Abstract
Background
A biomechanical model of the heart can be used to incorporate multiple data sources
(electrocardiography, imaging, invasive hemodynamics). The purpose of this study was
to use this approach in a cohort of patients with tetralogy of Fallot after complete
repair (rTOF) to assess comparative influences of residual right ventricular outflow
tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health.
Methods
Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR)
and cardiovascular magnetic resonance imaging were included in this retrospective
study. Biomechanical models specific to individual patient and physiology (before
and after PVR) were created and used to estimate the RV myocardial contractility.
The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic
volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values.
Results
RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased
in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility
(median decrease 35%) after PVR than those with predominant pulmonary regurgitation
(median decrease 11%). The model simulated post-PVR decreased EDV for the majority
and suggested an increase of Qeff—both in line with published data.
Conclusions
This study used a biomechanical model to synthesize multiple clinical inputs and give
an insight into RV health. Individualized modeling allows us to predict the RV response
to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work
than isolated pulmonary regurgitation.
Résumé
Contexte
Une modélisation biomécanique du cœur peut être utilisée pour intégrer des sources
de données multiples (électrocardiographie, imagerie, hémodynamique invasive). Le
but de cette étude était d'utiliser cette approche pour une cohorte de patients atteints
de tétralogie de Fallot après réparation complète (TdFr) pour évaluer, au niveau du
ventricule, les influences comparatives de la sténose résiduelle de la voie d'éjection
du ventricule droit (SVEVD) et de la régurgitation pulmonaire.
Méthodes
Vingt patients atteints de TdFr ayant subi un remplacement percutané de la valve pulmonaire
(RVP) et une imagerie par résonance magnétique cardiovasculaire ont été inclus dans
cette étude rétrospective. Des modèles biomécaniques adaptés à chaque patient et à
sa physiologie (avant et après le RVP) ont été créés et utilisés pour estimer la contractilité
myocardique du ventricule droit (VD). La capacité des modèles à capturer les changements
post-RVP du volume télédiastolique (VTD) du VD et du débit effectif dans l'artère
pulmonaire (Qeff) a également été comparée aux valeurs attendues.
Résultats
La contractilité du VD avant le RVP (moyenne 66 ± 16 kPa, moyenne ± déviation standard))
était plus élevée chez les patients atteints de TdFr par rapport au VD normal (38-48
kPa) (P < 0,05). La contractilité a diminué de manière significative chez tous les patients
après le RVP (P < 0,05). Les patients présentant une SVEVD prédominante ont montré une plus grande
réduction de la contractilité (diminution médiane de 35 %) après le RVP que ceux présentant
une régurgitation pulmonaire prédominante (diminution médiane de 11 %). Le modèle
a simulé une diminution du VTD-VD après le RVP pour la majorité des patients et a
suggéré une augmentation du Qeff, ce qui est conforme aux données publiées.
Conclusions
Cette étude a utilisé un modèle biomécanique pour synthétiser de multiples données
cliniques et donner un aperçu de l'état de santé du VD. La modélisation individualisée
nous permet de prédire la réponse du VD au RVP. Les premières données suggèrent que
la SVEVD résiduelle impose un travail ventriculaire plus important que la régurgitation
pulmonaire isolée.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Magnetic resonance imaging to assess the hemodynamic effects of pulmonary valve replacement in adults late after repair of tetralogy of Fallot.Circulation. 2002; 106: 1703-1707
- Impact of pulmonary valve replacement in tetralogy of Fallot with pulmonary regurgitation: a comparison of intervention and nonintervention.Ann Thorac Surg. 2012; 94: 1619-1626
- Preoperative thresholds for mid-to-late haemodynamic and clinical outcomes after pulmonary valve replacement in tetralogy of Fallot.Eur Heart J. 2016; 37: 829-835
- Early insertion of a pulmonary valve for chronic regurgitation helps restoration of ventricular dimensions.Ann Thorac Surg. 2005; 80: 1615-1621
- Physiological and phenotypic characteristics of late survivors of tetralogy of Fallot repair who are free from pulmonary valve replacement.Circulation. 2013; 128: 1861-1868
- Timing and technique of pulmonary valve replacement in the patient with tetralogy of Fallot.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2012; 15: 27-33
- Optimal timing for pulmonary valve replacement in adults after tetralogy of Fallot repair.Am J Cardiol. 2005; 95: 779-782
- Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support.J Cardiovasc Magn Reson. 2011; 13: 9
- Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort.Heart. 2014; 100: 247-253
- Image-based predictive modeling of heart mechanics.Annu Rev Biomed Eng. 2015; 17: 351-383
- Multiphysics and multiscale modelling, data–model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics.Interface Focus. 2016; 6: 20150083
- Estimation of passive and active properties in the human heart using 3D tagged MRI.Biomech Model Mechanobiol. 2016; 15: 1121-1139
- Estimation of tissue contractility from cardiac cine-MRI using a biomechanical heart model.Biomech Model Mechanobiol. 2012; 11: 609-630
- Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling.PLoS One. 2020; 15e0229015
- Equilibrated warping: finite element image registration with finite strain equilibrium gap regularization.Med Image Anal. 2018; 50: 1-22
- Left ventricular torsion obtained using equilibrated warping in patients with repaired tetralogy of Fallot.Pediatr Cardiol. 2021; 42: 1275-1283
- Normal values for cardiovascular magnetic resonance in adults and children.J Cardiovasc Magn Reson. 2015; 17: 29
- Dimensional reductions of a cardiac model for effective validation and calibration.Biomech Model Mechanobiol. 2014; 13: 897-914
- Monitoring of cardiovascular physiology augmented by a patient-specific biomechanical model during general anesthesia. A proof of concept study.PLoS One. 2020; 15e0232830
- An energy-preserving muscle tissue model: formulation and compatible discretizations.Int J Multiscale Comput Eng. 2012; 10: 189
- Muscle structure and theories of contraction.Prog Biophys Biophys Chem. 1957; 7: 255-318
- Thermodynamic properties of muscle contraction models and associated discrete-time principles.Adv Model Simul Eng Sci. 2019; 6: 6
- Total arterial inertance as the fourth element of the Windkessel model.Am J Physiol. 1999; 276: H81-H88
- Modeling and estimation of the cardiac electromechanical activity.Comput Struct. 2006; 84: 1743-1759
- Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application.Am J Physiol Heart Circ Physiol. 2006; 291: H403-H412
- Assessment of atrioventricular valve regurgitation using biomechanical cardiac modeling.in: Pop M. Wright G.A. Functional Imaging and Modelling of the Heart: 9th International Conference, FIMH 2017, Toronto, ON, Canada, June 11-13, 2017, Proceedings. Springer, 2017: 401-411
- Comparison of bare metal stenting and percutaneous pulmonary valve implantation for treatment of right ventricular outflow tract obstruction.Circulation. 2009; 119: 2995-3001
- Determination of pressure data from velocity data with a view toward its application in cardiovascular mechanics. Part 1. Theoretical considerations.Int J Eng Sci. 2016; 105: 108-127
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Pulmonary right ventricular resynchronization in congenital heart disease.Circ Cardiovasc Imaging. 2017; 10e006424
- Modeling pathologies of diastolic and systolic heart failure.Ann Biomed Eng. 2016; 44: 112-127
- A generic approach toward finite growth with examples of athlete’s heart, cardiac dilation, and cardiac wall thickening.J Mech Phys Solids. 2010; 58: 1661-1680
- A computational model that predicts reverse growth in response to mechanical unloading.Biomech Model Mechanobiol. 2015; 14: 12
- Combining data assimilation and machine learning to build data-driven models for unknown long time dynamics—applications in cardiovascular modeling.Int J Numer Methods Biomed Eng. 2021; 37e3471
- Studying dynamic myofiber aggregate reorientation in dilated cardiomyopathy using in vivo magnetic resonance diffusion tensor imaging.Circ Cardiovasc Imaging. 2016; 9e005018
Article info
Publication history
Published online: June 29, 2021
Accepted:
June 26,
2021
Received:
April 15,
2021
Footnotes
See page 1805 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
