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research article

A comprehensive stroke risk assessment by combining atrial computational fluid dynamics simulations and functional patient data

Zingaro, Alberto
•
Ahmad, Zan
•
Kholmovski, Eugene
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April 25, 2024
Scientific Reports

Stroke, a major global health concern often rooted in cardiac dynamics, demands precise risk evaluation for targeted intervention. Current risk models, like the CHA 2 DS 2 -VASc \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\text {CHA}_2\text {DS}_2\text {-VASc}$$\end{document} score, often lack the granularity required for personalized predictions. In this study, we present a nuanced and thorough stroke risk assessment by integrating functional insights from cardiac magnetic resonance (CMR) with patient-specific computational fluid dynamics (CFD) simulations. Our cohort, evenly split between control and stroke groups, comprises eight patients. Utilizing CINE CMR, we compute kinematic features, revealing smaller left atrial volumes for stroke patients. The incorporation of patient-specific atrial displacement into our hemodynamic simulations unveils the influence of atrial compliance on the flow fields, emphasizing the importance of LA motion in CFD simulations and challenging the conventional rigid wall assumption in hemodynamics models. Standardizing hemodynamic features with functional metrics enhances the differentiation between stroke and control cases. While standalone assessments provide limited clarity, the synergistic fusion of CMR-derived functional data and patient-informed CFD simulations offers a personalized and mechanistic understanding, distinctly segregating stroke from control cases. Specifically, our investigation reveals a crucial clinical insight: normalizing hemodynamic features based on ejection fraction fails to differentiate between stroke and control patients. Differently, when normalized with stroke volume, a clear and clinically significant distinction emerges and this holds true for both the left atrium and its appendage, providing valuable implications for precise stroke risk assessment in clinical settings. This work introduces a novel framework for seamlessly integrating hemodynamic and functional metrics, laying the groundwork for improved predictive models, and highlighting the significance of motion-informed, personalized risk assessments.

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Type
research article
DOI
10.1038/s41598-024-59997-2
Web of Science ID

WOS:001211032500026

Author(s)
Zingaro, Alberto
Ahmad, Zan
Kholmovski, Eugene
Sakata, Kensuke
Dede, Luca
Morris, Alan K.
Quarteroni, Alfio  
Trayanova, Natalia A.
Date Issued

2024-04-25

Publisher

Nature Portfolio

Published in
Scientific Reports
Volume

14

Issue

1

Article Number

9515

Subjects

Flow

•

Fibrillation

•

Framework

•

Appendage

•

Velocity

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Impact

•

Score

•

Size

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
CIB  
FunderGrant Number

Ministero dell'Istruzione, dell'Universit e della Ricerca (Ministry of Education, University and Research)

2017AXL54F

Italian Ministry of University and Research (MIUR) within the PRIN (Research projects of relevant national interest)

T32 GM119998

National Heart, Lung, and Blood Institute, National Institutes of Health (NIH)

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Available on Infoscience
July 3, 2024
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/208978
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