606 research outputs found
Interaction of elastomechanics and fluid dynamics in the human heart : Opportunities and challenges of light coupling strategies
Das menschliche Herz ist das hochkomplexe Herzstück des kardiovaskulären Systems, das permanent, zuverlässig und autonom den Blutfluss im Körper aufrechterhält. In Computermodellen wird die Funktionalität des Herzens nachgebildet, um Simulationsstudien durchzuführen, die tiefere Einblicke in die zugrundeliegenden Phänomene ermöglichen oder die Möglichkeit bieten, relevante Parameter unter vollständig kontrollierten Bedingungen zu variieren. Angesichts der Tatsache, dass Herz-Kreislauf-Erkrankungen die häufigste Todesursache in den Ländern der westlichen Hemisphäre sind, ist ein Beitrag zur frühzeit- igen Diagnose derselben von großer klinischer Bedeutung. In diesem Zusammenhang können computergestützte Strömungssimulationen wertvolle Einblicke in die Blutflussdynamik liefern und bieten somit die Möglichkeit, einen zentralen Bereich der Physik dieses multiphysikalischen Organs zu untersuchen. Da die Verformung der Endokardoberfläche den Blutfluss antreibt, müssen die Effekte der Elastomechanik als Randbedingungen für solche Strömungssimulationen berücksichtigt werden. Um im klinischen Kontext relevant zu sein, muss jedoch ein Mittelweg zwischen dem Rechenaufwand und der erforderlichen Genauigkeit gefunden werden, und die Modelle müssen sowohl robust als auch zuverlässig sein. Daher werden in dieser Arbeit die Möglichkeiten und Herausforderungen leichter und daher weniger komplexer Kopplungsstrategien mit Schwerpunkt auf drei Schlüsselaspekten bewertet:
Erstens wird ein auf dem Immersed Boundary-Ansatz basierender Fluiddynamik-Löser implementiert, da diese Methode mit einer sehr robusten Darstellung von bewegten Netzen besticht. Die grundlegende Funktionalität wurde für verschiedene vereinfachte Geometrien verifiziert und zeigte eine hohe Übereinstimmung mit der jeweiligen analytischen Lösung. Vergleicht man die 3D-Simulation einer realistischen Geometrie des linken Teils des Herzens mit einem körperangepassten Netzbeschreibung, so wurden grundlegende globale Größen korrekt reproduziert. Allerdings zeigten Variationen der Randbedingungen einen großen Einfluss auf die Simulationsergebnisse.
Die Anwendung des Lösers zur Simulation des Einflusses von Pathologien auf die Blutströmungsmuster ergab Ergebnisse in guter Übereinstimmung mit Literaturwerten. Bei Simulationen der Mitralklappeninsuffizienz wurde der rückströmende Anteil mit Hilfe einer Partikelverfolgungsmethode visualisiert. Bei hypertropher Kardiomyopathie wurden die Strömungsmuster im linken Ventrikel mit Hilfe eines passiven Skalartransports bewertet, um die lokale Konzentration des ursprünglichen Blutvolumens zu visualisieren.
Da in den vorgenannten Studien nur ein unidirektionaler Informationsfluss vom elas- tomechanischen Modell zum Strömungslöser berücksichtigt wurde, wird die Rückwirkung des räumlich aufgelösten Druckfeldes aus den Strömungssimulationen auf die Elastomechanik quantifiziert. Es wird ein sequenzieller Kopplungsansatz eingeführt, um fluiddynamische Einflüsse in einer Schlag-für-Schlag-Kopplungsstruktur zu berücksichtigen. Die geringen Abweichungen im mechanischen Solver von 2 mm verschwanden bereits nach einer Iteration, was darauf schließen lässt, dass die Rückwirkungen der Fluiddynamik im gesunden Herzen begrenzt ist.
Zusammenfassend lässt sich sagen, dass insbesondere bei Strömungsdynamiksimula- tionen die Randbedingungen mit Vorsicht gewählt werden müssen, da sie aufgrund ihres großen Einflusses die Anfälligkeit der Modelle erhöhen. Nichtsdestotrotz zeigten verein- fachte Kopplungsstrategien vielversprechende Ergebnisse bei der Reproduktion globaler fluiddynamischer Größen, während die Abhängigkeit zwischen den Lösern reduziert und Rechenaufwand eingespart wird
4D FLOW CMR in congenital heart disease
This thesis showed that the use of a cloud-based reconstruction applicationwith advanced eddy currents correction, integrated with interactiveimaging evaluation tools allowed for remote visualization and interpretationof 4D flow data and that was sufficient for gross visualizationof aortic valve regurgitation. Further, this thesis demonstrated that bulkflow and pulmonary regurgitation can be accurately quantified using 4Dflow imaging analyzed. Peak systolic velocity over the pulmonary valvemay be underestimated. However, the measurement of peak systolicvelocity can be optimized if measured at the level of highest velocity inthe pulmonary artery. Also correlated against invasive measurements (inan animal model), this thesis shows that aorta flow and pulmonary flowcan be accurately and simultaneously measured by 4D flow MRI.When applied in clinical practice, 4D flow has extra advantages, of beingable to visualize flow pattern, vorticity and to predict aortic growth. InASD patients it can measure shunt volume directly following the septumframe by frame. In Fontan patients in can visualize better than standardMRI the Fontan circuit and it can measure flow at multiple points alongthe Fontan circuit. We observed in our Fontan population that shunt lesionswere very common, most of the time via veno-venous collaterals.Further using advanced computations, we showed that WSS angle wasthe only independent predictor of aortic growth in BAV patients. We alsoshowed the feasibility of GLS analysis on 4D flow MRI and presented anintegrative approach in which flow and functional data are acquired inone sequence.From the technical point of view, 4D flow MRI has proved to complementthe traditional components of the standard cardiac MR exams, enablingin-depth insights into hemodynamics. At this moment it proved its addedvalue, but in most of the cases it is not able yet to replace the standardexam. This is still due to long scanning times and relatively longpost-processing times.<br/
Characterising Shape Variation in the Human Right Ventricle Using Statistical Shape Analysis: Preliminary Outcomes and Potential for Predicting Hypertension in a Clinical Setting
Variations in the shape of the human right ventricle (RV) have previously been shown to be predictive of heart function and long term prognosis in Pulmonary Hypertension (PH), a deadly disease characterised by high blood pressure in the pulmonary arteries. The extent to which ventricular shape is also affected by non-pathological features such as sex, body mass index (BMI) and age is explored in this thesis. If fundamental differences in the shape of a structurally normal RV exist, these might also impact the success of a predictive model. This thesis evaluates the extent to which non-pathological features affect the shape of the RV and determines the best ways, in terms of procedure and analysis, to adapt the model to consistently predict PH. It also identifies areas where the statistical shape analysis procedure is robust, and considers the extent to which specific, non-pathological, characteristics impact the diagnostic potential of the statistical shape model. Finally, recommendations are made on next steps in the development of a classification procedure for PH. The dataset was composed of clinically-obtained, cardiovascular magnetic resonance images (CMR) from two independent sources; The University of Pittsburgh Medical Center and Newcastle University. Shape change is assessed using a 3D statistical shape analysis technique, which topologically maps heart meshes through an harmonic mapping approach to create a unique shape function for each shape. Proper Orthogonal Decomposition (POD) was applied to the complete set of shape functions in order to determine and rank a set of shape features (i.e. modes and corresponding coefficients from the decomposition). MRI scanning protocol produced the most significant difference in shape; a shape mode associated with detail at the RV apex and ventricular length from apex to base strongly correlated with the MRI sequence used to record each subject. Qualitatively, a protocol which skipped slices produced a shorter RV with less detail at the apex. Decomposition of sex, age and BMI also derives unique RV shape descriptors which correspond to anatomically meaningful features. The shape features are shown to be able to predict presence of PH. The predictive model can be improved by including BMI as a factor, but these improvements are mainly concentrated in identification of healthy subjects
Quantitative Cardiac Magnetic Resonance Imaging Biomarkers for the Characterisation of Ischaemic Cardiomyopathy
Our understanding of the processes that determine outcomes in patients with ischaemic cardiomyopathy is based on conventional physiological concepts such as ischaemia and viability. Qualitative methods for characterising these processes tend to be binary and often fail to capture the complexity of the underlying biology. Importantly, these are perhaps inadequate to evaluate treatment effects, including the impact of coronary revascularisation.
The aim of this thesis was to deploy novel quantitative cardiac magnetic resonance (CMR) techniques to evaluate and distinguish between the pathophysiological processes that determine outcomes in patients with ischaemic cardiomyopathy, through integration of anatomical, functional, perfusion and tissue characterisation information. The work is centred around the use of coronary artery bypass graft (CABG) surgery as the method for revascularisation, and focuses on the impact of myocardial blood flow alterations on cardiac physiology and clinical outcomes.
In this work, I first evaluate the impact of surgical revascularisation on myocardial structure and function in patients with impaired left ventricular (LV) systolic function, using paired assessments before and after CABG. I found that at 6 months following revascularisation, despite improvement in functional capacity, more than a third of total myocardial segments examined are no longer considered revascularised. As a result, the overall augmentation in global myocardial blood flow (MBF) following CABG surgery is significantly blunted.
There are however technical concerns regarding the quantitative estimation of myocardial blood flow in patients with coronary artery grafts, particularly in relation to the impact of long coronary grafts on contrast kinetics. I therefore evaluated the impact of arterial contrast delay on myocardial blood flow estimation in patients with left internal mammary artery (LIMA) grafts. I showed that absolute MBF estimation is minimally affected by delayed contrast arrival in patients with LIMA grafts, and that irrespective of graft patency, residual native disease severity is a key determinant of myocardial blood flow.
Following these findings, I then assessed the prognostic impact of myocardial blood flow in a large cohort of patients with prior CABG. The only imaging study to date examining the prognostic role of quantitative perfusion indices in this population, it demonstrated that both stress MBF and myocardial perfusion reserve (MPR) independently predict adverse cardiovascular outcomes and all cause-mortality.
Finally, using the existing quantitative perfusion technique and its associated framework, I co-developed and implemented a non-invasive, in-line method of measuring pulmonary transit time (PTT) and pulmonary blood volume (PBV) during routine CMR scanning. I then found that both imaging parameters can be used as independent quantitative prognostic biomarkers in patients with known or suspected coronary artery disease
Using averaged models from 4D ultrasound strain imaging allows to signifcantly diferentiate local wall strains in calcifed regions of abdominal aortic aneurysms
Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion
Introduction to Human Biology
This OER is intended as a textbook for a one semester introductory course in Human Anatomy and Physiology for non-science majors. It covers the major topics typically covered in A&P, but in a simplified, easier to understand manner. This textbook aims to educate students interested in lower-level health careers and non-science majors without the intimidating detail found in current textbooks. Text and images were created to be more accessible for these student populations
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