Sensitivity analysis of in silico fluid simulations to predict thrombus formation after left atrial appendage occlusion
Mill, J. (Universitat Pompeu Fabra)
Agudelo, V. (Institut d'Investigació Biomèdica Sant Pau)
Olivares, A. L. (Universitat Pompeu Fabra)
Pons, M.I. (Universitat Pompeu Fabra)
Silva, E. (Hospital Universitario Puerta del Mar (Cadis, Andalusia))
Nuñez-Garcia, M. (LIRYC Institute. Centre Hospitalier Universitaire de Bordeaux. Université de Bordeaux)
Morales, X. (Universitat Pompeu Fabra)
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
Freixa, X. (Hospital Clínic i Provincial de Barcelona)
Noailly, J. (Universitat Pompeu Fabra)
Camara, Oscar (Universitat Pompeu Fabra)

Fecha:	2021
Resumen:	Atrial fibrillation (AF) is nowadays the most common human arrhythmia and it is consid-ered a marker of an increased risk of embolic stroke. It is known that 99% of AF-related thrombi are generated in the left atrial appendage (LAA), an anatomical structure located within the left atrium (LA). Left atrial appendage occlusion (LAAO) has become a good alternative for nonvalvular AF patients with contraindications to anticoagulants. However, there is a non-negligible number of device-related thrombus (DRT) events, created next to the device surface. In silico fluid simulations can be a powerful tool to better understand the relation between LA anatomy, haemodynamics, and the process of thrombus formation. Despite the increasing literature in LA fluid modelling, a consensus has not been reached yet in the community on the optimal modelling choices and boundary conditions for generating realistic simulations. In this line, we have performed a sensitivity analysis of several boundary conditions scenarios, varying inlet/outlet and LA wall movement configurations, using patient-specific imaging data of six LAAO patients (three of them with DRT at follow-up). Mesh and cardiac cycle convergence were also analysed. The boundary conditions scenario that better predicted DRT cases had echocardiography-based velocities at the mitral valve outlet, a generic pressure wave from an AF patient at the pulmonary vein inlets, and a dynamic mesh approach for LA wall deformation, emphasizing the need for patient-specific data for realistic simulations. The obtained promising results need to be further validated with larger cohorts, ideally with ground truth data, but they already offer unique insights on thrombogenic risk in the left atria.
Ayudas:	European Commission. Horizon 2020 SC1-DTH-06-2020 European Commission. Horizon 2020 101016496 Agencia Estatal de Investigación RTI2018-101193-B-I00 Ministerio de Ciencia, Innovación y Universidades MDM-2015-0502 Ministerio de Economía y Competitividad PRE2018-084062 Ministerio de Economía y Competitividad RYC-2015-18888
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Sensitivity analysis ; Boundary conditions ; Computational fluid dynamics ; Dynamic mesh ; Device-related thrombus ; Left atrium ; Left atrial appendage
Publicado en:	Mathematics, Vol. 9 Núm. 18 (september 2021) , p. 2304, ISSN 2227-7390

DOI: 10.3390/math9182304

19 p, 13.5 MB

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