. As regards maximum tissue temperature, the differences between continuous and pulsatile flow were always less than 1 °C, with slightly higher differences in maximum blood temperature, but never over 6 °C. While the progress of maximum tissue temperature was identical for continuous and pulsatile flow, maximum blood temperature with the pulsatile profile showed small amplitude oscillations associated with blood flow pulsatility. CONCLUSIONS The findings show that intracardiac blood pulsatility has a negligible effect on lesion size and a very limited impact on maximum tissue and blood temperatures, which suggests that future experimental studies based on ex vivo or in silico models can ignore pulsatility in intracardiac blood flow.
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Affiliation(s)
| | - Enrique Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana González-Suárez
- Electrical and Electronic Engineering, National University of Ireland Galway, Galway, Ireland.,Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
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5
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Ma L, Yerly J, Di Sopra L, Piccini D, Lee J, DiCarlo A, Passman R, Greenland P, Kim D, Stuber M, Markl M. Using 5D flow MRI to decode the effects of rhythm on left atrial 3D flow dynamics in patients with atrial fibrillation. Magn Reson Med 2021; 85:3125-3139. [PMID: 33400296 PMCID: PMC7904609 DOI: 10.1002/mrm.28642] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE This study used a 5D flow framework to explore the influence of arrhythmia on thrombogenic hemodynamic parameters in patients with atrial fibrillation (AF). METHODS A fully self-gated, 3D radial, highly accelerated free-running 5D flow sequence with interleaved four-point velocity-encoding was acquired using an in vitro arrhythmic flow phantom and in 25 patients with a history of AF (68 ± 8 y, 6 female). Self-gating signals were used to calculate AF burden, bin data, and tag each k-space line with its RRLength . Data were binned as an RR-resolved dataset with four RR-interval bins (RR1-RR4, short-to-long) for compressed sensing reconstruction. AF burden was calculated as interquartile range of all intrascan RR-intervals divided by median RR-interval, and left atrial (LA) stasis as the percent of the cardiac cycle where the velocity was <0.1 m/s. RESULTS In vitro results demonstrated successful recovery of RR-binned flow curves using RR-resolved 5D flow compared to a real-time PC reference standard. In vivo, 5D flow was acquired in 8:48 minutes. AF burden was significantly correlated with 5D flow-derived peak (PV) and mean (MV) velocity and stasis (|ρ| = 0.54-0.75, P < .001). Sensitivity analyses determined a threshold for low versus high AF burden at 9.7%. High burden patients had increased LA mean stasis (up to +42%, P < .01), and lower MV and PV (-30%, -40.6%, respectively, P < .01). RR4 deviated furthest from respiratory-resolved reconstruction (end-expiration) with increased mean stasis (7.6% ± 14.0%, P = .10) and decreased PV (-12.7 ± 14.2%, P = .09). CONCLUSIONS RR-resolved 5D flow can capture temporal and RR-resolved 3D hemodynamics in <10 minutes and offers a novel approach to investigate arrhythmias.
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Affiliation(s)
- Liliana Ma
- Department of Radiology, Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Jérôme Yerly
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Lorenzo Di Sopra
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland
| | - Davide Piccini
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Jeesoo Lee
- Department of Radiology, Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda DiCarlo
- Department of Radiology, Feinberg School of Medicine, Chicago, IL, USA
| | - Rod Passman
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Philip Greenland
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel Kim
- Department of Radiology, Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Switzerland
- Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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6
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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7
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Nakaza M, Matsumoto M, Sekine T, Inoue T, Ando T, Ogawa M, Obara M, Leonowicz O, Kumita S, Usuda J. Dual-VENC 4D Flow MRI Can Detect Abnormal Blood Flow in the Left Atrium That Potentially Causes Thrombosis Formation after Left Upper Lobectomy. Magn Reson Med Sci 2021; 21:433-443. [PMID: 33790138 PMCID: PMC9316132 DOI: 10.2463/mrms.mp.2020-0170] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of the current study was to clarify the blood flow pattern in the left atrium (LA), potentially causing the formation of thrombosis after left upper lobectomy (LUL). The blood flow in the LA was evaluated and compared between LUL patients with and without thrombosis. For the evaluation, we applied highly accelerated 4D flow MRI with dual-velocity encoding (VENC) scheme, which was expected to be able to capture slow flow components in the LA accurately. Methods: Eight volunteers and 18 patients subjected to LUL underwent dual-VENC 4D Flow MRI. Eight patients had a history of thrombosis. We measured the blood flow velocity and stasis ratio (proportion in the volume that did not exceed 10 cm/s in any cardiac phase) in the LA and left superior pulmonary vein (LSPV) stump. For visual assessment, the presence of each collision of the blood flow from pulmonary veins and vortex flow in the LA were evaluated. Each acquired value was compared between healthy participants and LUL patients, and in LUL patients with and without thrombosis. Results: In LUL patients, blood flow velocity near the inflow part of the left superior pulmonary vein (Lt Upp) and mean velocity in the LA were lower, and stasis ratio in the LA was higher compared with healthy volunteers (Lt Upp 9.10 ± 3.09 vs.13.23 ± 14.19 cm/s, mean velocity in the LA 9.81 ± 2.49 vs. 11.40 ± 1.15 cm/s, and stasis ratio 25.28 ± 18.64 vs. 4.71 ± 3.03%, P = 0.008, 0.037, and < 0.001). There was no significant difference in any quantification values between LUL patients with and without thrombosis. For visual assessment, the thrombus formation was associated with no collision pattern (62.5% vs. 10%, P = 0.019) and not with vortex flow pattern (50% vs. 30%, P = 0.751). Conclusion: The net blood flow velocity was not associated with the thrombus formation. In contrast, a specific blood flow pattern, the absence of blood flow collision from pulmonary veins, correlates to the thrombus formation in the LA.
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Affiliation(s)
| | | | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School.,Department of Radiology, Nippon Medical School Musashi Kosugi Hopital
| | - Tatsuya Inoue
- Department of Respiratory Surgery, Nippon Medical School
| | | | | | | | | | | | - Jitsuo Usuda
- Department of Respiratory Surgery, Nippon Medical School
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8
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Mills MT, Grafton-Clarke C, Williams G, Gosling RC, Al Baraikan A, Kyriacou AL, Morris PD, Gunn JP, Swoboda PP, Levelt E, Tsampasian V, van der Geest RJ, Swift AJ, Greenwood JP, Plein S, Vassiliou V, Garg P. Feasibility and validation of trans-valvular flow derived by four-dimensional flow cardiovascular magnetic resonance imaging in patients with atrial fibrillation. Wellcome Open Res 2021; 6:73. [PMID: 34095509 PMCID: PMC8150120 DOI: 10.12688/wellcomeopenres.16655.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/12/2023] Open
Abstract
Background: Four-dimensional (4D) flow cardiovascular magnetic resonance imaging (MRI) is an emerging technique used for intra-cardiac blood flow assessment. The role of 4D flow cardiovascular MRI in the assessment of trans-valvular flow in patients with atrial fibrillation (AF) has not previously been assessed. The purpose of this study was to assess the feasibility, image quality, and internal validity of 4D flow cardiovascular MRI in the quantification of trans-valvular flow in patients with AF. Methods: Patients with AF and healthy controls in sinus rhythm underwent cardiovascular MRI, including 4D flow studies. Quality assurance checks were done on the raw data and streamlines. Consistency was investigated by trans-valvular flow assessment between the mitral valve (MV) and the aortic valve (AV). Results: Eight patients with AF (88% male, mean age 62±13 years, mean heart rate (HR) 83±16 beats per minute (bpm)) were included and compared with ten healthy controls (70% male, mean age 41±20 years, mean HR 68.5±9 bpm). All scans were of either good quality with minimal blurring artefacts, or excellent quality with no artefacts. No significant bias was observed between the AV and MV stroke volumes in either healthy controls (-4.8, 95% CI -15.64 to 6.04; P=0.34) or in patients with AF (1.64, 95% CI -4.7 to 7.94; P=0.56). A significant correlation was demonstrated between MV and AV stroke volumes in both healthy controls (r=0.87, 95% CI 0.52 to 0.97; P=0.001) and in AF patients (r=0.82, 95% CI 0.26 to 0.97; P=0.01). Conclusions: In patients with AF, 4D flow cardiovascular MRI is feasible with good image quality, allowing for quantification of trans-valvular flow.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Gareth Williams
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca C Gosling
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Abdulaziz Al Baraikan
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andreas L Kyriacou
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Julian P Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Peter P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Eylem Levelt
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - John P Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Vass Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Pankaj Garg
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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9
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Schnaubelt S, Niederdöckl J, Simon A, Schütz N, Holaubek C, Edlinger-Stanger M, Niessner A, Steinlechner B, Sulzgruber P, Spiel AO, Domanovits H. Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation. Sci Rep 2020; 10:6852. [PMID: 32321982 PMCID: PMC7176672 DOI: 10.1038/s41598-020-64001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Postoperative atrial fibrillation (POAF) is one of the most frequent complications after cardiothoracic surgery and a predictor for postoperative mortality and prolonged ICU-stay. Current guidelines suggest the multi-channel inhibitor Vernakalant as a treatment option for rhythm control. However, rare cases of severe hypotension and cardiogenic shock following drug administration have been reported. To elucidate the impact of Vernakalant on hemodynamics, we included ten ICU patients developing POAF after elective cardiac surgery, all of them awake and breathing spontaneously, in this prospective trial. Patients received the recommended dosage of Vernakalant and were clinically observed and monitored (heart rate, invasive blood pressure, pulse oximetry, central venous pressure) in 1-minute-intervals for 20 minutes before- and 120 minutes after the first dose of Vernakalant. The median time from the end of surgery until occurrence of POAF amounted up to 52.8 [45.9–77.4] hours, it took 3.5 [1.2–10.1] hours from occurrence of POAF until the first application of Vernakalant. All patients received catecholamine support with epinephrine that was held steady and not dynamic throughout the observational phase. We noted stable hemodynamic conditions, with a trend towards a reduction in heart rate throughout the 120 minutes after drug administration. In 7 patients (70%), conversion to sustained sinus rhythm (SR) occurred within 8.0 minutes [6.0–9.0]. No serious adverse events (SAEs) were noted during the observation period. In this prospective trial in ICU-patients showing POAF after cardiac surgery, intravenous Vernakalant did not induce clinically relevant negative effects on patients’ hemodynamics but resulted in conversion to sustained SR after a median of 8.0 minutes in 7 out of ten patients.
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Affiliation(s)
- S Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - J Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - A Simon
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - N Schütz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - C Holaubek
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - M Edlinger-Stanger
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - A Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - B Steinlechner
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - P Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - A O Spiel
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - H Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
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10
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Sharma SP, Turagam MK, Gopinathannair R, Reddy V, Kar S, Mohanty S, Cheng J, Holmes DR, Sondergaard L, Natale A, Lakkireddy D. Direct Current Cardioversion of Atrial Fibrillation in Patients With Left Atrial Appendage Occlusion Devices. J Am Coll Cardiol 2019; 74:2267-2274. [DOI: 10.1016/j.jacc.2019.08.1045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/31/2019] [Accepted: 08/18/2019] [Indexed: 11/29/2022]
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11
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Karlsson LO, Erixon H, Ebbers T, Bolger A, Carlhäll CJ. Post-cardioversion Improvement in LV Function Defined by 4D Flow Patterns and Energetics in Patients With Atrial Fibrillation. Front Physiol 2019; 10:659. [PMID: 31191353 PMCID: PMC6549517 DOI: 10.3389/fphys.2019.00659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Atrial fibrillation (AF) is a prevalent cause of cardiovascular morbidity, including thromboembolism and heart failure. Left ventricular dysfunction (LVD) detected in AF patients may be either precursor or consequence of the arrythmia. Successful cardioversion of chronic AF is often followed by a transient period of left atrial (LA) stunning, where depressed mechanical atrial contraction persists despite reinstitution of sinus rhythm. To determine if AF-associated LVD would improve with resolution of LA dysfunction, AF patients were examined immediately and 4 weeks after cardioversion to sinus rhythm. 4D flow cardiovascular magnetic resonance (CMR) assesses ventricular function according to the volumes and energetics of functional components of the LV volume. Previously, described 4D CMR markers of LVD include decreased volume and end-diastolic kinetic energy (KE) of the Direct flow, which is the portion of LV volume that passes directly from inflow to outflow in a single cycle. We hypothesize that impaired LV flow patterns and energetics will be found immediately after cardioversion during atrial stunning, and that those parameters will improve as atrial function returns. Methods Ten patients with a history of AF underwent CMR 2-3 h (Time-1) and 4 weeks (Time-2), following electrical cardioversion to sinus rhythm. 4D phase-contrast velocity data and morphological images were acquired at a 3T CMR system. Using a previously evaluated method, pathlines were emitted from the LV end diastolic volume (LVEDV) and traced forward and backward in time until end-systole. The LVEDV was automatically separated into four functional flow components whose volume and KE were calculated. Results Left atrial fractional area change increased over the follow-up period (P = 0.001), indicating recovery of LA mechanical function. LVEF increased between Time-1 and Time-2 (P = 0.003); LVEDVI did not change (P = 0.319). Over that interval, the ratios of Direct flow/LVEDV volume and KE increased (P = 0.001 and P = 0.003, respectively), while the ratios of Residual volume/LVEDV volume and KE decreased (P = 0.001 and P = 0.005, respectively). Conclusion Post-cardioversion recovery of LA function was associated with improvements in conventional and 4D CMR markers of LV function. Flow-specific measures demonstrate the negative but potentially reversible impact of LA dysfunction on volume and energetic aspects of LV function.
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Affiliation(s)
- Lars Olof Karlsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hanna Erixon
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ann Bolger
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Carl-Johan Carlhäll
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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12
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Visualizing and quantifying flow stasis in abdominal aortic aneurysms in men using 4D flow MRI. Magn Reson Imaging 2019; 57:103-110. [DOI: 10.1016/j.mri.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 01/24/2023]
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13
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Aguado AM, Olivares AL, Yagüe C, Silva E, Nuñez-García M, Fernandez-Quilez Á, Mill J, Genua I, Arzamendi D, De Potter T, Freixa X, Camara O. In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools. Front Physiol 2019; 10:237. [PMID: 30967786 PMCID: PMC6440369 DOI: 10.3389/fphys.2019.00237] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/22/2019] [Indexed: 01/26/2023] Open
Abstract
According to clinical studies, around one third of patients with atrial fibrillation (AF) will suffer a stroke during their lifetime. Between 70 and 90% of these strokes are caused by thrombus formed in the left atrial appendage. In patients with contraindications to oral anticoagulants, a left atrial appendage occluder (LAAO) is often implanted to prevent blood flow entering in the LAA. A limited range of LAAO devices is available, with different designs and sizes. Together with the heterogeneity of LAA morphology, these factors make LAAO success dependent on clinician's experience. A sub-optimal LAAO implantation can generate thrombi outside the device, eventually leading to stroke if not treated. The aim of this study was to develop clinician-friendly tools based on biophysical models to optimize LAAO device therapies. A web-based 3D interactive virtual implantation platform, so-called VIDAA, was created to select the most appropriate LAAO configurations (type of device, size, landing zone) for a given patient-specific LAA morphology. An initial LAAO configuration is proposed in VIDAA, automatically computed from LAA shape features (centreline, diameters). The most promising LAAO settings and LAA geometries were exported from VIDAA to build volumetric meshes and run Computational Fluid Dynamics (CFD) simulations to assess blood flow patterns after implantation. Risk of thrombus formation was estimated from the simulated hemodynamics with an index combining information from blood flow velocity and complexity. The combination of the VIDAA platform with in silico indices allowed to identify the LAAO configurations associated to a lower risk of thrombus formation; device positioning was key to the creation of regions with turbulent flows after implantation. Our results demonstrate the potential for optimizing LAAO therapy settings during pre-implant planning based on modeling tools and contribute to reduce the risk of thrombus formation after treatment.
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Affiliation(s)
- Ainhoa M Aguado
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Andy L Olivares
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Yagüe
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Etelvino Silva
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Nuñez-García
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Álvaro Fernandez-Quilez
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Mill
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ibai Genua
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom De Potter
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Center, Aalst, Belgium
| | - Xavier Freixa
- Department of Cardiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Camara
- PhySense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
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14
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Lin M, Hao L, Cao Y, Zhao Y, Rong B, Han W, Xie F, Zhong J. Successful catheter ablation of atrial fibrillation improves but not reverses the abnormalities of left atrial mechanics and energy loss. Echocardiography 2019; 36:752-760. [DOI: 10.1111/echo.14304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/12/2019] [Accepted: 02/07/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- Mingjie Lin
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Li Hao
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Yuan Cao
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Yachao Zhao
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Bing Rong
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Fei Xie
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesThe State and Shandong Province Joint Key Laboratory of Translational Cardiovascular MedicineDepartment of CardiologyQilu Hospital of Shandong University Jinan China
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Dillon-Murphy D, Marlevi D, Ruijsink B, Qureshi A, Chubb H, Kerfoot E, O'Neill M, Nordsletten D, Aslanidi O, de Vecchi A. Modeling Left Atrial Flow, Energy, Blood Heating Distribution in Response to Catheter Ablation Therapy. Front Physiol 2019; 9:1757. [PMID: 30618785 PMCID: PMC6302108 DOI: 10.3389/fphys.2018.01757] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction: Atrial fibrillation (AF) is a widespread cardiac arrhythmia that commonly affects the left atrium (LA), causing it to quiver instead of contracting effectively. This behavior is triggered by abnormal electrical impulses at a specific site in the atrial wall. Catheter ablation (CA) treatment consists of isolating this driver site by burning the surrounding tissue to restore sinus rhythm (SR). However, evidence suggests that CA can concur to the formation of blood clots by promoting coagulation near the heat source and in regions with low flow velocity and blood stagnation. Methods: A patient-specific modeling workflow was created and applied to simulate thermal-fluid dynamics in two patients pre- and post-CA. Each model was personalized based on pre- and post-CA imaging datasets. The wall motion and anatomy were derived from SSFP Cine MRI data, while the trans-valvular flow was based on Doppler ultrasound data. The temperature distribution in the blood was modeled using a modified Pennes bioheat equation implemented in a finite-element based Navier-Stokes solver. Blood particles were also classified based on their residence time in the LA using a particle-tracking algorithm. Results: SR simulations showed multiple short-lived vortices with an average blood velocity of 0.2-0.22 m/s. In contrast, AF patients presented a slower vortex and stagnant flow in the LA appendage, with the average blood velocity reduced to 0.08–0.14 m/s. Restoration of SR also increased the blood kinetic energy and the viscous dissipation due to the presence of multiple vortices. Particle tracking showed a dramatic decrease in the percentage of blood remaining in the LA for longer than one cycle after CA (65.9 vs. 43.3% in patient A and 62.2 vs. 54.8% in patient B). Maximum temperatures of 76° and 58°C were observed when CA was performed near the appendage and in a pulmonary vein, respectively. Conclusion: This computational study presents novel models to elucidate relations between catheter temperature, patient-specific atrial anatomy and blood velocity, and predict how they change from SR to AF. The models can quantify blood flow in critical regions, including residence times and temperature distribution for different catheter positions, providing a basis for quantifying stroke risks.
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Affiliation(s)
- Desmond Dillon-Murphy
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - David Marlevi
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Ahmed Qureshi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Henry Chubb
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - David Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Oleg Aslanidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Adelaide de Vecchi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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16
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Rigatelli G, Zuin M, Fong A. Computational Flow Dynamic Analysis of Right and Left Atria in Patent Foramen Ovale: Potential Links with Atrial Fibrillation. J Atr Fibrillation 2018; 10:1852. [PMID: 29988264 DOI: 10.4022/jafib.1852] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022]
Abstract
Background An impairment of the left atrial function similar to that usually observed in atrial fibrillation (AF) has been observed also in patients with patent foramen ovale (PFO) and permanent right-to-left shunting (RLS). Methods We reconstructed the geometrical model of right atrium (RA), PFO, left atrium (LA) and left atrial appendage (LAA) of 65 patients with mild (36 patients mean age 45.5±6.8 years, 24 females) or permanent (29 patients, mean age 45.1±5.3 years, 21 females) RLS using anatomical data obtained by transoesophageal echocardiography (TEE) and cardiac MRI, performed as a part of our institutional screening protocol for paradoxical embolism. Using computational fluid dynamic analysis (CFD) we assessed the vorticity magnitude in both the LA and LAA to analyse a possible rheological relationship between PFO and AF. Results The anatomical models, in terms of dimensions, were comparable among the patients with mild and permanent RLS. A higher vorticity magnitude was observed in the mild shunt both in the LA (101.12±21.3 vs 88.3±22.6, p=0.02) and LAA (62±14.4 vs 32.4±12.3, p<0.01) when compared to the permanent R-L shunting. Conclusion The lower vorticity magnitude across the LA and LAA in patients with permanent RLS suggests a possible higher stagnation of the blood in these anatomical sites, similarly as previously observed in patients with AF.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy and Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Alan Fong
- Department of Cardiology, Clinical Research Center, Sarawak General Hospital, Sarawak, Malaysia
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