CT-Based Analysis of Left Ventricular Hemodynamics Using Statistical Shape Modeling and Computational Fluid Dynamics

Frontiers in Cardiovascular Medicine

article

Leonid Goubergrits¹  Katharina Vellguth¹  Lukas Obermeier¹  Adriano Schlief¹  Lennart Tautz³  Jan Bruening¹  Hans Lamecker⁴  Angelika Szengel⁴  Olena Nemchyna⁵  Christoph Knosalla⁵  Titus Kuehne¹  Natalia Solowjowa⁵ 

[1] Institute of Computer-Assisted Cardiovascular Medicine, Charité-Universitätsmedizin Berlin;Einstein Center Digital Future;Fraunhofer Institute for Digital Medicine MEVIS;1000shapes;Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin;German Centre for Cardiovascular Research;Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health

关键词: cardiac computed tomography;    intraventricular hemodynamics;    statistical shape modeling;    fluid-structure interaction;    computational fluid dynamics;    left ventricle aneurysms;    mitral regurgitation;   

DOI  :  10.3389/fcvm.2022.901902

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Cardiac computed tomography (CCT) based computational fluid dynamics (CFD) allows to assess intracardiac flow features, which are hypothesized as an early predictor for heart diseases and may support treatment decisions. However, the understanding of intracardiac flow is challenging due to high variability in heart shapes and contractility. Using statistical shape modeling (SSM) in combination with CFD facilitates an intracardiac flow analysis. The aim of this study is to prove the usability of a new approach to describe various cohorts. Materials and Methods CCT data of 125 patients (mean age: 60.6 ± 10.0 years, 16.8% woman) were used to generate SSMs representing aneurysmatic and non-aneurysmatic left ventricles (LVs). Using SSMs, seven group-averaged LV shapes and contraction fields were generated: four representing patients with and without aneurysms and with mild or severe mitral regurgitation (MR), and three distinguishing aneurysmatic patients with true, intermediate aneurysms, and globally hypokinetic LVs. End-diastolic LV volumes of the groups varied between 258 and 347 ml, whereas ejection fractions varied between 21 and 26%. MR degrees varied from 1.0 to 2.5. Prescribed motion CFD was used to simulate intracardiac flow, which was analyzed regarding large-scale flow features, kinetic energy, washout, and pressure gradients. Results SSMs of aneurysmatic and non-aneurysmatic LVs were generated. Differences in shapes and contractility were found in the first three shape modes. Ninety percent of the cumulative shape variance is described with approximately 30 modes. A comparison of hemodynamics between all groups found shape-, contractility- and MR-dependent differences. Disturbed blood washout in the apex region was found in the aneurysmatic cases. With increasing MR, the diastolic jet becomes less coherent, whereas energy dissipation increases by decreasing kinetic energy. The poorest blood washout was found for the globally hypokinetic group, whereas the weakest blood washout in the apex region was found for the true aneurysm group. Conclusion The proposed CCT-based analysis of hemodynamics combining CFD with SSM seems promising to facilitate the analysis of intracardiac flow, thus increasing the value of CCT for diagnostic and treatment decisions. With further enhancement of the computational approach, the methodology has the potential to be embedded in clinical routine workflows and support clinicians.

【 授权许可】

CC BY