Impact of Transcatheter Aortic Valve Replacement on Coronary Hemodynamics using Clinical Measurements and an Image-Based Patient-Specific Lumped Parameter Model
Bibliographic record
Abstract
Cardiovascular disease, including coronary artery disease and aortic valve stenosis, impacts tens of millions of people annually and carries a massive global economic burden. Advances in medical imaging, hardware and software are leading to an increased interest in the field of cardiovascular computational modelling to help combat the devastating impact of cardiovascular disease. Lumped parameter modelling (a branch of computational modelling) holds the potential of aiding in the early diagnosis of these diseases, assisting clinicians in determining personalized and optimal treatments and offering a unique in-silico setting to study cardiac and circulatory diseases due to its rapid computation time, ease of automation and relative simplicity. In this thesis, cardiovascular lumped parameter modelling is presented in detail and a patient-specific framework capable of simulating blood flow waveforms and hemodynamic data in the heart and coronary arteries was developed. The framework used only non-invasive clinical data and images (Computed Tomography images, echocardiography data and cuff blood pressure) as inputs. The novel model was then applied to 19 patients with aortic stenosis who underwent transcatheter aortic valve replacement. The diastolic coronary flow waveforms in the left anterior descending artery, left circumflex artery and right coronary artery were validated against a previously developed patient-specific 3D fluid-structure interaction model for all 19 subjects (pre and post intervention). There were strong qualitative and quantitative agreements between the two models. After the procedure, aortic valve area and net pressure gradient across the aortic valve improved for almost all the subjects. As for the hemodynamic data, according to the model, there was substantial variability in terms of the increase or decrease post intervention. On average, left ventricle workload and maximum left ventricle pressure decreased by 4.5% and 13.0% while cardiac output, mean arterial pressure and resting heart rate increased by 9.9%, 6.9% and 1.9% respectively. There were also subject specific changes in coronary blood flow (37% had increased flow in all three coronary arteries, 32% had decreased flow in all coronary arteries, and 31% had both increased and decreased flow in different coronary arteries). All in all, a proof-of-concept cardiac and coronary lumped parameter framework was developed, validated, and applied in this thesis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".