Patient-Specific Computational Analysis of Hemodynamics and Wall Mechanics and Their Interactions in Pulmonary Arterial Hypertension

Figures

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  Figure 1. Comparison of (A) end-diastolic diameter and (B) RAC between control and PAH groups. The PAH group has significant larger diameter (median: 32 mm, IQR: 5.25 mm vs. median: 25 mm, IQR: 2 mm; P = 0.015) and lower RAC (median: 0.22, IQR: 0.10 vs. median: 0.42, IQR: 0.04; P = 0.004) compared to the control group.

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  Figure 2. Comparison of the estimated linearized stiffness E between PAH and control groups (median: 297 kPa, IQR: 202 kPa vs. median: 75 kPa, IQR: 5 kPa; P = 0.007). The PAH group's E is approximately four times higher than the control group.

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  Figure 3. Spatial distribution of the maximum surface displacement in all PAH and control patients organized from the case with the lowest (left) to the highest (right) elastic modulus.

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  Figure 4. Volumetric flow waveform of control subject CTL-2 as an example of the characteristic wavefrom in controls (left) and measured waveforms for each PAH patient arranged with increasing linearized stiffness E. Blue shaded region denotes total regurgitant flow in the proximal PA. The color countour, which is used in Figure 3. represents the maximun surface displacement.

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  Figure 5. Volume of the total regurgitant flow over a cardiac cycle vs. linearized stiffness E for all PAH patients showing a linear correlation (r = 0.84, P = 0.018).

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  Figure 6. Comparison of (A) the total distal resistance (control: median: 3.99 mmHg × min/l, IQR: 1.15 mmHg × min/l vs. PAH: median: 6.89 mmHg × min/l, IQR: 2.16 mmHg × min/l; P = 0.002) and (B) total distal compliance (control: median: 0.85 ml/mmHg, IQR: 0.51 ml/mmHg vs. PAH: median: 0.13 ml/mmHg, IQR: 0.15 ml/mmHg; P = 0.041) between the control and PAH groups.

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  Figure 7. (A) Color-coded spatial distribution of TAWSS for all subjects (control and PAH) arranged with increasing linearized stiffness E. (B) Averaged TAWSS (over the entire model) as a function of E showing a weaker correlation (r = −0.646; P = 0.032) and a stronger correlation (r = −0.746; R = 0.088) in all and only PAH subjects, respectively. Control (white) and PAH (gray). (C) Comparison of TAWSS averaged over the MPA (control: median: 1.56 Pa, IQR: 0.89 Pa vs. PAH: median: 0.81 Pa, IQR: 0.47 Pa) and over the entire model (median: 1.32 Pa, IQR: 0.69 Pa vs. median: 2.12 Pa, IQR: 1.66 P; P = 0.062) between PAH and control groups.