使用HeartMate2和HeartMate3心室辅助装置患者左心室的统计形状建模

IF 6.3 2区 医学 Q1 BIOLOGY
Marjan Azimi , Diogo Ferreira de Almeida , Mehrdad Khamooshi , Sam Liao , Michael Šeman , Andrew Taylor , David McGiffin , Shaun D. Gregory
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引用次数: 0

摘要

左心室辅助装置(LVAD)在治疗终末期心力衰竭方面取得了可喜的成果。然而,植入 LVAD 后心室内血流动力学的改变会导致非生理剪切率和停滞或再循环区,从而增加流入插管周围血栓形成的风险。关于最佳导流套管设计及其与血栓形成风险的关系,目前存在相互矛盾的建议,这可能是由于患者的解剖结构存在差异。为了探究这些差异的来源,我们利用左心室(LV)的统计形状模型(SSM)对解剖结构的变化对血栓形成风险的影响进行了数值评估。19 例 LVAD 患者的 CT 扫描(包括 5 台 HeartMate2 (HM2) 和 14 台 HeartMate3 (HM3) 装置)均经过人工分割。采用相干点漂移(CPD)算法对分割的左心室进行登记。使用主成分分析 (PCA) 为 HM2 和 HM3 组群分别开发了 SSM。比较了多种解剖指标,如左心室容积、球形度和横截面圆度。针对 LV 壁僵硬、主动脉瓣关闭和 LVAD 流速为 5 L/min 的终末期心力衰竭状况进行了计算流体动力学(CFD)分析。HM2和HM3队列在球形度、心尖圆度和圆锥度上表现出差异,这可能与设备形状和植入技术有关。对于两种 SSM,较大的左心室容积是导致瘀血量增加和血液清除速度减慢的主要解剖特征,从而导致较高的血栓形成风险。导致血栓形成风险增加的第二个解剖指标是左心室球形度降低(HM2 患者)和心尖隆起的形成(HM3 患者)。这项研究强调了 HM2 和 HM3 患者左心室形状的统计学差异,表明左心室的特定几何特征可能使患者在植入 LVAD 后容易形成血栓。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Statistical shape modelling of the left ventricle for patients with HeartMate2 and HeartMate3 ventricular assist devices
Left ventricular assist devices (LVADs) have demonstrated promising outcomes in the management of end-stage heart failure. However, the altered intraventricular flow dynamics following LVAD implantation can lead to non-physiological shear rates and stagnant or recirculating zones, which increase the risk of thrombosis around the inflow cannula. There are conflicting recommendations regarding the optimal inflow cannula design and its association with thrombosis risk, possibly due to anatomical variations among patients. To explore the sources of these discrepancies, statistical shape models (SSMs) of the left ventricle (LV) were utilized to numerically evaluate the impact of anatomical variations on thrombosis risk.
Nineteen CT scans of LVAD patients, consisting of 5 HeartMate2 (HM2) and 14 HeartMate3 (HM3) devices, were manually segmented. The coherent point drift (CPD) algorithm was implemented to register the segmented LVs. Separate SSMs were developed for HM2 and HM3 cohorts using a principal component analysis (PCA). Multiple anatomical metrics such as LV volume, sphericity, and cross-sectional circularity were compared. A computational fluid dynamics (CFD) analysis was performed for an end-stage heart failure condition characterised by rigid LV walls, closed aortic valve and LVAD flow rate of 5 L/min. Thrombosis risk was assessed by wall shear stress (WSS), stasis volume, turbulent kinetic energy (TKE) and washout.
The HM2 and HM3 cohorts exhibited differences in sphericity, apical circularity, and conicity, which may be attributed to device shape and implantation technique. For both SSMs, larger LV volume was the main anatomical feature contributing to increased stasis volume and slower blood clearance, leading to higher thrombosis risk. The second anatomical metric contributing to increased thrombosis risk was reduced LV sphericity (HM2 patients) and formation of an apical bulge (HM3 patients).
This study highlighted the statistical differences in LV shape between HM2 and HM3 patients, demonstrating how specific geometrical features of the LV may predispose patients to thrombus formation after LVAD implantation.
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来源期刊
Computers in biology and medicine
Computers in biology and medicine 工程技术-工程:生物医学
CiteScore
11.70
自引率
10.40%
发文量
1086
审稿时长
74 days
期刊介绍: Computers in Biology and Medicine is an international forum for sharing groundbreaking advancements in the use of computers in bioscience and medicine. This journal serves as a medium for communicating essential research, instruction, ideas, and information regarding the rapidly evolving field of computer applications in these domains. By encouraging the exchange of knowledge, we aim to facilitate progress and innovation in the utilization of computers in biology and medicine.
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