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A Computational Framework for Personalized Blood Flow Analysis in the Human Left Atrium

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Abstract

Atrial fibrillation (AF), the most common human arrhythmia, is a marker of an increased risk of embolic stroke. However, recent studies suggest that AF may not be mechanistically responsible for the stroke events. An alternative explanation for the mechanism of intracardiac thrombosis and stroke in patients with AF is structural remodeling of the left atrium (LA). Nevertheless, a mechanistic link between LA structural remodeling and intracardiac thrombosis is unclear, because there is no clinically feasible methodology to evaluate the complex relationship between these two phenomena in individual patients. Computational fluid dynamics (CFD) is a powerful tool that could potentially link LA structural remodeling and intracardiac thrombosis in individual patients by evaluating the patient-specific LA blood flow characteristics. However, the lack of knowledge of the material and mechanical properties of the heart wall in specific patients makes it challenging to solve the complexity of fluid–structure interaction. In this study, our aim was to develop a clinically feasible methodology to perform personalized blood flow analysis within the heart. We propose an alternative computational approach to perform personalized blood flow analysis by providing the three-dimensional LA endocardial surface motion estimated from patient-specific cardiac CT images. In two patients (case 1 and 2), a four-dimensional displacement vector field was estimated using nonrigid registration. The LA blood outflow across the mitral valve (MV) was calculated from the LV volume, and the flow field within the LA was derived from the incompressible Navier–Stokes equation. The CFD results successfully captured characteristic features of LA blood flow observed clinically by transesophageal echocardiogram. The LA global flow characteristics and vortex structures also agreed well with previous reports. The time course of LAA emptying was similar in both cases, despite the substantial difference in the LA structure and function. We conclude that our CT-based, personalized LA blood flow analysis is a clinically feasible methodology that can be used to improve our understanding of the mechanism of intracardiac thrombosis and stroke in individual patients with LA structural remodeling.

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Abbreviations

AF:

Atrial fibrillation

CFD:

Computational fluid dynamics

CT:

Computed tomography

LA:

Left atrium

LAA:

Left atrial appendage

LV:

Left ventricle

MV:

Mitral valve

PV:

Pulmonary vein

TEE:

Transesophageal echocardiogram

3D:

Three-dimensional

4D:

Four-dimensional

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Acknowledgments

The authors thank Satoshi Ii for valuable input as to the CFD methodology. The authors also thank Yuko Inoue and Susumu Tao for clinical input. This work was supported by research grants from the Japan Society for the Promotion of Science (JSPS) (Research Fellowship for Young Scientist A2616220, to Otani), Magic That Matters Fund for Cardiovascular Research (to Ashikaga) and Zegar Family Foundation (to Ashikaga).

Conflict of interest

None.

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Authors and Affiliations

  1. Cardiac Arrhythmia Service, Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA

    Tomohiro Otani, Abdullah Al-Issa & Hiroshi Ashikaga

  2. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Amir Pourmorteza, Elliot R. McVeigh & Hiroshi Ashikaga

  3. Department of Mechanical Science and Bioengineering, Osaka University Graduate School of Engineering Science, Osaka, Japan

    Tomohiro Otani & Shigeo Wada

  4. Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20814, USA

    Amir Pourmorteza

  5. Departments of Bioengineering, Medicine, Radiology, University of California, San Diego, La Jolla, CA, USA

    Elliot R. McVeigh

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  1. Tomohiro Otani
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  2. Abdullah Al-Issa
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  3. Amir Pourmorteza
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  6. Hiroshi Ashikaga
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Correspondence to Hiroshi Ashikaga.

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Associate Editor Peter E. McHugh oversaw the review of this article.

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Otani, T., Al-Issa, A., Pourmorteza, A. et al. A Computational Framework for Personalized Blood Flow Analysis in the Human Left Atrium. Ann Biomed Eng 44, 3284–3294 (2016). https://doi.org/10.1007/s10439-016-1590-x

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