A doppler-exclusive computational diagnostic framework to enhance conventional 2-D clinical ultrasound with 3-D mitral valve dynamics and cardiac hemodynamics

Abstract

Mitral valve diseases are prevalent cardiac conditions especially by aging. With their high prevalence, the accessibility, accuracy, and reliability of the diagnostic methods are crucial. Mitral valve dynamics assessment could offer crucial insights into the progression of cardiac deterioration and recovery, significantly influencing patient care, intervention planning, and critical clinical decision-making in scenarios with potentially life-threatening risks. In this study, we developed a Doppler-exclusive computational diagnostic framework to assess mitral valve motion and dynamics as well as cardiac hemodynamics in patients non-invasively and at no risk to the patients. The framework was developed based on transthoracic echocardiogram (TTE) data (N=20), validated against transesophageal echocardiography (TEE) data (N=12) as well as CT data (N=4). In addition, we demonstrated the framework’s diagnostic abilities by providing novel and clinically-relevant analyses and interpretations of clinical data. Based on our findings, patient-specific left ventricular pressure was a strong predictor of stress levels in our cohort of 20 patients, despite being neglected by previous studies. There was a very strong negative correlation between the 3-D finite element-based coaptation area and vena Contracta width (R = -0.8; p < 0.001). Furthermore, the LV conicity index, as the geometrical parameter showing left ventricle dilatation, had a strong positive correlation with end diastolic von Mises stress, used for quantification of leaflet tethering (R = 0.78; p < 0.001). Finally, the patient-specific left ventricular pressure, and the rest length of the chords played a primary role in the biomechanical behavior of the mitral leaflets. The developed framework, while aligned with the current clinical metrics, could provide a strong add-on to the established clinical practice for the diagnosis of mitral valve diseases. Notably, this framework is novel in that it relies solely on standard Doppler ultrasound inputs, requiring no additional imaging or invasive measurements to achieve 3-D assessment. Clinically, the DE-MV-Dyn can be seamlessly applied in routine echocardiography exams to provide clinicians with new patient-specific metrics (e.g., leaflet stress, strain, and dynamic coaptation measures) for improved diagnosis and personalized mitral valve therapy planning.