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Proceedings Paper

Estimation of left ventricular blood flow parameters: clinical application of patient-specific CFD simulations from 4D echocardiography
Author(s): David Larsson; Jeannette H. Spühler; Elif Günyeli; Tino Weinkauf; Johan Hoffman; Massimiliano Colarieti-Tosti; Reidar Winter; Matilda Larsson
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Paper Abstract

Echocardiography is the most commonly used image modality in cardiology, assessing several aspects of cardiac viability. The importance of cardiac hemodynamics and 4D blood flow motion has recently been highlighted, however such assessment is still difficult using routine echo-imaging. Instead, combining imaging with computational fluid dynamics (CFD)-simulations has proven valuable, but only a few models have been applied clinically. In the following, patient-specific CFD-simulations from transthoracic dobutamin stress echocardiography have been used to analyze the left ventricular 4D blood flow in three subjects: two with normal and one with reduced left ventricular function. At each stress level, 4D-images were acquired using a GE Vivid E9 (4VD, 1.7MHz/3.3MHz) and velocity fields simulated using a presented pathway involving endocardial segmentation, valve position identification, and solution of the incompressible Navier-Stokes equation. Flow components defined as direct flow, delayed ejection flow, retained inflow, and residual volume were calculated by particle tracing using 4th-order Runge-Kutta integration. Additionally, systolic and diastolic average velocity fields were generated. Results indicated no major changes in average velocity fields for any of the subjects. For the two subjects with normal left ventricular function, increased direct flow, decreased delayed ejection flow, constant retained inflow, and a considerable drop in residual volume was seen at increasing stress. Contrary, for the subject with reduced left ventricular function, the delayed ejection flow increased whilst the retained inflow decreased at increasing stress levels. This feasibility study represents one of the first clinical applications of an echo-based patient-specific CFD-model at elevated stress levels, and highlights the potential of using echo-based models to capture highly transient flow events, as well as the ability of using simulation tools to study clinically complex phenomena. With larger patient studies planned for the future, and with the possibility of adding more anatomical features into the model framework, the current work demonstrates the potential of patient-specific CFD-models as a tool for quantifying 4D blood flow in the heart.

Paper Details

Date Published: 13 March 2017
PDF: 11 pages
Proc. SPIE 10139, Medical Imaging 2017: Ultrasonic Imaging and Tomography, 101390L (13 March 2017); doi: 10.1117/12.2249608
Show Author Affiliations
David Larsson, KTH Royal Institute of Technology (Sweden)
Karolinska Institutet (Sweden)
Jeannette H. Spühler, KTH Royal Institute of Technology (Sweden)
Elif Günyeli, Karolinska Institutet (Sweden)
Tino Weinkauf, KTH Royal Institute of Technology (Sweden)
Johan Hoffman, KTH Royal Institute of Technology (Sweden)
Massimiliano Colarieti-Tosti, KTH Royal Institute of Technology (Sweden)
Karolinska Institutet (Sweden)
Reidar Winter, Karolinska Institutet (Sweden)
Matilda Larsson, KTH Royal Institute of Technology (Sweden)
Karolinska Institutet (Sweden)

Published in SPIE Proceedings Vol. 10139:
Medical Imaging 2017: Ultrasonic Imaging and Tomography
Neb Duric; Brecht Heyde, Editor(s)

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