title: A clinical method for mapping and quantifying blood stasis in the left ventricle.
abstract: In patients at risk of intraventrcular thrombosis, the benefits of chronic anticoagulation therapy need to be balanced with the pro-hemorrhagic effects of therapy. Blood stasis in the cardiac chambers is a recognized risk factor for intracardiac thrombosis and potential cardiogenic embolic events. In this work, we present a novel flow image-based method to assess the location and extent of intraventricular stasis regions inside the left ventricle (LV) by digital processing flow-velocity images obtained either by phase-contrast magnetic resonance (PCMR) or 2D color-Doppler velocimetry (echo-CDV). This approach is based on quantifying the distribution of the blood Residence Time (TR) from time-resolved blood velocity fields in the LV. We tested the new method in illustrative examples of normal hearts, patients with dilated cardiomyopathy and one patient before and after the implantation of a left ventricular assist device (LVAD). The method allowed us to assess in-vivo the location and extent of the stasis regions in the LV. Original metrics were developed to integrate flow properties into simple scalars suitable for a robust and personalized assessment of the risk of thrombosis. From a clinical perspective, this work introduces the new paradigm that quantitative flow dynamics can provide the basis to obtain subclinical markers of intraventricular thrombosis risk. The early prediction of LV blood stasis may result in decrease strokes by appropriate use of anticoagulant therapy for the purpose of primary and secondary prevention. It may also have a significant impact on LVAD device design and operation set-up.
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rossini
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States. Electronic address: legazpi.pablo@gmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Legazpi
authors.affiliation: Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States.
authors.forename: Vi
authors.initials: V
authors.lastname: Vu
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Fernández-Friera
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Candelas
authors.initials: C
authors.lastname: Pérez Del Villar
authors.affiliation: Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Rodríguez-López
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Benito
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States.
authors.forename: María-Guadalupe
authors.initials: MG
authors.lastname: Borja
authors.affiliation: Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Pastor-Escuredo
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Yotti
authors.affiliation: Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Ledesma-Carbayo
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, CA 92037, United States.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kahn
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibáñez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Department of Mechanical Engineering, San Diego State University, San Diego, CA 92182, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: May-Newman
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Bermejo
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California San Diego, La Jolla, CA 92093, United States; Institute for Engineering in Medicine, University of California San Diego, La Jolla, CA 92093, United States.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Del Álamo
mesh_terms: D000818:Animals; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006353:Heart-Assist Devices; D008297:Male; D013552:Swine; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery
keywords: Blood stasis; Echocardiography; Intraventricular thrombosis; Left ventricular assist devices; Phase contrast magnetic resonance; Residence time