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

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Abstract

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.

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Author and article information

Contributors

Leonid Goubergrits: URI : http://loop.frontiersin.org/people/509864/overview

Katharina Vellguth: URI : http://loop.frontiersin.org/people/1620476/overview

Lukas Obermeier: URI : http://loop.frontiersin.org/people/1692614/overview

Lennart Tautz: URI : http://loop.frontiersin.org/people/1294190/overview

Jan Bruening: URI : http://loop.frontiersin.org/people/1131715/overview

Hans Lamecker: URI : http://loop.frontiersin.org/people/742096/overview

Olena Nemchyna: URI : http://loop.frontiersin.org/people/1317597/overview

Christoph Knosalla: URI : http://loop.frontiersin.org/people/1321313/overview

Natalia Solowjowa: URI : http://loop.frontiersin.org/people/1430738/overview

Journal

Journal ID (nlm-ta): Front Cardiovasc Med

Journal ID (iso-abbrev): Front Cardiovasc Med

Journal ID (publisher-id): Front. Cardiovasc. Med.

Title: Frontiers in Cardiovascular Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2297-055X

Publication date (Electronic): 05 July 2022

Publication date Collection: 2022

Volume: 9

Electronic Location Identifier: 901902

Affiliations

[1] ¹Institute of Computer-Assisted Cardiovascular Medicine, Charité-Universitätsmedizin Berlin , Berlin, Germany

[2] ²Einstein Center Digital Future , Berlin, Germany

[3] ³Fraunhofer Institute for Digital Medicine MEVIS , Bremen, Germany

[4] ⁴1000shapes , Berlin, Germany

[5] ⁵Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany

[6] ⁶German Centre for Cardiovascular Research (DZHK), Partner Site Berlin , Berlin, Germany

[7] ⁷Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health , Berlin, Germany

Author notes

Edited by: Sabina Gallina, University of Studies G. d'Annunzio Chieti and Pescara, Italy

Reviewed by: Rajiv Rampat, William Harvey Hospital, United Kingdom; Elias Karabelas, University of Graz, Austria

*Correspondence: Natalia Solowjowa solowjowa@ 123456dhzb.de

This article was submitted to Cardiovascular Medicine, a section of the journal Frontiers in Cardiovascular Medicine

†These authors share first authorship

Article

DOI: 10.3389/fcvm.2022.901902

PMC ID: 9294248

PubMed ID: 35865389

SO-VID: c6b3adf1-3e20-48d5-afe7-4f104dc91704

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 22 March 2022

Date accepted : 07 June 2022

Page count

Figures: 10, Tables: 3, Equations: 6, References: 67, Pages: 20, Words: 12383

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

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CLINICAL CALORIMETRY

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