Bart Bijnens

Xabier Morales, Ayah Elsayed, Debbie Zhao et al.

The left atrium (LA) plays a pivotal role in modulating left ventricular filling, but our comprehension of its hemodynamics is significantly limited by the constraints of conventional ultrasound analysis. 4D flow magnetic resonance imaging (4D Flow MRI) holds promise for enhancing our understanding of atrial hemodynamics. However, the low velocities within the LA and the limited spatial resolution of 4D Flow MRI make analyzing this chamber challenging. Furthermore, the absence of dedicated computational frameworks, combined with diverse acquisition protocols and vendors, complicates gathering large cohorts for studying the prognostic value of hemodynamic parameters provided by 4D Flow MRI. In this study, we introduce the first open-source computational framework tailored for the analysis of 4D Flow MRI in the LA, enabling comprehensive qualitative and quantitative analysis of advanced hemodynamic parameters. Our framework proves robust to data from different centers of varying quality, producing high-accuracy automated segmentations (Dice $>$ 0.9 and Hausdorff 95 $<$ 3 mm), even with limited training data. Additionally, we conducted the first comprehensive assessment of energy, vorticity, and pressure parameters in the LA across a spectrum of disorders to investigate their potential as prognostic biomarkers.

Gabriel Bernardino, Oualid Benkarim, María Sanz-de la Garza et al.

Statistical shape analysis is a powerful tool to assess organ morphologies and find shape changes associated to a particular disease. However, imbalance in confounding factors, such as demographics might invalidate the analysis if not taken into consideration. Despite the methodological advances in the field, providing new methods that are able to capture complex and regional shape differences, the relationship between non-imaging information and shape variability has been overlooked. We present a linear statistical shape analysis framework that finds shape differences unassociated to a controlled set of confounding variables. It includes two confounding correction methods: confounding deflation and adjustment. We applied our framework to a cardiac magnetic resonance imaging dataset, consisting of the cardiac ventricles of 89 triathletes and 77 controls, to identify cardiac remodelling due to the practice of endurance exercise. To test robustness to confounders, subsets of this dataset were generated by randomly removing controls with low body mass index, thus introducing imbalance. The analysis of the whole dataset indicates an increase of ventricular volumes and myocardial mass in athletes, which is consistent with the clinical literature. However, when confounders are not taken into consideration no increase of myocardial mass is found. Using the downsampled datasets, we find that confounder adjustment methods are needed to find the real remodelling patterns in imbalanced datasets.

Gabriel Bernardino, Amir Hodzic, Helene Langet et al.

3D echocardiography is an increasingly popular tool for assessing cardiac remodelling in the right ventricle (RV). It allows quantification of the cardiac chambers without any geometric assumptions, which is the main weakness of 2D echocardiography. However, regional quantification of geometry and function is limited by the lower spatial and temporal resolution and the scarcity of identifiable anatomical landmarks. We developed a technique for regionally assessing the 3 relevant RV regions: apical, inlet and outflow. The method's inputs are end-diastolic (ED) and end-systolic (ES) segmented 3D surface models. The method first defines a partition of the ED endocardium using the geodesic distances from each surface point to apex, tricuspid valve and pulmonary valve: the landmarks that define the 3 regions. The ED surface mesh is then tetrahedralised, and the endocardial-defined partition is interpolated in the blood cavity via the Laplace equation. For obtaining an ES partition, the endocardial partition is transported from ED to ES using a commercial image-based tracking, and then interpolated towards the endocardium, similarly to ED, for computing volumes and ejection fraction (EF). We present a full assessment of the method's validity and reproducibility. First, we assess reproducibility under segmentation variability, obtaining intra- and inter- observer errors (4-10% and 10-23% resp.). Finally, we use a synthetic remodelling dataset to identify the situations in which our method is able to correctly determine the region that has remodelled. This dataset is generated by a novel mesh reconstruction method that deforms a reference mesh, locally imposing a given strain, expressed in anatomical coordinates. We show that the parcellation method is adequate for capturing local circumferential and global circumferential and longitudinal RV remodelling.