Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling.
Bram RuijsinkKonrad ZugajJames WongKuberan PushparajahTarique HussainPhilippe MoireauReza RazaviDominique ChapelleRadomir ChabiniokPublished in: PloS one (2020)
Understanding (patho)physiological phenomena and mechanisms of failure in patients with Fontan circulation-a surgically established circulation for patients born with a functionally single ventricle-remains challenging due to the complex hemodynamics and high inter-patient variations in anatomy and function. In this work, we present a biomechanical model of the heart and circulation to augment the diagnostic evaluation of Fontan patients with early-stage heart failure. The proposed framework employs a reduced-order model of heart coupled with a simplified circulation including venous return, creating a closed-loop system. We deploy this framework to augment the information from data obtained during combined cardiac catheterization and magnetic resonance exams (XMR), performed at rest and during dobutamine stress in 9 children with Fontan circulation and 2 biventricular controls. We demonstrate that our modeling framework enables patient-specific investigation of myocardial stiffness, contractility at rest, contractile reserve during stress and changes in vascular resistance. Hereby, the model allows to identify key factors underlying the pathophysiological response to stress in these patients. In addition, the rapid personalization of the model to patient data and fast simulation of cardiac cycles make our framework directly applicable in a clinical workflow. We conclude that the proposed modeling framework is a valuable addition to the current clinical diagnostic XMR exam that helps to explain patient-specific stress hemodynamics and can identify potential mechanisms of failure in patients with Fontan circulation.
Keyphrases
- heart failure
- end stage renal disease
- magnetic resonance
- early stage
- left ventricular
- ejection fraction
- chronic kidney disease
- newly diagnosed
- electronic health record
- peritoneal dialysis
- stress induced
- case report
- prognostic factors
- squamous cell carcinoma
- young adults
- low birth weight
- computed tomography
- pulmonary hypertension
- pulmonary artery
- radiation therapy
- risk assessment
- pulmonary arterial hypertension
- smooth muscle
- health information
- human health
- coronary artery
- sentinel lymph node