Department of Mechanical and Industrial Engineering, Galway Medical Technology Centre (GMedTech), Galway Mayo Institute of Technology, Dublin Road, Galway, Ireland.
Cardiovascular Research Centre, National University of Ireland Galway, University Road, Galway, Ireland.
Int J Comput Assist Radiol Surg. 2019 Aug;14(8):1415-1430. doi: 10.1007/s11548-019-01985-3. Epub 2019 May 3.
The presence and progression of heart failure (HF) are associated with cardiac remodelling, defined as cellular, molecular and interstitial changes which occur after injury and manifest as changes in left ventricular (LV) size, mass, geometry and function. This research study was designed to investigate the changes to LV morphology and shape which occur in the presence of heart failure using three-dimensional (3D) modelling and analysis of cardiac-gated CT scans from both healthy individuals and patients classified with HF.
A number of quantitative and qualitative strategies were applied to cardiac CT scans of HF patients and healthy controls (n = 7) in order to analyse changes to LV size, shape and structure and to examine LV remodelling in the different classes of HF. Three-dimensional wireframe representations of endocardial and epicardial borders were created, three-dimensional computer stereolithography models of the inner LV cavity and myocardial wall segments were generated and three-dimensionally printed and a number of clinical LV dimension and shape indices were measured. All data were analysed using one-way ANOVA with post hoc Tukey method for multiple comparisons for significant variables.
Results of most significance included abnormalities in LV mass and end-systolic dimensions and significantly increased septal wall thickness among mid-range ejection fraction cases. Also of importance were significant increases in both dimension-based and volumetric sphericity index measures in all HF cases. Three-dimensional printed models provided qualitative information as to changes in inner LV cavity and myocardial wall morphology across the cardiac cycle for healthy and HF cases and validated quantitative findings.
Findings from this study can successfully be applied to motivate the research and development of new HF treatment strategies and devices as well as for the development of a realistic cardiac simulator system.
心力衰竭（HF）的存在和进展与心脏重构有关，心脏重构定义为损伤后发生的细胞、分子和间质变化，表现为左心室（LV）大小、质量、几何形状和功能的变化。本研究旨在使用三维（3D）建模和心脏门控 CT 扫描分析来自健康个体和 HF 患者的 LV 形态和形状的变化。
对 HF 患者和健康对照者（n=7）的心脏 CT 扫描应用了多种定量和定性策略，以分析 LV 大小、形状和结构的变化，并检查不同 HF 类型的 LV 重构。创建了心内膜和心外膜边界的三维线框表示，生成了 LV 内腔和心肌壁段的三维计算机立体光刻模型，并进行了三维打印，并测量了一些临床 LV 尺寸和形状指数。所有数据均采用单因素方差分析，对有显著差异的变量采用 Tukey 后检验进行多重比较。
最显著的结果包括 LV 质量和收缩末期尺寸异常，以及中范围射血分数病例的室间隔壁厚度显著增加。同样重要的是，所有 HF 病例的基于维度和基于体积的球形指数测量值均显著增加。3D 打印模型为健康和 HF 病例的 LV 内腔和心肌壁形态在整个心动周期中的变化提供了定性信息，并验证了定量发现。
本研究的结果可成功应用于激励新的 HF 治疗策略和设备的研究和开发，以及开发逼真的心脏模拟器系统。
