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Patient-specific computational fluid dynamics for hypertrophic obstructive cardiomyopathy
Quanfei Hou1, Wenqian Wu1, Lingyun Fang1
1Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.
Insights
Computational fluid dynamics (CFD) with cardiac computed tomography angiography (CCTA) accurately assesses hypertrophic obstructive cardiomyopathy (HOCM) hemodynamics. This patient-specific CFD approach, combined with virtual myectomy, aids in optimizing septal myectomy planning for HOCM patients.
Area of Science:
- Cardiovascular Imaging
- Medical Simulation
- Computational Fluid Dynamics
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) exhibits heterogeneous morphology and function, challenging traditional imaging assessments.
- Multimodality imaging is crucial but can yield uncertain results in HOCM evaluation.
- Existing imaging modalities struggle to fully capture the complex hemodynamics in HOCM.
Purpose of the Study:
- To develop and validate a patient-specific hemodynamic assessment using cardiac computed tomography angiography (CCTA) and computational fluid dynamics (CFD) for HOCM patients.
- To demonstrate the usability of CCTA-based CFD in a cohort of HOCM patients.
- To explore the potential of virtual myectomy guided by CFD for surgical planning.
Main Methods:
- Retrospective analysis of eight HOCM patients undergoing septal myectomy with pre- and post-operative CCTA and transthoracic echocardiography (TTE).
- Three-dimensional model reconstruction from CCTA data for patient-specific CFD simulations.
- Estimation of blood velocity, pressure gradient, and wall shear stress using CFD, with comparison to TTE findings.
- Performance of virtual myectomy based on CFD simulations to predict optimal resection volumes.
Main Results:
- Successful 3D reconstruction of complex HOCM anatomy in all patients.
- CFD simulations accurately assessed pressure gradients and flow velocities, showing good correlation with TTE (peak pressure gradient r=0.87/0.84, flow velocity r=0.87/0.90 pre/post-op).
- CFD-predicted minimal resection volumes for virtual myectomy aligned with actual surgical resection volumes.
Conclusions:
- CCTA-based CFD offers a unique approach for assessing patient-specific morphology and hemodynamics in HOCM.
- Integrating CFD with virtual myectomy can optimize therapeutic planning for septal myectomy.
- This technology shows promise as a complement to existing imaging strategies for HOCM management.
Background:
The heterogeneous morphologic and functional expression of hypertrophic obstructive cardiomyopathy (HOCM) is evidenced by established imaging, multimodality imaging is essential for a comprehensive assessment but may remain uncertain. This study aimed to develop a patient-specific hemodynamics assessment with cardiac computed tomography angiography (CCTA) based computational fluid dynamics (CFD) and prove its usability in cohorts of HOCM patients.
Methods:
A retrospective study was performed on eight HOCM patients with septal myectomy who had both preoperative and postoperative CCTA as well as transthoracic echocardiography (TTE). The three-dimensional models were reconstructed from CCTA data, following which patient-specific CFD simulations were performed to estimate the blood velocity, pressure gradient, and wall shear stress. The simulation output was compared with TTE. Based on CFD simulations, retrospective and blinded virtual myectomy was also performed, to predict the minimum resected volume for improving obstruction in patients.
Result:
The complex HOCM anatomy was successfully reconstructed for all 8 patients. The CFD simulation accurately assessed the pressure gradient, flow velocity. There was a good correlation between the peak pressure gradient measured by CFD and TTE in the pre- and post-operative assessments (r = 0.87 and 0.84, respectively), and the flow velocity (r = 0.87 and 0.90, respectively). The volumes of minimal resection myocardium predicted by CFD and virtual myectomy were consistent with the actual resection volumes.
Conclusion:
CCTA-based CFD for HOCM patients may play a unique role in the assessment of patient-specific morphology and hemodynamics. Combination with virtual myectomy might allow for optimizing therapy planning in septal myectomy.
Clinical Perspective:
CFD based CCTA may emerge as a complement to established imaging strategies, with accurate three-dimensional reconstruction and hemodynamic simulation of the left ventricle in this retrospective study. Combined with virtual myectomy, CFD simulation might allow for predicting the volume of resected myocardium for septal myectomy. Moving forward, this technology may be used by clinicians to better assess the conditions of HOCM patients, and guide the extent and depth of resection during septal myectomy. Therefore, further prospective clinical evaluation is clearly warranted.
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