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Sensitivity analysis of in silico fluid simulations to predict thrombus formation after left atrial appendage occlusion

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dc.contributor.author Mill, Jordi
dc.contributor.author Agudelo, Victor
dc.contributor.author Olivares Miyares, Andy Luis
dc.contributor.author Pons Vidal, Maria Isabel
dc.contributor.author Silva, Etelvino
dc.contributor.author Nuñez-Garcia, Marta
dc.contributor.author Morales Ferez, Xabier
dc.contributor.author Arzamendi, Dabit
dc.contributor.author Freixa, Xavier
dc.contributor.author Noailly, Jérôme
dc.contributor.author Camara, Oscar
dc.date.accessioned 2022-06-28T06:13:02Z
dc.date.available 2022-06-28T06:13:02Z
dc.date.issued 2021
dc.identifier.citation Mill J, Agudelo V, Olivares AL, Pons MI, Silva E, Nuñez-Garcia M, Morales X, Arzamendi D, Freixa X, Noailly J, Camara O. Sensitivity analysis of in silico fluid simulations to predict thrombus formation after left atrial appendage occlusion. Mathematics. 2021;9:2304. DOI: 10.3390/math9182304
dc.identifier.issn 2227-7390
dc.identifier.uri http://hdl.handle.net/10230/53605
dc.description.abstract Atrial fibrillation (AF) is nowadays the most common human arrhythmia and it is considered 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.
dc.description.sponsorship This work was supported by the Spanish Ministry of Science, Innovation and Universities under the Retos I+D Programme (RTI2018-101193-B-I00), the Maria de Maeztu Units of Excellence Programme (MDM-2015-0502), the Spanish Ministry of Economy and Competitiveness under the Programme for the Formation of Doctors (PRE2018-084062), and MINECO (RYC-2015-18888). Additionally, this work was supported by the H2020 EU SimCardioTest project (Digital transformation in Health and Care SC1-DTH-06-2020; grant agreement No. 101016496).
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher MDPI
dc.relation.ispartof Mathematics. 2021;9:2304.
dc.rights © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.title Sensitivity analysis of in silico fluid simulations to predict thrombus formation after left atrial appendage occlusion
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.3390/math9182304
dc.subject.keyword sensitivity analysis
dc.subject.keyword boundary conditions
dc.subject.keyword computational fluid dynamics
dc.subject.keyword dynamic mesh
dc.subject.keyword device-related thrombus
dc.subject.keyword left atrium
dc.subject.keyword left atrial appendage
dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/101016496
dc.relation.projectID info:eu-repo/grantAgreement/ES/1PE/RYC-2015-18888
dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/RTI2018-101193-B-I00
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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