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Minderhoud SCS, Hirsch A, Marin F, Kardys I, Rodríguez-Matas JF, Chiastra C, Roos-Hesselink JW, Wentzel JJ, Helbing WA, Akyildiz AC. Serial RV wall stress measurements: association with right ventricular function in repaired Tetralogy of Fallot patients. Front Cardiovasc Med 2023; 10:1256792. [PMID: 37928767 PMCID: PMC10621746 DOI: 10.3389/fcvm.2023.1256792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Background Optimal timing of pulmonary valve replacement (PVR) in Tetralogy of Fallot (TOF) patients remains challenging. Ventricular wall stress is considered to be an early marker of right ventricular (RV) dysfunction. Objectives To investigate the association of RV wall stresses and their change over time with functional parameters in TOF patients. Methods Ten TOF patients after surgical repair with moderate/severe pulmonary regurgitation were included. At two timepoints (median follow-up time 7.2 years), patient-specific computational biventricular models for wall stress assessment were created using CMR short-axis cine images and echocardiography-based RV pressures. RV ejection fraction (RVEF), NT-proBNP and cardiopulmonary exercise tests were used as outcome measures reflecting RV function. Associations between regional RV diastolic wall stress and RV function were investigated using linear mixed models. Results Increased wall stress correlated with lower RV mass (rrm = -0.70, p = 0.017) and lower RV mass-to-volume (rrm = -0.80, p = 0.003) using repeated measures. Wall stress decreased significantly over time, especially in patients with a stable RVEF (p < 0.001). Higher wall stress was independently associated with lower RVEF, adjusted for left ventricular ejection fraction, RV end-diastolic volume and time since initial surgery (decrease of 1.27% RVEF per kPa increase in wall stress, p = 0.029) using repeated measurements. No association was found between wall stress, NT-proBNP, and exercise capacity. Conclusions Using a computational method to calculate wall stress locally in geometrically complex ventricles, we demonstrated that lower wall stress might be important to maintain ventricular function. RV wall stress assessment can be used in serial follow-up, and is potentially an early marker of impending RV dysfunction.
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Affiliation(s)
- Savine C. S. Minderhoud
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Francesca Marin
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - José F. Rodríguez-Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jolanda J. Wentzel
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Willem A. Helbing
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Paediatric Cardiology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ali C. Akyildiz
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
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Carro J, Rodríguez-Matas JF, Monasterio V, Pueyo E. Corrigendum to "Limitations in electrophysiological model development and validation caused by differences between simulations and experimental protocols" [Prog. Biophys. Mol. Biol. 129 (2017) 53-64]. Prog Biophys Mol Biol 2018; 140:175. [PMID: 30448076 DOI: 10.1016/j.pbiomolbio.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jesús Carro
- Universidad San Jorge, Campus Universitario, Autov A23 Km 299, 50830, Villanueva de Gállego, Zaragoza, Spain; Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Spain.
| | - José F Rodríguez-Matas
- Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; LaBS, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Italy
| | - Violeta Monasterio
- Universidad San Jorge, Campus Universitario, Autov A23 Km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Esther Pueyo
- Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Spain
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Ortillés Á, Rodríguez-Matas JF, Ariza-Gracia MÁ, Pascual G, Calvo B. Why Non-contact Tonometry Tests Cannot Evaluate the Effects of Corneal Collagen Cross-linking. J Refract Surg 2017; 33:184-192. [PMID: 28264133 DOI: 10.3928/1081597x-20161206-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 10/31/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the feasibility of characterizing and following up the mechanical behavior of the corneal tissue after corneal cross-linking (CXL) by using a combined mechanical (in vivo indentation and in vitro uniaxial tensile tests) and morphological (immunohisto-chemistry) experimental protocol. METHODS CXL (3 mW/cm2; 370 nm) for 20 minutes (total dose 3.6 J/cm2) was performed on 12 New Zealand rabbits. The mechanical behavior of the cornea was characterized in small and large strain regimens using an in vivo indentation test with a laboratory device and an in vitro uniaxial tensile test, respectively. These tests and corneal immunohistochemistry were performed before (PreCXL) and on the 7th (PostCXL-7d) and 56th days (PostCXL-56d) after CXL. The intraocular pressure and corneal thickness were measured before each test. RESULTS For the indentation tests, significant differences were found between PreCXL and PostCXL-7d and between PostCXL-7d and PostCXL-56d, but not between PreCXL and PostCXL-56d. On average, for the small strain regimen, PostCXL-7d corneas showed the most compliant behavior, with progressive recovery of the corneal stiffness over time. For the large strain regimen, significant differences in the maximum tangent modulus between PreCXL and PostCXL-7d and between PreCXL and PostCXL-56d were observed for the uniaxial tensile tests, with no significant differences between PostCXL-7d and PostCXL-56d. Immunohistochemistry showed a lack of cells in the anterior stroma at PostCXL-7d, but at PostCXL-56d the cell density and morphology were comparable to PreCXL. CONCLUSIONS Indentation tests cannot characterize the changes in the corneal collagen scaffold caused by the CXL, but the uniaxial test can. However, indentation tests can assess the recovery of keratocyte density after CXL. [J Refract Surg. 2017;33(3):184-192.].
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Carro J, Rodríguez-Matas JF, Monasterio V, Pueyo E. Limitations in electrophysiological model development and validation caused by differences between simulations and experimental protocols. Prog Biophys Mol Biol 2016; 129:53-64. [PMID: 27899270 DOI: 10.1016/j.pbiomolbio.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/20/2016] [Indexed: 10/20/2022]
Abstract
Models of ion channel dynamics are usually built by fitting isolated cell experimental values of individual parameters while neglecting the interaction between them. Another shortcoming regards the estimation of ionic current conductances, which is often based on quantification of Action Potential (AP)-derived markers. Although this procedure reduces the uncertainty in the calculation of conductances, many studies evaluate electrophysiological AP-derived markers from single cell simulations, whereas experimental measurements are obtained from tissue preparations. In this work, we explore the limitations of these approaches to estimate ion channel dynamics and maximum current conductances and how they could be overcome by using multiscale simulations of experimental protocols. Four human ventricular cell models, namely ten Tusscher and Panfilov (2006), Grandi et al. (2010), O'Hara et al. (2011), and Carro et al. (2011), were used. Two problems involving scales from ion channels to tissue were investigated: 1) characterization of L-type calcium voltage-dependent inactivation ICa,L; 2) identification of major ionic conductance contributors to steady-state AP markers, including APD90, APD75, APD50, APD25, Triangulation and maximal and minimal values of V and dV/dt during the AP (Vmax, Vmin, dV/dtmax, dV/dtmin). Our results show that: 1) ICa,L inactivation characteristics differed significantly when calculated from model equations and from simulations reproducing the experimental protocols. 2) Large differences were found in the ionic currents contributors to APD25, Triangulation, Vmax, dV/dtmax and dV/dtmin between single cells and 1D-tissue. When proposing any new model formulation, or evaluating an existing model, consistency between simulated and experimental data should be verified considering all involved effects and scales.
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Affiliation(s)
- Jesús Carro
- Universidad San Jorge, Campus Universitario, Autov A23 Km 299, 50830, Villanueva de Gállego, Zaragoza, Spain; Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Spain.
| | - José F Rodríguez-Matas
- Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; LaBS, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Italy.
| | - Violeta Monasterio
- Universidad San Jorge, Campus Universitario, Autov A23 Km 299, 50830, Villanueva de Gállego, Zaragoza, Spain.
| | - Esther Pueyo
- Aragon Institute for Engineering Research, Universidad de Zaragoza, Spain; CIBER in Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Spain.
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Ariza-Gracia MÁ, Zurita J, Piñero DP, Calvo B, Rodríguez-Matas JF. Automatized Patient-Specific Methodology for Numerical Determination of Biomechanical Corneal Response. Ann Biomed Eng 2015; 44:1753-72. [PMID: 26307330 DOI: 10.1007/s10439-015-1426-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/10/2015] [Indexed: 11/24/2022]
Abstract
This work presents a novel methodology for building a three-dimensional patient-specific eyeball model suitable for performing a fully automatic finite element (FE) analysis of the corneal biomechanics. The reconstruction algorithm fits and smooths the patient's corneal surfaces obtained in clinic with corneal topographers and creates an FE mesh for the simulation. The patient's corneal elevation and pachymetry data is kept where available, to account for all corneal geometric features (central corneal thickness-CCT and curvature). Subsequently, an iterative free-stress algorithm including a fiber's pull-back is applied to incorporate the pre-stress field to the model. A convergence analysis of the mesh and a sensitivity analysis of the parameters involved in the numerical response is also addressed to determine the most influential features of the FE model. As a final step, the methodology is applied on the simulation of a general non-commercial non-contact tonometry diagnostic test over a large set of 130 patients-53 healthy, 63 keratoconic (KTC) and 14 post-LASIK surgery eyes. Results show the influence of the CCT, intraocular pressure (IOP) and fibers (87%) on the numerical corneal displacement (U(Num)) the good agreement of the U(Num) with clinical results, and the importance of considering the corneal pre-stress in the FE analysis. The potential and flexibility of the methodology can help improve understanding of the eye biomechanics, to help to plan surgeries, or to interpret the results of new diagnosis tools (i.e., non-contact tonometers).
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Affiliation(s)
- M Á Ariza-Gracia
- Applied Mechanics and Bioengineering (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.
| | - J Zurita
- Department of Mechanical Engineering, Energetics and Materials, Public University of Navarra, Pamplona, Spain
| | - D P Piñero
- Ophthalmology Department (OFTALMAR), Medimar International Hospital, Alicante, Spain.,Optics, Pharmacologist and Anatomy Department, University of Alicante, Alicante, Spain
| | - B Calvo
- Applied Mechanics and Bioengineering (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.,Bioengineering, Biomaterials and Nanomedicine Online, Biomedical Research Center (CIBBER-BBN), Madrid, Spain
| | - J F Rodríguez-Matas
- Applied Mechanics and Bioengineering (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.,LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milano, Italy
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