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Edin, C., Ekstedt, M., Scheffel, T., Karlsson, M., Swahn, E., Östgren, C. J., . . . Carlhäll, C.-J. (2022). Ectopic fat is associated with cardiac remodeling - A comprehensive assessment of regional fat depots in type 2 diabetes using multi-parametric MRI.. Frontiers in Cardiovascular Medicine, 9, Article ID 813427.
Open this publication in new window or tab >>Ectopic fat is associated with cardiac remodeling - A comprehensive assessment of regional fat depots in type 2 diabetes using multi-parametric MRI.
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2022 (English)In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 9, article id 813427Article in journal (Refereed) Published
Abstract [en]

Background: Different regional depots of fat have distinct metabolic properties and may relate differently to adverse cardiac remodeling. We sought to quantify regional depots of body fat and to investigate their relationship to cardiac structure and function in Type 2 Diabetes (T2D) and controls.

Methods: From the SCAPIS cohort in Linköping, Sweden, we recruited 92 subjects (35% female, mean age 59.5 ± 4.6 years): 46 with T2D and 46 matched controls. In addition to the core SCAPIS data collection, participants underwent a comprehensive magnetic resonance imaging examination at 1.5 T for assessment of left ventricular (LV) structure and function (end-diastolic volume, mass, concentricity, ejection fraction), as well as regional body composition (liver proton density fat fraction, visceral adipose tissue, abdominal subcutaneous adipose tissue, thigh muscle fat infiltration, fat tissue-free thigh muscle volume and epicardial adipose tissue).

Results: Compared to the control group, the T2D group had increased: visceral adipose tissue volume index (P < 0.001), liver fat percentage (P < 0.001), thigh muscle fat infiltration percentage (P = 0.02), LV concentricity (P < 0.001) and LV E/e'-ratio (P < 0.001). In a multiple linear regression analysis, a negative association between liver fat percentage and LV mass (St Beta -0.23, P < 0.05) as well as LV end-diastolic volume (St Beta -0.27, P < 0.05) was found. Epicardial adipose tissue volume and abdominal subcutaneous adipose tissue volume index were the only parameters of fat associated with LV diastolic dysfunction (E/e'-ratio) (St Beta 0.24, P < 0.05; St Beta 0.34, P < 0.01, respectively). In a multivariate logistic regression analysis, only visceral adipose tissue volume index was significantly associated with T2D, with an odds ratio for T2D of 3.01 (95% CI 1.28-7.05, P < 0.05) per L/m2 increase in visceral adipose tissue volume.

Conclusions: Ectopic fat is predominantly associated with cardiac remodeling, independently of type 2 diabetes. Intriguingly, liver fat appears to be related to LV structure independently of VAT, while epicardial fat is linked to impaired LV diastolic function. Visceral fat is associated with T2D independently of liver fat and abdominal subcutaneous adipose tissue.

Place, publisher, year, edition, pages
Frontiers Media SA, 2022
Keywords
cardiac remodeling, ectopic fat, left ventricular diastolic function, left ventricular structure, magnetic resonance imaging, type 2 diabetes, visceral fat
National Category
Endocrinology and Diabetes Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-190027 (URN)10.3389/fcvm.2022.813427 (DOI)000890713700001 ()35966535 (PubMedID)
Note

This work was funded by the Swedish Research Council, theSwedish Heart and Lung Foundation, and through ALF GrantsRegion Östergötland.

Available from: 2022-11-17 Created: 2022-11-17 Last updated: 2023-05-04
Henningsson, M., Carlhäll, C., Ebbers, T. & Kihlberg, J. (2022). Non-contrast myocardial perfusion in rest and exercise stress using systolic flow-sensitive alternating inversion recovery. Magnetic Resonance Materials in Physics, Biology and Medicine, 35(5), 711-718
Open this publication in new window or tab >>Non-contrast myocardial perfusion in rest and exercise stress using systolic flow-sensitive alternating inversion recovery
2022 (English)In: Magnetic Resonance Materials in Physics, Biology and Medicine, ISSN 0968-5243, E-ISSN 1352-8661, Vol. 35, no 5, p. 711-718Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate systolic flow-sensitive alternating inversion recovery (FAIR) during rest and exercise stress using 2RR (two cardiac cycles) or 1RR intervals between inversion pulse and imaging. Materials and methods 1RR and 2RR FAIR was implemented on a 3T scanner. Ten healthy subjects were scanned during rest and stress. Stress was performed using an in-bore ergometer. Heart rate, mean myocardial blood flow (MBF) and temporal signal-to-noise ratio (TSNR) were compared using paired t tests. Results Mean heart rate during stress was higher than rest for 1RR FAIR (85.8 +/- 13.7 bpm vs 63.3 +/- 11.1 bpm; p &lt; 0.01) and 2RR FAIR (83.8 +/- 14.2 bpm vs 63.1 +/- 10.6 bpm; p &lt; 0.01). Mean stress MBF was higher than rest for 1RR FAIR (2.97 +/- 0.76 ml/g/min vs 1.43 +/- 0.6 ml/g/min; p &lt; 0.01) and 2RR FAIR (2.8 +/- 0.96 ml/g/min vs 1.22 +/- 0.59 ml/g/min; p &lt; 0.01). Resting mean MBF was higher for 1RR FAIR than 2RR FAIR (p &lt; 0.05), but not during stress. TSNR was lower for stress compared to rest for 1RR FAIR (4.52 +/- 2.54 vs 10.12 +/- 3.69; p &lt; 0.01) and 2RR FAIR (7.36 +/- 3.78 vs 12.41 +/- 5.12; p &lt; 0.01). 2RR FAIR TSNR was higher than 1RR FAIR for rest (p &lt; 0.05) and stress (p &lt; 0.001). Discussion We have demonstrated feasibility of systolic FAIR in rest and exercise stress. 2RR delay systolic FAIR enables non-contrast perfusion assessment during stress with relatively high TSNR.

Place, publisher, year, edition, pages
Springer, 2022
Keywords
Non-contrast myocardial perfusion; Exercise stress test; Systolic flow-sensitive alternating inversion recovery; Arterial spin labeling
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-182214 (URN)10.1007/s10334-021-00992-3 (DOI)000734710400001 ()34958438 (PubMedID)
Note

Funding Agencies|Linkoping University; Markus Henningsson (vetenskapsradet) [2018-04164]; Carl-Johan Carlhall (region ostergotland) [LIO-797721]; Johan Kihlberg [LIO-825791]; Carl-Johan Carlhall (medicinska forskningsradet) [2018-02779]; Carl-Johan Carlhall (hjart-lungfonden) [20170440]

Available from: 2022-01-11 Created: 2022-01-11 Last updated: 2023-05-03
Kvernby, S., Flejmer, A. M., Dasu, A., Bolger, A. F., Ebbers, T. & Engvall, J. (2022). T1 and T2 Mapping for Early Detection of Treatment-Related Myocardial Changes in Breast Cancer Patients [Letter to the editor]. Paper presented at 2021/07/19. Journal of Magnetic Resonance Imaging, 55(2), 620-622
Open this publication in new window or tab >>T1 and T2 Mapping for Early Detection of Treatment-Related Myocardial Changes in Breast Cancer Patients
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2022 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 55, no 2, p. 620-622Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, Ltd, 2022
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-178024 (URN)10.1002/jmri.27820 (DOI)000670288800001 ()34231931 (PubMedID)
Conference
2021/07/19
Note

Funding agencies: This study was partially financed through ALF Grants, Region Ostergotland LIO-284291, LIO-284411, and LIO-448281, and LIU Cancer Projects Grants 2012.

Available from: 2021-07-19 Created: 2021-07-19 Last updated: 2023-05-04Bibliographically approved
Sundin, J., Bustamante, M., Ebbers, T., Dyverfeldt, P. & Carlhäll, C. (2022). Turbulent Intensity of Blood Flow in the Healthy Aorta Increases With Dobutamine Stress and is Related to Cardiac Output. Frontiers in Physiology, 13, Article ID 869701.
Open this publication in new window or tab >>Turbulent Intensity of Blood Flow in the Healthy Aorta Increases With Dobutamine Stress and is Related to Cardiac Output
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2022 (English)In: Frontiers in Physiology, E-ISSN 1664-042X, Vol. 13, article id 869701Article in journal (Refereed) Published
Abstract [en]

Introduction: The blood flow in the normal cardiovascular system is predominately laminar but operates close to the threshold to turbulence. Morphological distortions such as vascular and valvular stenosis can cause transition into turbulent blood flow, which in turn may cause damage to tissues in the cardiovascular system. A growing number of studies have used magnetic resonance imaging (MRI) to estimate the extent and degree of turbulent flow in different cardiovascular diseases. However, the way in which heart rate and inotropy affect turbulent flow has not been investigated. In this study we hypothesized that dobutamine stress would result in higher turbulence intensity in the healthy thoracic aorta.Method: 4D flow MRI data were acquired in twelve healthy subjects at rest and with dobutamine, which was infused until the heart rate increased by 60% when compared to rest. A semi-automatic segmentation method was used to segment the thoracic aorta in the 4D flow MR images. Subsequently, flow velocity and several turbulent kinetic energy (TKE) parameters were calculated in the ascending aorta, aortic arch, descending aorta and whole thoracic aorta.Results: With dobutamine infusion there was an increase in heart rate (66 +/- 9 vs. 108 +/- 13 bpm, p < 0.001) and stroke volume (88 +/- 13 vs. 102 +/- 25 ml, p < 0.01). Additionally, there was an increase in Peak Average velocity (0.7 +/- 0.1 vs. 1.2 +/- 0.2 m/s, p < 0.001, Peak Max velocity (1.3 +/- 0.1 vs. 2.0 +/- 0.2 m/s, p < 0.001), Peak Total TKE (2.9 +/- 0.7 vs. 8.0 +/- 2.2 mJ, p < 0.001), Peak Median TKE (36 +/- 7 vs. 93 +/- 24 J/m3, p = 0.002) and Peak Max TKE (176 +/- 33 vs. 334 +/- 69 J/m3, p < 0.001). The relation between cardiac output and Peak Total TKE in the whole thoracic aorta was very strong (R-2 = 0.90, p < 0.001).Conclusion: TKE of blood flow in the healthy thoracic aorta increases with dobutamine stress and is strongly related to cardiac output. Quantification of such turbulence intensity parameters with cardiac stress may serve as a risk assessment of aortic disease development.

Place, publisher, year, edition, pages
FRONTIERS MEDIA SA, 2022
Keywords
4D flow MRI; aortic blood flow; cardiovascular magnetic resonance; dobutamine stress; turbulent blood flow
National Category
Physiology
Identifiers
urn:nbn:se:liu:diva-186168 (URN)10.3389/fphys.2022.869701 (DOI)000807849800001 ()35694404 (PubMedID)
Available from: 2022-06-23 Created: 2022-06-23 Last updated: 2024-01-17
Marlevi, D., Balmus, M., Hessenthaler, A., Viola, F., Fovargue, D., Vecchi, A. d., . . . Nordsletten, D. A. (2021). Non-invasive estimation of relative pressure for intracardiac flows using virtual work-energy. Medical Image Analysis, 68, Article ID 101948.
Open this publication in new window or tab >>Non-invasive estimation of relative pressure for intracardiac flows using virtual work-energy
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2021 (English)In: Medical Image Analysis, ISSN 1361-8415, E-ISSN 1361-8423, Vol. 68, article id 101948Article in journal (Refereed) Published
Abstract [en]

Intracardiac blood flow is driven by differences in relative pressure, and assessing these is critical in understanding cardiac disease. Non-invasive image-based methods exist to assess relative pressure, however, the complex flow and dynamically moving fluid domain of the intracardiac space limits assessment. Recently, we proposed a method, ?WERP, utilizing an auxiliary virtual field to probe relative pressure through complex, and previously inaccessible flow domains. Here we present an extension of ?WERP for intracardiac flow assessments, solving the virtual field over sub-domains to effectively handle the dynamically shifting flow domain. The extended ?WERP is validated in an in-silico benchmark problem, as well as in a patient-specific simulation model of the left heart, proving accurate over ranges of realistic image resolutions and noise levels, as well as superior to alternative approaches. Lastly, the extended ?WERP is applied on clinically acquired 4D Flow MRI data, exhibiting realistic ventricular relative pressure patterns, as well as indicating signs of diastolic dysfunction in an exemplifying patient case. Summarized, the extended ?WERP approach represents a directly applicable implementation for intracardiac flow assessments.

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
4D Flow MRI; Cardiac hemodynamics; Dynamic domains; Fluid mechanics; Relative pressure; Virtual work-energy
National Category
Medical Image Processing
Identifiers
urn:nbn:se:liu:diva-184023 (URN)10.1016/j.media.2020.101948 (DOI)000613292600002 ()33383332 (PubMedID)2-s2.0-85098474544 (Scopus ID)
Note

Funding agencies: D.M. holds a Knut and Alice Wallenberg Foundation scholar-ship for postdoctoral studies at Massachusetts Institute of Technology. M.B. acknowledges funding from King’s College London and Imperical College London ESPRC Centre for Doctoral Training in Medical Imaging (EP/L015226/1). D.N. would like to acknowledge funding from Engineering and Physical Sciences Research Council (EP/N011554/1 and EP/R003866/1). P.L. holds a Wellcome Trust Senior Research Fellowship (g.a. 209450/Z/17/Z). T.E. would like to acknowledge funding from the Swedish Research Council (2018–04454) and the Swedish Heart-Lung Foundation (2018-0657). This work was also supported by the Wellcome ESPRC Centre for Medical Engineering at King’s College London (WT 203148/Z/16/Z) and the British Heart Foundation (TG/17/3/33406). E.R.E. was funded in part by NIH R01 49039.

Available from: 2022-04-25 Created: 2022-04-25 Last updated: 2023-12-28Bibliographically approved
Garg, P., Swift, A. J., Zhong, L., Carlhäll, C., Ebbers, T., Westenberg, J., . . . Myerson, S. G. (2020). Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging. Nature Reviews Cardiology, 17(5), 298-312
Open this publication in new window or tab >>Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging
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2020 (English)In: Nature Reviews Cardiology, ISSN 1759-5002, E-ISSN 1759-5010, Vol. 17, no 5, p. 298-312Article in journal (Refereed) Published
Abstract [en]

Mitral regurgitation (MR) is a common valvular heart disease and is the second most frequent indication for heart valve surgery in Western countries. Echocardiography is the recommended first-line test for the assessment of valvular heart disease, but cardiovascular magnetic resonance imaging (CMR) provides complementary information, especially for assessing MR severity and to plan the timing of intervention. As new CMR techniques for the assessment of MR have arisen, standardizing CMR protocols for research and clinical studies has become important in order to optimize diagnostic utility and support the wider use of CMR for the clinical assessment of MR. In this Consensus Statement, we provide a detailed description of the current evidence on the use of CMR for MR assessment, highlight its current clinical utility, and recommend a standardized CMR protocol and report for MR assessment.

Place, publisher, year, edition, pages
Nature Publishing Group, 2020
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-164305 (URN)10.1038/s41569-019-0305-z (DOI)000526649800009 ()31819230 (PubMedID)2-s2.0-85076516502 (Scopus ID)
Note

Funding agencies: National Institute for Health Research (NIHR) Biomedical Research Centre at University Hospitals Bristol National Health Service (NHS) Foundation Trust; University of Bristol

Available from: 2020-03-16 Created: 2020-03-16 Last updated: 2021-04-27Bibliographically approved
Kihlberg, J., Gupta, V., Haraldsson, H., Sigfridsson, A., Sarvari, S. I., Ebbers, T. & Engvall, J. (2020). Clinical validation of three cardiovascular magnetic resonance techniques to measure strain and torsion in patients with suspected coronary artery disease. Journal of Cardiovascular Magnetic Resonance, 22(83)
Open this publication in new window or tab >>Clinical validation of three cardiovascular magnetic resonance techniques to measure strain and torsion in patients with suspected coronary artery disease
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2020 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 22, no 83Article in journal (Refereed) Published
Abstract [en]

BackgroundSeveral cardiovascular magnetic resonance (CMR) techniques can measure myocardial strain and torsion with high accuracy. The purpose of this study was to compare displacement encoding with stimulated echoes (DENSE), tagging and feature tracking (FT) for measuring circumferential and radial myocardial strain and myocardial torsion in order to assess myocardial function and infarct scar burden both at a global and at a segmental level.

Method116 patients with a high likelihood of coronary artery disease (European SCORE > 15%) underwent CMR examination including cine images, tagging, DENSE and late gadolinium enhancement (LGE) in the short axis direction. In total, 97 patients had signs of myocardial disease and 19 had no abnormalities in terms of left ventricular (LV) wall mass index, LV ejection fraction, wall motion, LGE or a history of myocardial infarction. Thirty-four patients had myocardial infarct scar with a transmural LGE extent (transmurality) that exceeded 50% of the wall thickness in at least one segment. Global circumferential strain (GCS) and global radial strain (GRS) was analyzed using FT of cine loops, deformation of tag lines or DENSE displacement.

ResultsDENSE and tagging both showed high sensitivity (82% and 71%) at a specificity of 80% for the detection of segments with > 50% LGE transmurality, and receiver operating characteristics (ROC) analysis showed significantly higher area under the curve-values (AUC) for DENSE (0.87) than for tagging (0.83, p < 0.001) and FT (0.66, p = 0.003). GCS correlated with global LGE when determined with DENSE (r = 0.41), tagging (r = 0.37) and FT (r = 0.15). GRS had a low but significant negative correlation with LGE; DENSE r = − 0.10, FT r = − 0.07 and tagging r = − 0.16. Torsion from DENSE and tagging had a weak correlation (− 0.20 and − 0.22 respectively) with global LGE.

ConclusionCircumferential strain from DENSE detected segments with > 50% scar with a higher AUC than strain determined from tagging and FT at a segmental level. GCS and torsion computed from DENSE and tagging showed similar correlation with global scar size, while when computed from FT, the correlation was lower.

Place, publisher, year, edition, pages
BioMed Central, 2020
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-171915 (URN)10.1186/s12968-020-00684-2 (DOI)000596074800001 ()33280612 (PubMedID)2-s2.0-85097198969 (Scopus ID)
Note

Funding agencies: Linkoping University Library; EU FP 7European Union (EU) [223615]; Swedish Heart Lung FoundationSwedish Heart-Lung Foundation [20120449]; Swedish Research CouncilSwedish Research Council; Medical Research Council of Southeast Sweden [35141, 88731, 157921]

Available from: 2020-12-15 Created: 2020-12-15 Last updated: 2021-12-28Bibliographically approved
Viola, F., Dyverfeldt, P., Carlhäll, C. & Ebbers, T. (2020). Data Quality and Optimal Background Correction Order of Respiratory-Gated k-Space Segmented Spoiled Gradient Echo (SGRE) and Echo Planar Imaging (EPI)-Based 4D Flow MRI. Journal of Magnetic Resonance Imaging, 51(3), 885-896
Open this publication in new window or tab >>Data Quality and Optimal Background Correction Order of Respiratory-Gated k-Space Segmented Spoiled Gradient Echo (SGRE) and Echo Planar Imaging (EPI)-Based 4D Flow MRI
2020 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 51, no 3, p. 885-896Article in journal (Refereed) Published
Abstract [en]

Background A reduction in scan time of 4D Flow MRI would facilitate clinical application. A recent study indicates that echo-planar imaging (EPI) 4D Flow MRI allows for a reduction in scan time and better data quality than the recommended k-space segmented spoiled gradient echo (SGRE) sequence. It was argued that the poor data quality of SGRE was related to the nonrecommended absence of respiratory motion compensation. However, data quality can also be affected by the background offset compensation. Purpose To compare the data quality of respiratory motion-compensated SGRE and EPI 4D Flow MRI and their dependence on background correction (BC) order. Study Type Retrospective. Subjects Eighteen healthy subjects (eight female, mean age 32 +/- 5 years). Field Strength and Sequence 5T. SGRE and EPI-based 4D Flow MRI. Assessment Data quality was investigated visually and by comparing flows through the cardiac valves and aorta. Measurements were obtained from transvalvular flow and pathline analysis. Statistical Tests Linear regression and Bland-Altman analysis were used. Wilcoxon test was used for comparison of visual scoring. Students t-test was used for comparison of flow volumes. Results No significant difference was found by visual inspection (P = 0.08). Left ventricular (LV) flows were strongly and very strongly associated with SGRE and EPI, respectively (R-2 = 0.86-0.94 SGRE; 0.71-0.79 EPI, BC0-4). LV and right ventricular (RV) outflows and LV pathline flows were very strongly associated (R-2 = 0.93-0.95 SGRE; 0.88-0.91 EPI, R-2 = 0.91-0.95 SGRE; 0.91-0.93 EPI, BC1-4). EPI LV outflow was lower than the short-axis-based stroke volume. EPI RV outflow and proximal descending aortic flow were lower than SGREs. Data Conclusion Both sequences yielded good internal data consistency when an adequate background correction was applied. Second and first BC order were considered sufficient for transvalvular flow analysis in SGRE and EPI, respectively. Higher BC orders were preferred for particle tracing. Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2019.

Place, publisher, year, edition, pages
WILEY, 2020
Keywords
4D flow MRI; phase contrast CMR; echo-planar imaging; spoiled gradient echo; data quality; background phase offsets
National Category
Medical Laboratory and Measurements Technologies
Identifiers
urn:nbn:se:liu:diva-159576 (URN)10.1002/jmri.26879 (DOI)000477430100001 ()31332874 (PubMedID)
Note

Funding Agencies|Swedish Research Council [621-2014-6191]; Swedish Heart and Lung Foundation [20140398]

Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2023-12-28
Casas Garcia, B., Lantz, J., Viola, F., Cedersund, G., Bolger, A. F., Carlhäll, C.-J., . . . Ebbers, T. (2020). Publisher Correction: Bridging the gap between measurements and modelling: a cardiovascular functional avatar. Scientific Reports, 10(1)
Open this publication in new window or tab >>Publisher Correction: Bridging the gap between measurements and modelling: a cardiovascular functional avatar
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2020 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Nature Publishing Group, 2020
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-174235 (URN)10.1038/s41598-020-58809-7 (DOI)000528916600001 ()31996774 (PubMedID)2-s2.0-85078668524 (Scopus ID)
Note

Correction to: Scientifc Reports https://doi.org/10.1038/s41598-017-06339-0

Available from: 2021-03-17 Created: 2021-03-17 Last updated: 2023-12-28Bibliographically approved
Lantz, J., Gupta, V., Henriksson, L., Karlsson, M., Persson, A., Carlhäll, C.-J. & Ebbers, T. (2019). Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI. Annals of Biomedical Engineering, 47(2), 413-424
Open this publication in new window or tab >>Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI
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2019 (English)In: Annals of Biomedical Engineering, ISSN 0090-6964, E-ISSN 1573-9686, Vol. 47, no 2, p. 413-424Article in journal (Refereed) Published
Abstract [en]

Blood flow simulations are making their way into the clinic, and much attention is given to estimation of fractional flow reserve in coronary arteries. Intracardiac blood flow simulations also show promising results, and here the flow field is expected to depend on the pulmonary venous (PV) flow rates. In the absence of in vivo measurements, the distribution of the flow from the individual PVs is often unknown and typically assumed. Here, we performed intracardiac blood flow simulations based on time-resolved computed tomography on three patients, and investigated the effect of the distribution of PV flow rate on the flow field in the left atrium and ventricle. A design-of-experiment approach was used, where PV flow rates were varied in a systematic manner. In total 20 different simulations were performed per patient, and compared to in vivo 4D flow MRI measurements. Results were quantified by kinetic energy, mitral valve velocity profiles and root-mean-square errors of velocity. While large differences in atrial flow were found for varying PV inflow distributions, the effect on ventricular flow was negligible, due to a regularizing effect by mitral valve. Equal flow rate through all PVs most closely resembled in vivo measurements and is recommended in the absence of a priori knowledge.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2019
Keywords
Sensitivity analysis, Design-of-experiments, Computational fluid dynamics, In vivo measurements
National Category
Medical Image Processing Fluid Mechanics and Acoustics
Identifiers
urn:nbn:se:liu:diva-153252 (URN)10.1007/s10439-018-02153-5 (DOI)000456383600007 ()30362080 (PubMedID)2-s2.0-85055724908 (Scopus ID)
Funder
Knut and Alice Wallenberg Foundation
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2021-10-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1395-8296

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