肺高血圧症における血管特異的リモデリングの定量化および右室機能予測のための患者固有の集中定数モデル

Pulmonary hypertension (PH) is a heterogeneous disease with patient-specific variability and vessel-specific remodeling, which eventually lead to right ventricular (RV) failure. The gold standard for RV assessment-pressure-volume (PV) loop acquisition-is invasive and limited to specialized settings. This study aims to develop a patient-specific lumped-parameter model that quantifies vessel-specific remodeling and simulates RV PV loops across PH phenotypes using routine clinical data.

A lumped-parameter model was calibrated using right heart catheterization and echocardiography data. Model agreement was assessed by R² values for pressure and flow goodness-of-fit, and model-derived hemodynamic metrics were compared with clinical values. A dimensionality reduction approach was applied to investigate how well different PH phenotypes could be separated.

Across the cohort, the lumped-parameter model showed good agreement with clinical data. Model-derived vessel-specific (pulmonary arterial, capillary, venular) parameters highlighted physiological distinctions among phenotypes. Predicted RV PV loops revealed phenotype-specific differences in right ventricular volumes, pressures, and stroke work. The linear discriminant analysis (LDA) demonstrated qualitative separability, indicating that model-derived, nonmeasurable features offer additional discriminatory information.

Our results demonstrate that lumped-parameter models can be calibrated to clinical data to quantify vessel-specific remodeling and simulate RV pressure-volume dynamics to provide useful information for distinguishing among different PH phenotypes. This underscores the potential of computational models as noninvasive, clinically feasible tools for assessing in-depth pulmonary vascular and RV function in PH.