Baiocchi Melissa, Barsoum Shirley, Khodaei Seyedvahid, de la Torre Hernandez Jose M, Valentino Sydney E, Dunford Emily C, MacDonald Maureen J, Keshavarz-Motamed Zahra
Department of Mechanical Engineering, McMaster University, Hamilton, ON, Canada.
Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
Front Bioeng Biotechnol. 2021 Jul 8;9:643453. doi: 10.3389/fbioe.2021.643453. eCollection 2021.
Due to the high individual differences in the anatomy and pathophysiology of patients, planning individualized treatment requires patient-specific diagnosis. Indeed, hemodynamic quantification can be immensely valuable for accurate diagnosis, however, we still lack precise diagnostic methods for numerous cardiovascular diseases including complex (and mixed) valvular, vascular, and ventricular interactions (C3VI) which is a complicated situation made even more challenging in the face of other cardiovascular pathologies. Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. In a recent paper, we developed a non-invasive and Doppler-based diagnostic and monitoring computational mechanics framework for C3VI, called C3VI-DE that uses input parameters measured reliably using Doppler echocardiography. In the present work, we have developed another computational-mechanics framework for C3VI (called C3VI-CT). C3VI-CT uses the same lumped-parameter model core as C3VI-DE but its input parameters are measured using computed tomography and a sphygmomanometer. Both frameworks can quantify: (1) global hemodynamics (metrics of cardiac function); (2) local hemodynamics (metrics of circulatory function). We compared accuracy of the results obtained using C3VI-DE and C3VI-CT against catheterization data (gold standard) using a C3VI dataset ( = 49) for patients with C3VI who undergo TAVR in both pre and post-TAVR with a high variability. Because of the dataset variability and the broad range of diseases that it covers, it enables determining which framework can yield the most accurate results. In contrast with C3VI-CT, C3VI-DE tracks both the cardiac and vascular status and is in great agreement with cardiac catheter data.
由于患者的解剖结构和病理生理学存在高度个体差异，制定个体化治疗方案需要针对患者的具体诊断。的确，血流动力学量化对于准确诊断非常有价值，然而，对于包括复杂（和混合）瓣膜、血管和心室相互作用（C3VI）在内的众多心血管疾病，我们仍然缺乏精确的诊断方法，面对其他心血管病变时，这种复杂情况更具挑战性。经导管主动脉瓣置换术（TAVR）是一种新的侵入性较小的干预措施，正成为主动脉瓣狭窄患者越来越多的选择。在最近的一篇论文中，我们为C3VI开发了一种基于多普勒的非侵入性诊断和监测计算力学框架，称为C3VI-DE，它使用通过多普勒超声心动图可靠测量的输入参数。在本研究中，我们为C3VI开发了另一种计算力学框架（称为C3VI-CT）。C3VI-CT使用与C3VI-DE相同的集总参数模型核心，但其输入参数通过计算机断层扫描和血压计测量。两个框架都可以量化：（1）整体血流动力学（心脏功能指标）；（2）局部血流动力学（循环功能指标）。我们使用一个C3VI数据集（n = 49），比较了使用C3VI-DE和C3VI-CT获得的结果与导管插入术数据（金标准）的准确性，该数据集用于在TAVR前后均具有高变异性的C3VI患者。由于数据集的变异性及其涵盖的广泛疾病范围，它能够确定哪个框架可以产生最准确的结果。与C3VI-CT相比，C3VI-DE可以跟踪心脏和血管状态，并且与心导管数据高度一致。
