Objective

This study assessed the ability of hemodynamic simulations to predict the success of catheter interventions in a swine model of branch pulmonary artery stenosis (bPAS).

Background

bPAS commonly occurs in congenital heart disease and is often managed with catheter based interventions. However, despite technical success, bPAS interventions do not lead to improved distal pulmonary blood flow (PBF) distribution in approximately 1/3rd of patients. New tools are needed to better identify which patients with bPAS would most benefit from catheter interventions.

Methods

For 13 catheter intervention cases in swine with surgically created left PAS (LPAS), PA pressures from right heart catheterization (RHC) and PBF distributions from MRI were measured before and after catheter interventions. Hemodynamic simulations with a reduced order computational fluid dynamics (CFD) model were performed using non-invasive PBF measurements derived from MRI, and then correlated with changes in invasive measures of hemodynamics and PBF distributions before and after catheter intervention to relieve bPAS.

Results

Compared to experimentally measured changes in left PBF distribution, simulations had a small bias (3.4 ± 11.1%), moderate agreement (ICC = 0.69 [0.24–0.90], 0.71 [0.23–0.91]), and good diagnostic capability to predict successful interventions (> 20% PBF increase) (AUC 0.83 [0.59–1.0]). Simulations had poorer prediction of changes in stenotic pressure gradient (ICC = 0.28 [− 0.33 to 0.73], r = 0.57 [− 0.04 to 0.87]) and MPA systolic pressure (ICC = 0.00 [− 0.52 to 0.53], r = 0.29 [− 0.32 to 0.72]).

Conclusion

While there was only weak to moderate agreement between predicted and measured changes in PA pressures and pulmonary blood flow distributions, hemodynamic simulations did show good diagnostic value for predicting successful versus unsuccessful catheter based interventions to relieve bPAS. The results of this proof of concept study are promising and should encourage future development for using hemodynamic models in planning interventions for patients with bPAS.

中文翻译：

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非侵入性 MRI 衍生的血流动力学模拟可预测肺动脉分支狭窄的成功与不成功导管干预：猪的概念验证和实验验证

客观的

本研究评估了血流动力学模拟预测肺动脉分支狭窄 (bPAS) 猪模型中导管干预成功的能力。

背景

bPAS 通常发生在先天性心脏病中，通常通过基于导管的干预措施进行管理。然而，尽管技术上取得了成功，但 bPAS 干预并未改善约 1/3 患者的远端肺血流 (PBF) 分布。需要新的工具来更好地确定哪些 bPAS 患者将从导管干预中获益最多。

方法

对于 13 例通过手术创建的左侧 PAS (LPAS) 的猪导管介入病例，在导管介入前后测量了来自右心导管 (RHC) 的 PA 压力和来自 MRI 的 PBF 分布。使用源自 MRI 的非侵入性 PBF 测量值进行具有降阶计算流体动力学 (CFD) 模型的血流动力学模拟，然后与导管干预前后血流动力学和 PBF 分布的侵入性测量值的变化相关联，以缓解 bPAS。

结果

与实验测量的左侧 PBF 分布变化相比，模拟具有小偏差 (3.4 ± 11.1%)、中等一致性 (ICC = 0.69 [0.24–0.90]、0.71 [0.23–0.91])，并且具有预测成功干预的良好诊断能力（> 20% PBF 增加）（AUC 0.83 [0.59–1.0]）。模拟对狭窄压力梯度（ICC = 0.28 [- 0.33 至 0.73]，r  = 0.57 [- 0.04 至 0.87]）和 MPA 收缩压（ICC = 0.00 [- 0.52 至 0.53]，r  = 0.29 [ − 0.32 至 0.72]）。

结论

虽然 PA 压力和肺血流分布的预测和测量变化之间只有弱到中等的一致性，但血流动力学模拟确实显示出良好的诊断价值，可用于预测基于导管的干预措施以缓解 bPAS 的成功与否。这项概念验证研究的结果很有希望，并应鼓励未来发展使用血流动力学模型来规划 bPAS 患者的干预措施。