A biomechanical modeling framework successfully augmented diagnostic XMR exams, enabling patient-specific quantification of myocardial contractility, which increased 2- to 2.5-fold during dobutamine stress in Fontan patients.
Observational (n=11)
No
Can a biomechanical modeling framework applied to XMR data during dobutamine stress identify patient-specific mechanisms of failure in children with Fontan circulation?
A novel biomechanical modeling framework applied to XMR data during dobutamine stress can help identify patient-specific pathophysiological mechanisms in children with Fontan circulation.
Understanding (patho)physiological phenomena and mechanisms of failure in patients with Fontan circulation-a surgically established circulation for patients born with a functionally single ventricle-remains challenging due to the complex hemodynamics and high inter-patient variations in anatomy and function. In this work, we present a biomechanical model of the heart and circulation to augment the diagnostic evaluation of Fontan patients with early-stage heart failure. The proposed framework employs a reduced-order model of heart coupled with a simplified circulation including venous return, creating a closed-loop system. We deploy this framework to augment the information from data obtained during combined cardiac catheterization and magnetic resonance exams (XMR), performed at rest and during dobutamine stress in 9 children with Fontan circulation and 2 biventricular controls. We demonstrate that our modeling framework enables patient-specific investigation of myocardial stiffness, contractility at rest, contractile reserve during stress and changes in vascular resistance. Hereby, the model allows to identify key factors underlying the pathophysiological response to stress in these patients. In addition, the rapid personalization of the model to patient data and fast simulation of cardiac cycles make our framework directly applicable in a clinical workflow. We conclude that the proposed modeling framework is a valuable addition to the current clinical diagnostic XMR exam that helps to explain patient-specific stress hemodynamics and can identify potential mechanisms of failure in patients with Fontan circulation.
Ruijsink et al. (Fri,) conducted a observational in Fontan circulation with early-stage heart failure (n=11). Dobutamine stress testing augmented by biomechanical modeling vs. Resting state was evaluated on Patient-specific estimation of myocardial contractility, stiffness, and vascular resistance. A biomechanical modeling framework successfully augmented diagnostic XMR exams, enabling patient-specific quantification of myocardial contractility, which increased 2- to 2.5-fold during dobutamine stress in Fontan patients.