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Image-Based Computational Model Predicts Dobutamine-Induced Hemodynamic Changes in Patients With Aortic Coarctation
Kilian Runte1,2, Kay Brosien1, Charlotte Schubert1,2
1Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).
Insights
A new reduced-order model accurately predicts dobutamine-induced pressure gradients in aortic coarctation patients. This tool offers a promising, non-invasive alternative to traditional heart catheterization for assessing hemodynamic changes during stress testing.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Computational Biology
Background:
- Pharmacological stress testing is crucial for evaluating patients with structural heart diseases like aortic coarctation.
- Assessing hemodynamic conditions, particularly pressure gradients across coarctation, is vital for treatment decisions.
- Current methods can be invasive, necessitating the development of alternative assessment tools.
Purpose of the Study:
- To develop and validate a reduced-order model for predicting dobutamine stress-induced pressure gradients in aortic coarctation.
- To compare the model's predictions with invasive measurements obtained during cardiac catheterization.
- To establish the model's accuracy and clinical utility as an alternative to conventional stress testing.
Main Methods:
- A reduced-order model was created using imaging data from 21 patients with aortic coarctation.
- The model was trained on data from a meta-analysis of dobutamine stress tests.
- Model predictions were validated against invasive measurements in an independent cohort of 21 patients.
Main Results:
- Dobutamine stress testing significantly increased pressure gradients across the coarctation in 19 patients (15.7±5.1 to 33.6±10.3 mm Hg).
- The model's predicted pressure gradients showed high agreement with catheter measurements (mean difference -2.2 mm Hg, limits of agreement ±11.16 mm Hg).
- Statistical equivalence was confirmed between catheter-measured and model-simulated stress pressure gradients (P=0.021).
Conclusions:
- The developed reduced-order model accurately predicts dobutamine-induced hemodynamic changes in aortic coarctation.
- The model provides an instant, web-based tool, serving as a viable alternative to invasive heart catheterization.
- This approach enhances clinical routine assessment for patients with aortic coarctation, improving diagnostic efficiency.
Background:
Pharmacological stress testing can help to uncover pathological hemodynamic conditions and is, therefore, used in the clinical routine to assess patients with structural heart diseases such as aortic coarctation with borderline indication for treatment. The aim of this study was to develop and test a reduced-order model predicting dobutamine stress induced pressure gradients across the coarctation.
Methods:
The reduced-order model was developed based on n=21 imaging data sets of patients with aortic coarctation and a meta-analysis of subjects undergoing dobutamine stress testing. Within an independent test cohort of n=21 patients with aortic coarctation, the results of the model were compared with dobutamine stress testing during catheterization.
Results:
In n=19 patients responding to dobutamine stress testing, pressure gradients across the coarctation during dobutamine stress increased from 15.7±5.1 to 33.6±10.3 mm Hg (paired t test, P<0.001). The model-predicted pressure gradients agreed with catheter measurements with a mean difference of -2.2 mm Hg and a limit of agreement of ±11.16 mm Hg according to Bland-Altman analysis. Significant equivalence between catheter-measured and simulated pressure gradients during stress was found within the study cohort (two 1-sided tests of equivalence with a noninferiority margin of 5.0 mm Hg, 33.6±10.33 versus 31.5±11.15 mm Hg, P=0.021).
Conclusions:
The developed reduced-order model can instantly predict dobutamine-induced hemodynamic changes with accuracy equivalent to heart catheterization in patients with aortic coarctation. The method is easy to use, available as a web-based calculator, and provides a promising alternative to conventional stress testing in the clinical routine. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02591940.
