Hemodynamic Analysis Research Articles

Flow diverters treatment planning of small- and medium-sized intracranial saccular aneurysms on the internal carotid artery via constraint-based virtual deployment.

The internal carotid artery (ICA) is a region with a high incidence for small- and medium-sized saccular aneurysms. However, the treatment relies heavily on the surgeon's experience to achieve optimal outcome. Although the finite element method (FEM) and computational fluid dynamics can predict the postoperative outcomes, due to the computational complexity of traditional methods, there is an urgent need for investigating the fast but versatile approaches related to numerical simulations of flow diverters (FDs) deployment coupled with the hemodynamic analysis to determine the treatment plan. We collected the preoperative and postoperative data from 34 patients (29 females, 5 males; mean age 55.74 ± 9.98 years) who were treated with a single flow diverter for small- to medium-sized intracranial saccular aneurysms on the ICA. The constraint-based virtual deployment (CVD) method is proposed to simulate the FDs expanding outward along the vessel centerline while be constrained by the inner wall of the vessel. The results indicate that there were no significant differences in the reduction rates of wall shear stress and aneurysms neck velocity between the FEM and methods. However, the solution time of CVD was greatly reduced by 98%. In the typical location of small- and medium-sized saccular aneurysms, namely the ICA, our virtual FDs deployment simulation effectively balances the computational accuracy and efficiency. Combined with hemodynamics analysis, our method can accurately represent the blood flow changes within the lesion region to assist surgeons in clinical decision-making.

Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case.

Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm's neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant's reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.

Analysis of Aortic Arch Hemodynamics With Simulated Bird's Beak Effects.

The objective of this study was to investigate the flow effects in different degrees of thoracic aortic stent graft protrusion extension by creating bird beak effect simulations using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using computer-aided software SolidWorks. Segmentation in 3D of an aortic arch from a computed tomography (CT) scan of a real-life patient was performed using SolidWorks. A parametric analysis of three models was performed: (A) Aortic arch with no stent, (B) 3mm bird-beak configuration, and (C) 6.5mm bird-beak configuration. Flow velocity, pressure, vorticity, wall shear stress (WSS), and time average WSS were assessed. The flow velocity in Model A remained relatively constant and low in the area of the ostium of the brachiocephalic artery and doubled in the left subclavian artery. On the contrary, Models B and C showed a decrease in velocity of 52.3 % in the left subclavian artery. Furthermore, Model B showed a drop in velocity of 82.7% below the bird-beak area, whereas Model C showed a decline of 80.9% in this area. The pressure inside the supra-aortic branches was higher in Model B and C compared with Model A. In Model A, vorticity only appeared at the level of the descending aorta, with low to non-vorticity in the aortic arch. In contrast, Models B and C had an average vorticity of 241.4Hz within the bird beak area. Regarding WSS, Model A, and Model B shared similar WSS in the peak systolic phase, in the aortic arch, and the bird beak area, whereas Model C had an increased WSS by 5Pa on average at these zones. In the present simulations' lower velocities, higher pressures, vortices, and WSS were observed around the bird beak zone, the aortic arch, and the supra-aortic vessels.

1-Year Mortality Prediction through Artificial Intelligence Using Hemodynamic Trace Analysis among Patients with ST Elevation Myocardial Infarction.

Background and Objectives: Patients presenting with ST Elevation Myocardial Infarction (STEMI) due to occlusive coronary arteries remain at a higher risk of excess morbidity and mortality despite being treated with primary percutaneous coronary intervention (PPCI). Identifying high-risk patients is prudent so that close monitoring and timely interventions can improve outcomes. Materials and Methods: A cohort of 605 STEMI patients [64.2 ± 13.2 years, 432 (71.41%) males] treated with PPCI were recruited. Their arterial pressure (AP) wave recorded throughout the PPCI procedure was analyzed to extract features to predict 1-year mortality. After denoising and extracting features, we developed two distinct feature selection strategies. The first strategy uses linear discriminant analysis (LDA), and the second employs principal component analysis (PCA), with each method selecting the top five features. Then, three machine learning algorithms were employed: LDA, K-nearest neighbor (KNN), and support vector machine (SVM). Results: The performance of these algorithms, measured by the area under the curve (AUC), ranged from 0.73 to 0.77, with accuracy, specificity, and sensitivity ranging between 68% and 73%. Moreover, we extended the analysis by incorporating demographics, risk factors, and catheterization information. This significantly improved the overall accuracy and specificity to more than 76% while maintaining the same level of sensitivity. This resulted in an AUC greater than 0.80 for most models. Conclusions: Machine learning algorithms analyzing hemodynamic traces in STEMI patients identify high-risk patients at risk of mortality.

Nonlinear biomechanics of diseased carotid arteries

The aim of this article is to analyse the nonlinear biomechanics of diseased carotid arteries as a potential tool for predicting the onset of cerebral strokes. A two-way coupled three-dimensional (3D) hyperelastic fluid-structure interaction (FSI) analysis of a diseased carotid artery with abnormal luminal projections at the carotid bulb known as carotid web (CaW) is conducted on the geometry of a patient artery, built upon employing CT angiography images. The blood-flow model incorporates non-Newtonian pulsatile turbulent fluid, and the artery wall is considered hyperelastic subject to blood-induced motion. The hemodynamics of artery induced by transient boundary conditions is determined, specifically focusing on shifts in crucial hemodynamic parameters such as wall shear stress (WSS) and alterations in the blood velocity pattern. Structural assessment of the artery wall involves quantifying the von Mises (VM) stress and deformation field. The analysis demonstrates that different CaW models result in different flow patterns for a selection of time steps in a cardiac cycle. The findings reveal that the presence of the web, as the most common disease among younger adults, can significantly influence the hemodynamic parameters and potentially accelerate the formation of thrombus and atherosclerosis. Hemodynamic analysis can potentially predict specific sites prone to plaque formation and rupture within the carotid artery.

Coronary hemodynamic simulation study.

In this paper, a two-way fluid-structure coupling model is developed to simulate and analyze the hemodynamic process based on dynamic coronary angiography, and examine the influence of different hemodynamic parameters on coronary arteries in typical coronary stenosis lesions. Using the measured FFR pressure data of a patient, the pressure-time function curve is fitted to ensure the accuracy of the boundary conditions. The average error of the simulation pressure results compared to the test data is 6.74%. In addition, the results related to blood flow, pressure contour and wall shear stress contour in a typical cardiac cycle are obtained by simulation analysis. These results are found to be in good agreement with the laws of the real cardiac cycle, which verifies the rationality of the simulation. In conclusion, based on the modeling and hemodynamic simulation analysis process of dynamic coronary angiography, this paper proposes a method to assist the analysis and evaluation of coronary hemodynamic and functional parameters, which has certain practical significance.

Entropy-based analysis of hemodynamics in elliptical arterial flows with non-Newtonian Rabinowitsch fluid

This research concerns examining the non-Newtonian blood flow behavior through an artery of elliptic cross-section, affected by several stenoses. The Rabinowitsch fluid model is used to investigate the non-Newtonian behavior of the blood for uniform and nonuniform shapes of stenosis. The mathematical equations have been converted into a dimensionless form, and their nonlinearity is reduced by applying the assumptions of mild stenosis. The resulting differential equations are solved by using analytical techniques. A new polynomial of degree eight is introduced to complete the solutions of mathematical equations. The entropy generation is studied mathematically to analyze the irreversibility effects. The detailed graphical examination delineates the physical aspects of mathematical results. The flow velocity is higher for uniform shape than for nonuniform stenosis. The rising percentage of stenosis significantly enhances the flow velocity of the stenotic region. The entropy is enormous near the stenotic wall and has small values near the centerline, which assures the smooth flow in this region. Further, the streamlines are plotted to find the position of stenosis and assess the flow nature for the growing height of stenosis and rising flow rate.

Overloaded transnidal pressure gradient as the hemodynamic mechanism leading to arteriovenous malformation rupture: a quantitative analysis using intravascular pressure monitoring and color-coded digital subtraction angiography

BackgroundThe hemodynamics of brain arteriovenous malformations (AVMs) may have implications for hemorrhage. This study aimed to explore the hemodynamics of ruptured AVMs by direct microcatheter intravascular pressure monitoring (MIPM) and...

Analysis of Intracranial Aneurysm Haemodynamics Altered by Wall Movement.

Computational fluid dynamics is intensively used to deepen our understanding of aneurysm growth and rupture in an attempt to support physicians during therapy planning. Numerous studies assumed fully rigid vessel walls in their simulations, whose sole haemodynamics may fail to provide a satisfactory criterion for rupture risk assessment. Moreover, direct in vivo observations of intracranial aneurysm pulsation were recently reported, encouraging the development of fluid-structure interaction for their modelling and for new assessments. In this work, we describe a new fluid-structure interaction functional setting for the careful evaluation of different aneurysm shapes. The configurations consist of three real aneurysm domes positioned on a toroidal channel. All geometric features, employed meshes, flow quantities, comparisons with the rigid wall model and corresponding plots are provided for the sake of reproducibility. The results emphasise the alteration of flow patterns and haemodynamic descriptors when wall deformations were taken into account compared with a standard rigid wall approach, thereby underlining the impact of fluid-structure interaction modelling.

MRI quantitative hemodynamic parameter histogram assement of hepatocellular carcinoma development in a rabbit VX2 liver cancer model

BackgroundNowadays, liver cancer is the second leading cause of cancer death in the world. Therefore, it is very important to understand tumor progression and evaluate tumor microcirculation for treatment strategy.ObjectiveTo explore the application of MRI quantitative hemodynamic parameter histogram analysis in the development of a rabbit VX2 liver cancer.MethodsFive New Zealand white rabbits were randomly selected each time for liver Dynamic contrast- enhanced MR perfusion (DCE-MRI) imaging at the 1st, 2nd, 3rd, 4th and 5th weeks after liver tumor implantation. The dynamic changes and the significant differences between the tumor volume and related derived parameters during tumor progression were compared and analyzed.ResultsIn the development of the VX2 liver cancer model, the tumor volume between the end of 1 ~ 5w group (F = 44.11; P = 0.000) was statistically significant (P < 0.01), and the significant differences were found between the 5th week and the 1st, 2nd, 3rd, 4th week, the 4th week and the 1st, 2nd week, the 3rd week and the 5th week (P < 0.01), respectively. The skewness and kurtosis of the volume transport constant (Ktrans) value, the maximum, 90th percentile and skewness of the reverse reflux rate constant (Kep) value, and the skewness, kurtosis, 75th and 90th percentiles of the plasma fraction (Vp) value were statistically significant (P < 0.05) at the end of each week. The 10th, 25th, 50th percentiles of the Kep value, the 10th, 25th percentiles of the extracellular space (EES) fraction (Ve) value, the 10th percentile of the Vp value was positively correlated with tumor volume (r > 0, P < 0.05). The expression of α-smooth muscle actin (α-SMA) was negatively correlated with the mean, 75th percentile of the Ktrans value, the 50th, 75th percentiles of the Kep value, the mean, minimum of the Vp value (r < 0, P<0.05). It was positively correlated with the skewness, kurtosis of the Ktrans value, the skewness of the Vp value (r > 0, P<0.05).ConclusionsMRI quantitative hemodynamic parameter histogram analysis can reflect the progress of the rabbit VX2 liver cancer. In particular, the skewness, kurtosis and percentiles of Ktrans, Kep and Vp can reflect the microvascular information and can be used as biomarkers to assess the development of Hepatocellular Carcinoma(HCC).

Systematic evaluation of MRI-based characterization of tumor-associated vascular morphology and hemodynamics via a dynamic digital phantom.

Validation of quantitative imaging biomarkers is a challenging task, due to the difficulty in measuring the ground truth of the target biological process. A digital phantom-based framework is established to systematically validate the quantitative characterization of tumor-associated vascular morphology and hemodynamics based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). A digital phantom is employed to provide a ground-truth vascular system within which 45 synthetic tumors are simulated. Morphological analysis is performed on high-spatial resolution DCE-MRI data (spatial/temporal resolution = 30 to ) to determine the accuracy of locating the arterial inputs of tumor-associated vessels (TAVs). Hemodynamic analysis is then performed on the combination of high-spatial resolution and high-temporal resolution (spatial/temporal resolution = 60 to to 10s) DCE-MRI data, determining the accuracy of estimating tumor-associated blood pressure, vascular extraction rate, interstitial pressure, and interstitial flow velocity. The observed effects of acquisition settings demonstrate that, when optimizing the DCE-MRI protocol for the morphological analysis, increasing the spatial resolution is helpful but not necessary, as the location and arterial input of TAVs can be recovered with high accuracy even with the lowest investigated spatial resolution. When optimizing the DCE-MRI protocol for hemodynamic analysis, increasing the spatial resolution of the images used for vessel segmentation is essential, and the spatial and temporal resolutions of the images used for the kinetic parameter fitting require simultaneous optimization. An in silico validation framework was generated to systematically quantify the effects of image acquisition settings on the ability to accurately estimate tumor-associated characteristics.

Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture.

Packed red blood cell transfusions occur frequently after congenital heart surgery to augment haemodynamics, with limited understanding of efficacy. The goal of this study was to analyse the hemodynamic response to packed red blood cell transfusions in a single cohort, as "proof-of-concept" utilising high-frequency data capture of real-time telemetry monitoring. Retrospective review of patients after the arterial switch operation receiving packed red blood cell transfusions from 15 July 2020 to 15 July 2021. Hemodynamic parameters were collected from a high-frequency data capture system (SickbayTM) continuously recording vital signs from bedside monitors and analysed in 5-minute intervals up to 6 hours before, 4 hours during, and 6 hours after packed red blood cell transfusions-up to 57,600 vital signs per packed red blood cell transfusions. Variables related to oxygen balance included blood gas co-oximetry, lactate levels, near-infrared spectroscopy, and ventilator settings. Analgesic, sedative, and vasoactive infusions were also collected. Six patients, at 8.5[IQR:5-22] days old and weighing 3.1[IQR:2.8-3.2]kg, received transfusions following the arterial switch operation. There were 10 packed red blood cell transfusions administered with a median dose of 10[IQR:10-15]mL/kg over 169[IQR:110-190]min; at median post-operative hour 36[IQR:10-40]. Significant increases in systolic and mean arterial blood pressures by 5-12.5% at 3 hours after packed red blood cell transfusions were observed, while renal near-infrared spectroscopy increased by 6.2% post-transfusion. No significant changes in ventilation, vasoactive support, or laboratory values related to oxygen balance were observed. Packed red blood cell transfusions given after the arterial switch operation increased arterial blood pressure by 5-12.5% for 3 hours and renal near-infrared spectroscopy by 6.2%. High-frequency data capture systems can be leveraged to provide novel insights into the hemodynamic response to commonly used therapies such as packed red blood cell transfusions after paediatric cardiac surgery.

Low shear stress induces macrophage infiltration and aggravates aneurysm wall inflammation via CCL7/CCR1/TAK1/ NF-κB axis

BackgroundThis study aimed to elucidate the mechanism by which wall shear stress (WSS) influences vascular walls, accounting for the susceptibility of intracranial aneurysms (IAs) to rupture. MethodWe collected blood samples from the sacs of 24 ruptured and 28 unruptured IAs and analyzed the expression of chemokine CCL7 using enzyme-linked immunosorbent assay (ELISA). Univariate and multivariate logistic regression analyses were employed to assess clinical data, aneurysm morphology, and hemodynamics in both groups. Pearson correlation analysis investigated the relationship between CCL7 expression in aneurysm sac blood and WSS. Additionally, we established a bionic cell parallel plate co-culture shear stress model and a mouse low shear stress (LSS) model. The model was modulated using CCL7 recombinant protein, CCR1 inhibitor, and TAK1 inhibitor. We further evaluated CCL7 expression in endothelial cells and the levels of TAK1, NF-κB, IL-1β, and TNF-α in macrophages. Subsequently, the intergroup differences in expression were calculated. ResultsCCL7 expression was significantly higher in the ruptured group compared to the unruptured group. Hemodynamic analysis indicated that WSS was an independent predictor of the risk of aneurysm rupture. A negative linear correlation was observed between CCL7 expression and WSS. Upon addition of CCL7 recombinant protein, upregulation of CCR1 expression and increased levels of p-TAK1 and p-p65 were observed. Treatment with CCR1 and TAK1 inhibitors reduced inflammatory cytokine expression in macrophages under LSS conditions. Overexpression of TAK1 significantly alleviated the inhibitory effects of CCR1 inhibitors on p-p65 and inflammatory cytokines. ConclusionLSS prompts endothelial cells to secrete CCL7, which, upon binding to the macrophage surface receptor CCR1, stimulates the release of macrophage inflammatory factors via the TAK1/NF-κB signaling pathway. This process exacerbates aneurysm wall inflammation and increases the risk of aneurysm rupture.

Deformed Popliteal Artery Due to Highly Flexed Knee Position Can Cause Kinks, Creating an Unfavorable Hemodynamic State.

Endovascular treatment devices of the femoropopliteal artery have evolved, improving clinical results. However, the effects of dynamic changes in the popliteal artery during knee flexion have not been sufficiently investigated. In this study we performed a 3-dimensional analysis to clarify the dynamic changes in the popliteal artery during knee flexion and their effects on hemodynamics.Methods and Results: To analyze dynamic changes in the popliteal artery in the knee flexion position, a computed tomography protocol was developed in the right-angled and maximum flexion knee positions. Thirty patients with lower extremity artery disease were recruited. V-Modeler software was used for anatomical and hemodynamic analyses. Various types of deformations of the popliteal artery were revealed, including hinge points and accessory flexions. Kinks can occur in the maximum flexion position; however, they rarely occur in the right-angled flexion position. In addition, hemodynamic analysis revealed a tendency for lower minimum wall shear stress and a higher maximum oscillatory shear index at the maximum curvature of the popliteal artery. Kinks in the maximum flexion position suggested that the outcome of endovascular treatment may change in areas such as Japan, where knee flexion is customary. Hemodynamics at the maximum curvature of the popliteal artery indicated that the luminal condition was unfavorable for endovascular treatment.

Patient-specific analysis of bicuspid aortic valve hemodynamics using a fully coupled fluid-structure interaction model

Bicuspid aortic valve (BAV), the most common congenital heart disease, is prone to develop significant valvular dysfunction and aortic wall abnormalities such as ascending aortic aneurysm. Growing evidence has suggested that abnormal BAV hemodynamics could contribute to disease progression. In order to investigate BAV hemodynamics, we performed 3D patient-specific fluid-structure interaction (FSI) simulations with fully coupled blood flow dynamics and valve motion throughout the cardiac cycle. Results showed that the hemodynamics during systole can be characterized by a systolic jet and two counter-rotating recirculation vortices. At peak systole, the jet was usually eccentric, with asymmetric recirculation vortices and helical flow motion in the ascending aorta. The flow structure at peak systole was quantified using the vorticity, flow rate reversal ratio and local normalized helicity (LNH) at four locations from the aortic root to the ascending aorta. The systolic jet was evaluated with the peak velocity, normalized flow displacement, and jet angle. It was found that peak velocity and normalized flow displacement (rather than jet angle) gave a strong correlation with the vorticity and LNH in the ascending aorta, which suggests that these two metrics could be used for clinical noninvasive evaluation of abnormal blood flow patterns in BAV patients.

Tailoring left ventricular assist device cannula implantation using coupled multi-scale multi-objective optimization

BackgroundThe frequent occurrence of thromboembolic cerebral events continues to limit the widespread implementation of Ventricular Assist Devices (VAD) despite continued advancements in VAD design and anti-coagulation treatments. Recent studies point to the optimal positioning of the outflow graft (OG) as a potential mitigator of post implantation thromboembolism. ObjectiveThis study aims to examine the tailoring of the OG implantation orientation with the goal of minimizing the number of thrombi reaching the cerebral vessels by means of a formal shape optimization scheme incorporated into a multi-scale hemodynamics analysis. MethodsA 3-D patient-specific computational fluid dynamics model is loosely coupled in a two-way manner to a 0-D lumped parameter model of the peripheral circulation. A Lagrangian particle-tracking scheme models and tracks thrombi as non-interacting solid spheres. The loose coupling between CFD and LPM is integrated into a geometric shape optimization scheme which aims to optimize an objective function that targets a drop in cerebral embolization, and an overall reduction in particle residence times. ResultsThe results elucidate the importance of OG anastomosis orientation and placement particularly in the case that studied particle release from the OG, as a fivefold decrease in cerebral embolization was observed between the optimal and non-optimal implantations. Another case considered particle release from the ventricle and aortic root walls, in which optimal implantation was achieved with a shallow insertion angle. Particle release from all three origins was investigated in the third case, demonstrating that the optimal configurations were generally characterized by VAD flow directed along the central lumen of the aortic arch. Because optimal configurations depended on the anatomic origin of the thrombus, it is important to determine, in clinical studies, the most likely sites of thrombus formation in VAD patients.

Comprehensive temporal analysis of right ventricular function and pulmonary haemodynamics in mechanically ventilated COVID-19 ARDS patients

BackgroundCardiac injury is frequently reported in COVID-19 patients, the right ventricle (RV) is mostly affected. We systematically evaluated the cardiac function and longitudinal changes in severe COVID-19 acute respiratory distress syndrome (ARDS) admitted to the intensive care unit (ICU) and assessed the impact on survival.MethodsWe prospectively performed comprehensive echocardiographic analysis on mechanically ventilated COVID-19 ARDS patients, using 2D/3D echocardiography. We defined left ventricular (LV) systolic dysfunction as ejection fraction (EF) < 40%, or longitudinal strain (LS) > − 18% and right ventricular (RV) dysfunction if two indices among fractional area change (FAC) < 35%, tricuspid annulus systolic plane excursion (TAPSE) < 1.6 cm, RV EF < 44%, RV–LS > − 20% were present. RV afterload was assessed from pulmonary artery systolic pressure (PASP), PASP/Velocity Time Integral in the right ventricular outflow tract (VTIRVOT) and pulmonary acceleration time (PAcT). TAPSE/PASP assessed the right ventriculoarterial coupling (VACR).ResultsAmong 176 patients included, RV dysfunction was common (69%) (RV–EF 41.1 ± 1.3%; RV–FAC 36.6 ± 0.9%, TAPSE 20.4 ± 0.4mm, RV–LS:− 14.4 ± 0.4%), usually accompanied by RV dilatation (RVEDA/LVEDA 0.82 ± 0.02). RV afterload was increased in most of the patients (PASP 33 ± 1.1 mmHg, PAcT 65.3 ± 1.5 ms, PASP/VTIRVOT, 2.29 ± 0.1 mmHg/cm). VACR was 0.8 ± 0.06 mm/mmHg. LV–EF < 40% was present in 21/176 (11.9%); mean LV–EF 57.8 ± 1.1%. LV–LS (− 13.3 ± 0.3%) revealed a silent LV impairment in 87.5%. A mild pericardial effusion was present in 70(38%) patients, more frequently in non-survivors (p < 0.05). Survivors presented significant improvements in respiratory physiology during the 10th ICU-day (PaO2/FiO2, 231.2 ± 11.9 vs 120.2 ± 6.7 mmHg; PaCO2, 43.1 ± 1.2 vs 53.9 ± 1.5 mmHg; respiratory system compliance—CRS, 42.6 ± 2.2 vs 27.8 ± 0.9 ml/cmH2O, all p < 0.0001). Moreover, survivors presented significant decreases in RV afterload (PASP: 36.1 ± 2.4 to 20.1 ± 3 mmHg, p < 0.0001, PASP/VTIRVOT: 2.5 ± 1.4 to 1.1 ± 0.7, p < 0.0001 PAcT: 61 ± 2.5 to 84.7 ± 2.4 ms, p < 0.0001), associated with RV systolic function improvement (RVEF: 36.5 ± 2.9% to 46.6 ± 2.1%, p = 0.001 and RV–LS: − 13.6 ± 0.7% to − 16.7 ± 0.8%, p = 0.001). In addition, RV dilation subsided in survivors (RVEDA/LVEDA: 0.8 ± 0.05 to 0.6 ± 0.03, p = 0.001). Day-10 CRS correlated with RV afterload (PASP/VTIRVOT, r: 0.535, p < 0.0001) and systolic function (RV–LS, 0.345, p = 0.001). LV–LS during the 10th ICU-day, while ΔRV–LS and ΔPASP/RVOTVTI were associated with survival.ConclusionsCOVID-19 improvements in RV function, RV afterload and RV–PA coupling at day 10 were associated with respiratory function and survival.

Software that combines deep learning, 3D reconstruction and CFD to analyze the state of carotid arteries from ultrasound imaging.

Ultrasound is one of the non-invasive techniques that are used in clinical diagnostics of carotid artery disease. This paper presents software methodology that can be used in combination with this imaging technique to provide additional information about the state of patient-specific artery. Overall three modules are combined within the proposed methodology. A clinical dataset is used within the deep learning module to extract the contours of the carotid artery. This data is then used within the second module to perform the three-dimensional reconstruction of the geometry of the carotid bifurcation and ultimately this geometry is used within the third module, where the hemodynamic analysis is performed. The obtained distributions of hemodynamic quantities enable a more detailed analysis of the blood flow and state of the arterial wall and could be useful to predict further progress of present abnormalities in the carotid bifurcation. The performance of the deep learning module was demonstrated through the high values of relevant common classification metric parameters. Also, the accuracy of the proposed methodology was shown through the validation of results for the reconstructed parameters against the clinically measured values. The presented methodology could be used in combination with standard clinical ultrasound examination to quickly provide additional quantitative and qualitative information about the state of the patient's carotid bifurcation and thus ensure a treatment that is more adapted to the specific patient.

Hemodynamical behavior analysis of anemic, diabetic, and healthy blood flow in the carotid artery

The influence of blood rheology on hemodynamic parameters is investigated using Computational Fluid Dynamics on blood flow through the human carotid artery. We performed three-dimensional modeling and simulation to study blood flow through the carotid artery, which is divided into internal and exterior parts with a decreased radius. The blood flow was classified as basic pulsatile to simulate the human heart's rhythmic pulses. For hemodynamic modeling viscosity of the fluid, the Carreau model was utilized with four distinct blood instances: Anemic, diabetic, and two healthy blood types. The boundary conditions with Carreau viscosity were applied using the Ansys Fluent simulator, and the governing equations were solved using the finite volume technique. Different time steps were tested for their impact on wall deformation, strain rate, blood velocity, pressure, wall shear, and skin friction coefficient. The hemodynamical parameters were calculated using many cross-sectional planes along the artery. Finally, the impact of the four types of blood cases listed above was investigated, and we discovered that each blood case has a substantial impact on blood velocity, pressure, wall shear, and strain rate along the artery.

Inter‐model and inter‐modality analysis of left ventricular hemodynamics: Comparative study of two CFD approaches based on echocardiography and magnetic resonance imaging

AbstractComputational fluid dynamics (CFD) carry the potential to provide detailed insights into intraventricular hemodynamics and complement in vivo flow measurement techniques. A variety of CFD approaches emerged in recent years, mostly building solely on medical image data as patient‐specific input. While the utilized medical imaging method and chosen CFD approach both influence the computed hemodynamics, thereto related differences are rarely investigated. The present study addresses this issue with an inter‐(imaging)‐modality and inter‐model comparison of intracardiac flow computations. Magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE) data of a volunteer were acquired and used to reconstruct the anatomical structures. For each modality, the reconstructed shapes were applied in two previously introduced CFD approaches to compute whole‐cycle ventricular flow patterns. While both methods involved benefits and challenges, similar valve velocities were computed, being in accordance with in vivo 4D flow MRI and pulsed‐wave Doppler velocity measurements (systolic peak velocity: 1.24–1.26 m/s (MRI), 0.9–1.25 m/s (TTE); diastolic peak velocity: 0.54 m/s (MRI), 0.59–0.75 m/s (TTE)). A detailed flow analysis with vortex formation, kinetic energy, and mid‐ventricular velocities indicated the computed inter‐modality differences to be larger than inter‐method ones. Quantitatively, this could be observed in the direct flow rate ( inter‐modality: 13, inter‐method, 3). These results help to gain trust in CFD approaches to compute intraventricular flow and emphasize the importance of standardized input data. Future studies, however, should consider a broader data base.