A mathematical model of myocardial perfusion based on the lattice Boltzmann method (LBM) is proposed and its applicability is investigated in both healthy and diseased cases. The myocardium is conceptualized as a porous material in which the transport and mass transfer of a contrast agent in blood flow is studied. The results of myocardial perfusion obtained using LBM in 1D and 2D are confronted with previously reported results in the literature and the results obtained using the mixed-hybrid finite element method. Since LBM is not suitable for simulating flow in heterogeneous porous media, a simplified and computationally efficient 1D-analog approach to 2D diseased case is proposed and its applicability discussed.
- MeSH
- analýza metodou konečných prvků * MeSH
- kontrastní látky MeSH
- koronární cirkulace fyziologie MeSH
- lidé MeSH
- modely kardiovaskulární * MeSH
- počítačová simulace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- funkce levé komory srdeční MeSH
- kardiovaskulární systém * MeSH
- lidé MeSH
- magnetická rezonanční spektroskopie MeSH
- magnetická rezonanční tomografie MeSH
- srdce * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
Ventricular-vascular interaction is central in the adaptation to cardiovascular disease. However, cardiomyopathy patients are predominantly monitored using cardiac biomarkers. The aim of this study is therefore to explore aortic function in dilated cardiomyopathy (DCM). Fourteen idiopathic DCM patients and 16 controls underwent cardiac magnetic resonance imaging, with aortic relative pressure derived using physics-based image processing and a virtual cohort utilized to assess the impact of cardiovascular properties on aortic behaviour. Subjects with reduced left ventricular systolic function had significantly reduced aortic relative pressure, increased aortic stiffness, and significantly delayed time-to-pressure peak duration. From the virtual cohort, aortic stiffness and aortic volumetric size were identified as key determinants of aortic relative pressure. As such, this study shows how advanced flow imaging and aortic hemodynamic evaluation could provide novel insights into the manifestation of DCM, with signs of both altered aortic structure and function derived in DCM using our proposed imaging protocol.
Cílem článku je seznámit čtenáře s výhodami a nevýhodami sekvence 4D Flow. Vyšetření touto sekvencí umožňuje retrospektivně zjistit průtok a jiné parametry toku v objemu zájmu. Je ovšem náročné jak z hlediska času, tak následného zpracování dat. Pro vysokou cenu komerčních programů může být pro uživatele nutné vytvořit si vlastní nástroje zpracování dat. Komerční programy poskytují omezené nástroje segmentace, ale naopak zvládají všechny základní korekce a nabízí množství funkcionalit. Přes svůj velký potenciál má sekvence svá omezení, zejména je to nízké prostorové rozlišení a dlouhá doba akvizice.
The goal of this paper is to inform about the 4D Flow sequence, its advantages and disadvantages. 4D Flow examination allows to assess flow rate and other flow parameters in the volume of interest retrospectively. However, it is expensive in terms of time and postprocessing. An in-house software may be necessary, as commercial programs remain costly. They offer a number of functionalities and data corrections. Their segmentations tools, however, remain relatively limited. Low spatial resolution and long data acquisition are the primary limitations of the sequence
- Klíčová slova
- 4D Flow,
- MeSH
- automatizované zpracování dat * metody MeSH
- diagnostické techniky kardiovaskulární přístrojové vybavení MeSH
- lidé MeSH
- magnetická rezonanční tomografie * metody MeSH
- reologie krve MeSH
- software MeSH
- vizualizace dat MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Clinical indicators of heart function are often limited in their ability to accurately evaluate the current mechanical state of the myocardium. Biomechanical modeling has been shown to be a promising tool in addition to clinical indicators. By providing a patient-specific measure of myocardial active stress (contractility), biomechanical modeling can enhance the precision of the description of patient's pathophysiology at any given point in time. In this work we aim to explore the ability of biomechanical modeling to predict the response of ventricular mechanics to the progressively decreasing afterload in repaired tetralogy of Fallot (rTOF) patients undergoing pulmonary valve replacement (PVR) for significant residual right ventricular outflow tract obstruction (RVOTO). We used 19 patient-specific models of patients with rTOF prior to pulmonary valve replacement (PVR), denoted as PSMpre, and patient-specific models of the same patients created post-PVR (PSMpost)-both created in our previous published work. Using the PSMpre and assuming cessation of the pulmonary regurgitation and a progressive decrease of RVOT resistance, we built relationships between the contractility and RVOT resistance post-PVR. The predictive value of such in silico obtained relationships were tested against the PSMpost, i.e. the models created from the actual post-PVR datasets. Our results show a linear 1-dimensional relationship between the in silico predicted contractility post-PVR and the RVOT resistance. The predicted contractility was close to the contractility in the PSMpost model with a mean (± SD) difference of 6.5 (± 3.0)%. The relationships between the contractility predicted by in silico PVR vs. RVOT resistance have a potential to inform clinicians about hypothetical mechanical response of the ventricle based on the degree of pre-operative RVOTO.
- MeSH
- biomechanika MeSH
- chirurgická náhrada chlopně MeSH
- Fallotova tetralogie chirurgie MeSH
- individualizovaná medicína * MeSH
- lidé MeSH
- modely kardiovaskulární MeSH
- obstrukce výtoku ze srdeční komory patofyziologie chirurgie MeSH
- plicní chlopeň chirurgie MeSH
- pooperační komplikace patofyziologie chirurgie MeSH
- prediktivní hodnota testů MeSH
- remodelace komor MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Relationships between right ventricular (RV) and left ventricular (LV) shape and function may be useful in determining optimal timing for pulmonary valve replacement in patients with repaired tetralogy of Fallot (rTOF). However, these are multivariate and difficult to quantify. We aimed to quantify variations in biventricular shape associated with pulmonary regurgitant volume (PRV) in rTOF using a biventricular atlas. METHODS: In this cross-sectional retrospective study, a biventricular shape model was customized to cardiovascular magnetic resonance (CMR) images from 88 rTOF patients (median age 16, inter-quartile range 11.8-24.3 years). Morphometric scores quantifying biventricular shape at end-diastole and end-systole were computed using principal component analysis. Multivariate linear regression was used to quantify biventricular shape associations with PRV, corrected for age, sex, height, and weight. Regional associations were confirmed by univariate correlations with distances and angles computed from the models, as well as global systolic strains computed from changes in arc length from end-diastole to end-systole. RESULTS: PRV was significantly associated with 5 biventricular morphometric scores, independent of covariates, and accounted for 12.3% of total shape variation (p < 0.05). Increasing PRV was associated with RV dilation and basal bulging, in conjunction with decreased LV septal-lateral dimension (LV flattening) and systolic septal motion towards the RV (all p < 0.05). Increased global RV radial, longitudinal, circumferential and LV radial systolic strains were significantly associated with increased PRV (all p < 0.05). CONCLUSION: A biventricular atlas of rTOF patients quantified multivariate relationships between left-right ventricular morphometry and wall motion with pulmonary regurgitation. Regional RV dilation, LV reduction, LV septal-lateral flattening and increased RV strain were all associated with increased pulmonary regurgitant volume. Morphometric scores provide simple metrics linking mechanisms for structural and functional alteration with important clinical indices.
- MeSH
- dítě MeSH
- dospělí MeSH
- Fallotova tetralogie * diagnostické zobrazování chirurgie MeSH
- funkce pravé komory srdeční MeSH
- insuficience plicnice * diagnostické zobrazování etiologie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- prediktivní hodnota testů MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
BACKGROUND: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. METHODS: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. RESULTS: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data. CONCLUSIONS: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.
- MeSH
- biologické modely * MeSH
- chirurgická náhrada chlopně metody MeSH
- dospělí MeSH
- Fallotova tetralogie chirurgie MeSH
- hemodynamika fyziologie MeSH
- insuficience plicnice vrozené diagnóza chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- magnetická rezonance kinematografická MeSH
- mnohočetné abnormality * MeSH
- následné studie MeSH
- plicní chlopeň abnormality diagnostické zobrazování chirurgie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- srdeční komory diagnostické zobrazování patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
Patients after surgical repair of Tetralogy of Fallot (rTOF) may suffer a decrease in left ventricular (LV) function. The aim of our study is to evaluate a novel method of assessing LV torsion in patients with rTOF, as an early indicator of systolic LV dysfunction. Motion tracking based on image registration regularized by the equilibrium gap principle, known as equilibrated warping, was employed to assess LV torsion. Seventy-six cases of rTOF and ten normal controls were included. The group of controls was assessed for reproducibility using both equilibrated warping and standard clinical tissue tracking software (CVI42, version 5.10.1, Calgary, Canada). Patients were dichotomized into two groups: normal vs. loss of torsion. Torsion by equilibrated warping was successfully obtained in 68 of 76 (89%) patients and 9 of 10 (90%) controls. For equilibrated warping, the intra- and interobserver coefficients of variation were 0.095 and 0.117, respectively, compared to 0.260 and 0.831 for tissue tracking by standard clinical software. The intra- and inter-observer intraclass correlation coefficients for equilibrated warping were 0.862 and 0.831, respectively, compared to 0.992 and 0.648 for tissue tracking. Loss of torsion was noted in 32 of the 68 (47%) patients with rTOF. There was no difference in LV or RV volumes or ejection fraction between these groups. The assessment of LV torsion by equilibrated warping is feasible and shows good reliability. Loss of torsion is common in patients with rTOF and its robust assessment might contribute into uncovering heart failure in an earlier stage.
- MeSH
- dítě MeSH
- dospělí MeSH
- dysfunkce levé srdeční komory diagnostické zobrazování patofyziologie MeSH
- Fallotova tetralogie chirurgie MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- počítačové zpracování obrazu metody MeSH
- pooperační komplikace diagnostické zobrazování patofyziologie MeSH
- předškolní dítě MeSH
- reprodukovatelnost výsledků MeSH
- retrospektivní studie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
During general anesthesia (GA), direct analysis of arterial pressure or aortic flow waveforms may be inconclusive in complex situations. Patient-specific biomechanical models, based on data obtained during GA and capable to perform fast simulations of cardiac cycles, have the potential to augment hemodynamic monitoring. Such models allow to simulate Pressure-Volume (PV) loops and estimate functional indicators of cardiovascular (CV) system, e.g. ventricular-arterial coupling (Vva), cardiac efficiency (CE) or myocardial contractility, evolving throughout GA. In this prospective observational study, we created patient-specific biomechanical models of heart and vasculature of a reduced geometric complexity for n = 45 patients undergoing GA, while using transthoracic echocardiography and aortic pressure and flow signals acquired in the beginning of GA (baseline condition). If intraoperative hypotension (IOH) appeared, diluted norepinephrine (NOR) was administered and the model readjusted according to the measured aortic pressure and flow signals. Such patients were a posteriori assigned into a so-called hypotensive group. The accuracy of simulated mean aortic pressure (MAP) and stroke volume (SV) at baseline were in accordance with the guidelines for the validation of new devices or reference measurement methods in all patients. After NOR administration in the hypotensive group, the percentage of concordance with 10% exclusion zone between measurement and simulation was >95% for both MAP and SV. The modeling results showed a decreased Vva (0.64±0.37 vs 0.88±0.43; p = 0.039) and an increased CE (0.8±0.1 vs 0.73±0.11; p = 0.042) in hypotensive vs normotensive patients. Furthermore, Vva increased by 92±101%, CE decreased by 13±11% (p < 0.001 for both) and contractility increased by 14±11% (p = 0.002) in the hypotensive group post-NOR administration. In this work we demonstrated the application of fast-running patient-specific biophysical models to estimate PV loops and functional indicators of CV system using clinical data available during GA. The work paves the way for model-augmented hemodynamic monitoring at operating theatres or intensive care units to enhance the information on patient-specific physiology.
- MeSH
- algoritmy MeSH
- arteriální tlak fyziologie MeSH
- biomechanika MeSH
- celková anestezie metody MeSH
- hemodynamické monitorování metody MeSH
- hypotenze farmakoterapie patofyziologie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- minutový srdeční výdej fyziologie MeSH
- modely kardiovaskulární * MeSH
- noradrenalin aplikace a dávkování MeSH
- ověření koncepční studie MeSH
- prospektivní studie MeSH
- tepový objem fyziologie MeSH
- vazokonstriktory aplikace a dávkování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The accuracy of phase-contrast magnetic resonance imaging (PC-MRI) measurement is investigated using a computational fluid dynamics (CFD) model with the objective to determine the magnitude of the flow underestimation due to turbulence behind a narrowed valve in a phantom experiment. MATERIALS AND METHODS: An acrylic stationary flow phantom is used with three insertable plates mimicking aortic valvular stenoses of varying degrees. Positive and negative horizontal fluxes are measured at equidistant slices using standard PC-MRI sequences by 1.5T and 3T systems. The CFD model is based on the 3D lattice Boltzmann method (LBM). The experimental and simulated data are compared using the Bland-Altman-derived limits of agreement. Based on the LBM results, the turbulence is quantified and confronted with the level of flow underestimation. RESULTS: LBM gives comparable results to PC-MRI for valves up to moderate stenosis on both field strengths. The flow magnitude through a severely stenotic valve was underestimated due to signal void in the regions of turbulent flow behind the valve, consistently with the level of quantified turbulence intensity. DISCUSSION: Flow measured by PC-MRI is affected by noise and turbulence. LBM can simulate turbulent flow efficiently and accurately, it has therefore the potential to improve clinical interpretation of PC-MRI.
- MeSH
- aortální chlopeň * MeSH
- aortální stenóza * MeSH
- fantomy radiodiagnostické MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- rychlost toku krve MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
