Key result
LAA epicardial geometry shows consistent hemodynamics with endocardial models after excluding the extreme 5%.
Why the study?
Thrombi blur the LAA intima outline on clinical imaging, making epicardial geometry modeling a last resort for hemodynamic analysis, but differences between inner and outer membrane contours are unclear.
Does using epicardial geometry instead of endocardial geometry for LAA modeling significantly alter hemodynamic parameters used to predict thrombosis?
Does using epicardial geometry instead of endocardial geometry for LAA modeling significantly alter hemodynamic parameters used to predict thrombosis?
Epicardial geometry can serve as a reliable alternative to endocardial geometry for LAA hemodynamic analysis in predicting thrombosis risk, provided extreme values at the LAA tip are excluded.
May support epicardial LAA geometry for animal hemodynamic analysis; leaves open translation to human thrombosis prediction.
Comparing the hemodynamic parameters of thrombus-positive and thrombus-negative patients in the early stages of the disease (before thrombus formation occurs) can help predict atrial fibrillation-related thrombosis. However, most clinical images of thrombus-positive are of existing thrombus, and the presence of thrombi blurs the outline of the atrial appendage intima. Therefore, using the left atrial appendage (LAA) epicardial geometry for hemodynamic analysis has become a last resort. This study compares hemodynamic differences using the modeling contour of the inner and outer membranes of the LAA. The research results show the velocity and shear strain rate of the endocardial and epicardial geometries exhibit relative consistency. As for the parameters related to wall shear stress, the difference in time-averaged wall shear stress mainly occurs at the LAA entrance and does not affect the determination of thrombosis risk factors. The difference in the oscillatory shear index mainly occurs at the tip of LAA and the parts with larger curvature, which are seriously affected by geometry. The differences between endothelial cell activation potential (ECAP) and relative residence time (RRT) are concentrated at the tip of the LAA, but the maximum and minimum values are significantly different. After we exclude the top and bottom 5% of values, we believe that ECAP and RRT are reliable parameters. This investigation conducted both qualitative and quantitative assessments of the hemodynamic disparities between the endocardial and epicardial geometries. The findings offer valuable data reference for related research.
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Chen et al. (2023) studied Atrial fibrillation-related thrombosis. Endocardial geometry modeling contour vs. Epicardial geometry modeling contour was evaluated on Hemodynamic differences (velocity, shear strain rate, wall shear stress, oscillatory shear index, ECAP, RRT). Hemodynamic analysis using LAA epicardial geometry showed relative consistency with endocardial geometry for velocity and shear strain rate; ECAP and RRT were reliable after excluding extreme 5%.
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