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Martinez-Legazpi, P.

Publications and source records attributed to Martinez-Legazpi, P..

11 recordsLinked to original sources

Joint Vector Flow Mapping and Segmentation: Ill-Posedness,Differentiable Bayesian Inference, and Synthetic Vortex-FlowBenchmarks

Vector flow mapping (VFM) reconstructs left-ventricular (LV) blood velocity from color-Doppler echocardiography by combining the measured beamwise component with physical and regularizing constraints. Analysis of the discrete VFM formulation shows that the inverse problem is intrinsically ill posed: the occurrence of singular modes can be predicted from the geometry of the segmented blood-pool domain, the imposed boundary conditions, and the degree of smoothing. These modes can propagate uncertainty along entire transverse bands of the reconstructed velocity field, yet conventional VFM neither quantifies this uncertainty nor allows for correcting the blood-pool segmentation. We introduce Bayesian VFM (B--VFM), a hierarchical framework that jointly infers radial and transverse velocities, a probabilistic blood-pool mask, their spatially resolved uncertainties, and hyperparameters weighting Doppler and segmentation fidelity, mass conservation, boundary conditions, and smoothness. The discretized posterior admits a closed-form gradient and exact Hessian, enabling computationally efficient, gradient-based MAP estimation, sampling, and direct analysis of ill-posed modes. Posterior inference combines Gibbs sampling of conjugate Gamma-distributed hyperparameters with conditional maximum-a-posteriori estimation and a Laplace approximation for the high-dimensional velocity and mask fields. To accommodate systematic departures from planar mass conservation, B-VFM can learn the covariance of the planar divergence residual from an ensemble of flows and incorporate it as a structured model-discrepancy prior. Independent chains converged reproducibly, while covariance priors learned from flow ensembles illustrated how model discrepancies can be incorporated into the inference. B--VFM was evaluated using Lamb-Chaplygin dipoles under ideal conditions and with Doppler corruption, Doppler voids, and segmentation defects, and using the Hicks-Moffatt family of spherical vortices to assess violations of planar mass conservation. The method produced smooth reconstructions, localized uncertainty near unreliable measurements and regions of model inconsistency, and used flow information to correct segmentation errors. Within the tested vortex family, the data-informed planar divergence prior reduced velocity bias and mask distortion. B--VFM thus provides an uncertainty-aware reconstruction method and a flexible foundation for future VFM formulations incorporating additional priors, observations, and physical models. Future work will evaluate the method using clinical data and more complex three-dimensional benchmark flows.

bioengineering↗

Left atrial flow and thrombosis risk from 4D CT contrast dynamics by physics-informed neural network and indicator dilution theory

Atrial fibrillation (AF) promotes blood stasis and thrombus formation, most often within the left atrial appendage (LAA), and can lead to stroke or transient ischemic attack (TIA). Time-resolved contrast-enhanced computed tomography (4D CT) captures left atrial (LA) opacification and washout, but it does not directly provide quantitative stasis metrics such as blood residence time. Patient-specific computational fluid dynamics (CFD) can quantify LA/LAA residence time, yet routine clinical use is limited by computational cost and sensitivity to patient-specific boundary conditions. Here, we present two complementary approaches to infer time-resolved 3D residence time fields directly from contrast dynamics. First, a physics-informed neural network (PINN) treats contrast as a passive scalar and jointly reconstructs velocity and residence time by enforcing the incompressible Navier-Stokes equations and transport equations for contrast concentration and residence time in moving, patient-specific LA anatomies. Second, an indicator dilution theory (IDT) formulation computes voxelwise, time-resolved residence time maps from contrast time curves alone by constructing a PV-referenced impulse response and modeling transport with a tank-in-series model with spatially dependent parameters. Both methods are benchmarked against patient-specific CFD in six cases spanning diverse LA function, including three patients with TIA or thrombus in the LAA and three patients free of events. Both approaches reproduce expected spatial and temporal trends, with higher residence time in the distal LAA and higher LAA residence time in cases with TIA or thrombus. IDT demonstrates the closest agreement with CFD across the full range of residence times and produces maps in seconds, facilitating clinical translation. In contrast, the PINN additionally recovers phase-dependent atrial flow structures, but tends to smooth and underestimate the highest residence-time regions and requires hours of training. Together, these results support a scalable workflow in which IDT enables rapid stasis screening from contrast CT, and PINNs provide a complementary pathway for detailed, patient-specific hemodynamic inference when full-field flow information is needed.

bioengineering↗

Integrated multi-modal data analysis for computational modeling of healthy and location-dependent myocardial infarction conditions in porcine hearts

Porcine hearts are widely used for preclinical cardiac evaluation. Computational models, by effectively integrating comprehensive experimental data, often reinforce this preclinical assessment. Using extensive multi-modal data, we developed swine ventricular digital twins for healthy and chronic myocardial infarction (MI) conditions to investigate the roles of the cardiac conduction system (CS), spatial repolarization heterogeneities, cardiomyocyte orientation, cell-to-cell coupling, and MI characteristics on ventricular function. We analyzed cardiac magnetic resonance (CMR) images, electrocardiograms (ECGs), and optical (OM) and electroanatomical mapping from 5 healthy and 10 MI pigs. CS architectures were built from OM and ECG recordings. Myocardial fiber orientation, action potential characteristics, and cell-to-cell conductivity in MI tissue were defined from OM and CMR data. Simulated ECGs for healthy and MI models of left anterior descending and left circumflex occlusions were compared to experimental ECGs and used to assess MI-induced changes. Personalized fiber orientation minimally affected electrophysiology, with conduction velocity (CV) and action potential duration (APD) changing less than 3.6% with respect to standard orientation. Accurate CS and repolarization heterogeneities reproduced depolarization (0.76 QRS similarity) and repolarization (0.74 T-wave similarity) patterns. Incorporating experimentally guided MI-induced alterations enabled replication of MI depolarization and repolarization features (relative errors: 0.5% CV, 2.9% APD), yielded realistic T-wave morphologies (0.63 similarity), and revealed ECG patterns specific to vessel-dependent occlusions. Thus, by integrating extensive multi-modal data, we advance porcine cardiac digital twins and demonstrate the influence of key structural and electrophysiological parameters on healthy and MI heart function, providing a robust computational framework for mechanistic and translational applications. Author summaryPigs are commonly used as preclinical models for cardiac evaluation due to their close resemblance to the human heart. Computational cardiac electrophysiology often supports and extends this preclinical assessment. However, the reliability of these in silico representations depends on the effective integration of comprehensive experimental data. Using extensive multi-modal data, we developed swine ventricular digital twins under healthy and chronic myocardial infarction conditions. These models allowed us to investigate the influence of the cardiac conduction system, spatial repolarization heterogeneities, cardiomyocyte orientation, cell-to-cell coupling, and vessel-specific infarction characteristics on ventricular function. Our results show that cardiomyocyte orientation exerts only a minor effect on electrophysiology, with average conduction velocity showing a slight decrease and action potential duration remaining unchanged when comparing standard versus personalized orientations. Accurate representation of conduction system architecture and repolarization heterogeneities enabled closed reproduction of experimental depolarization and repolarization patterns. Furthermore, by integrating experimentally guided reductions in cell-to-cell coupling and inward rectifier potassium current, along with personalized post-infarction activation alterations and a novel porcine cellular model, we were able to faithfully replicate infarction-specific depolarization-repolarization features. These refinements produced realistic T-wave morphologies and revealed electrocardiographic signatures associated with vessel-dependent infarctions, underscoring the translational potential of our approach.

bioengineering↗

Flow transport and not ejection fraction determines left ventricular stasis in patients with impaired systolic function

BackgroundImpaired left ventricular (LV) systolic function is a major risk factor for mural thrombosis and embolism, but LV ejection fraction (EF) poorly predicts these events, suggesting the existence of additional sources of variability. Advances in multi-dimensional flow imaging and patient-specific simulations have sparked the derivation of diverse metrics to assess blood stasis and transit efficiency. However, simple models to interpret these metrics and their dependence on chamber function are lacking. MethodsWe introduce queue models of LV blood transit connecting two common metrics of LV efficiency: flow component analysis and residence time (RT) mapping. These models yield closed-form expressions for the average RT of blood in the LV as a function of EF, direct flow (DF) --blood entering and leaving the LV in one cardiac cycle, and residual volume (RV) -- blood persisting in the LV for >2 cycles. Models performance was tested against RT obtained from vector flow mapping in 332 subjects, including controls and patients with acute myocardial infarction (AMI), hypertrophic (HCM) and dilated (DCM) cardiomyopathy. ResultsQueue models revealed RT is increasingly sensitive to DF as EF decreases, contradicting the traditional view of large DF as a teleological advantage. Instead, RT is minimized when blood transits in a first-in-first-out (FIFO) manner, while DF short-circuits the FIFO pattern, prolonging RT for other flow components. FIFO models show a good performance to assess RT in the studied subjects, especially when accounting for patient-specific DF and RV, with R: 0.62 for the pooled data, 0.70 for control, and 0.60, 0.80 and 0.40 for AMI, DCM and HCM groups respectively. ConclusionBy developing queue models of LV blood transit, and testing them on a large clinical database, we show large DF may contribute to increased blood stasis when EF is low. These models also explain why EF is a poor thrombosis risk marker in AMI and DCM.

physiology↗

Hemodynamics Affects Factor XI/XII Anticoagulation Efficacy in Patient-Specific Left Atrial Models

Atrial fibrillation (AF) disrupts the circulation of blood through the left atrium (LA), and may result in relative stasis in the left atrial appendage (LAA), increasing thromboembolic risk. Anticoagulant agents can lower this risk, but currently used agents target the common pathway central to the coagulation cascade, increasing bleeding risk. Anticoagulants such as factor XI/XII inhibitors target the initial phase of the intrinsic pathway, with a significantly lower associated bleeding risk. However, these agents efficacy in preventing thrombosis in patient-specific flow conditions is not fully understood. We hypothesized that patient-specific flow patterns in the LA and LAA not only influence the risk of thrombosis but also the effectiveness of anticoagulation agents. We simulated blood flow and the intrinsic coagulation pathway in patient-specific LA anatomies with and without factor XI/XII inhibition to test this hypothesis. We considered thirteen patients in sinus rhythm and AF, several of whom had an LAA clot or a history of transient ischemic attacks. We used computational fluid dynamics based on 4D CT imaging and a detailed 32-species coagulation system to run 247 simulations for 13 patients, systematically sweeping over a wide range of factor XI/XII inhibition levels. Implementing a novel multi-fidelity coagulation modeling approach accelerated computations by two orders of magnitude, enabling the large number of simulations performed. Our simulations provide spatiotemporally resolved maps of thrombin concentration throughout the LA, showing it peaks inside the LAA. Coagulation metrics based on peak LAA thrombin dynamics suggested patients could be classified as non-coagulating, moderately and severely coagulating cases. Severely coagulating cases had significantly slower flow and higher residence time than moderately coagulating patients inside the LAA, requiring stronger factor XI/XII inhibition to blunt thrombin growth. The methodology outlined in this study has the potential to enable personalized assessments of coagulation risk and tailor anticoagulation therapy based on medical imaging.

bioengineering↗

Patient-specific multi-physics simulations of fibrotic changes in left atrial tissue mechanics impact on hemodynamics

Stroke is a leading cause of death and disability worldwide. Atrial myopathy, including fibrosis, is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association are poorly understood. Fibrosis modifies myocardial structure, impairing electrical propagation and tissue biomechanics, and creating stagnant flow regions where clots could form. Fibrosis can be mapped non-invasively using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, fibrosis maps are not currently incorporated into stroke risk calculations or computational electro-mechano-fluidic models. We present multi-physics simulations of left atrial (LA) myocardial motion and hemodynamics using patient-specific anatomies and fibrotic maps from LGE-MRI. We modify tissue stiffness and active tension generation in fibrotic regions and investigate how these changes affect LA flow for different fibrotic burdens. We find that fibrotic regions and, to a lesser extent, non-fibrotic regions experience reduced myocardial strain, resulting in decreased LA emptying fraction consistent with clinical observations. Both fibrotic tissue stiffening and hypocontractility independently reduce LA function, but together, these two alterations cause more pronounced effects than either one alone. Fibrosis significantly alters flow patterns throughout the atrial chamber, and particularly, the filling and emptying jets of the left atrial appendage (LAA). The effects of fibrosis in LA flow are largely captured by the concomitant changes in LA emptying fraction except inside the LAA, where a multi-factorial behavior is observed. This work illustrates how high-fidelity, multi-physics models can be used to study thrombogenesis mechanisms in patient-specific anatomies, shedding light onto the links between atrial fibrosis and ischemic stroke. Key pointsO_LILeft atrial (LA) fibrosis is associated with arrhythmogenesis and increased risk of ischemic stroke; its extent and pattern can be quantified on a patient-specific basis using late gadolinium enhancement magnetic resonance imaging. C_LIO_LICurrent stroke risk prediction tools have limited personalization, and their accuracy could be improved by incorporating patient-specific information like fibrotic maps and hemodynamic patterns. C_LIO_LIWe present the first electro-mechano-fluidic multi-physics computational simulations of LA flow, including fibrosis and anatomies from medical imaging. C_LIO_LIMechanical changes in fibrotic tissue impair global LA motion, decreasing LA and left atrial appendage (LAA) emptying fractions, especially in subjects with higher fibrosis burdens. C_LIO_LIFibrotic-mediated LA motion impairment alters LA and LAA flow near the endocardium and the whole cavity, ultimately leading to more stagnant blood regions in the LAA. C_LI

bioengineering↗

Super-resolution Left Ventricular Flow and Pressure Mapping by Navier-Stokes-Informed Neural Networks

Intraventricular vector flow mapping (VFM) is a growingly adopted echocardiographic modality that derives time-resolved two-dimensional flow maps in the left ventricle (LV) from color-Doppler sequences. Current VFM models rely on kinematic constraints arising from planar flow incompressibility. However, these models are not informed by crucial information about flow physics; most notably the pressure and shear forces within the fluid and the resulting accelerations. This limitation has rendered VFM unable to combine information from different time frames in an acquisition sequence or derive fluctuating pressure maps. In this study, we leveraged recent advances in artificial intelligence (AI) to develop AI-VFM, a vector flow mapping modality that uses physics-informed neural networks (PINNs) encoding mass conservation and momentum balance inside the LV, and no-slip boundary conditions at the LV endocardium. AI-VFM recovers the flow and pressure fields in the LV from standard echocardiographic scans. It performs phase unwrapping and recovers flow data in areas without input color-Doppler data. AI-VFM also recovers complete flow maps at time points without color-Doppler input data, producing super-resolution flow maps. We show that informing the PINNs with momentum balance is essential to achieving temporal super-resolution and significantly increases the accuracy of AI-VFM compared to informing the PINNs only with mass conservation. AI-VFM is solely informed by each patients flow physics; it does not utilize explicit smoothness constraints or incorporate data from other patients or flow models. AI-VFM takes 15 minutes to run in off-the-shelf graphics processing units and its underlying PINN framework could be extended to map other flow-associated metrics like blood residence time or the concentration of coagulation species.

bioengineering↗

Efficient multi-fidelity computation of blood coagulation under flow

Clot formation is a crucial process that prevents bleeding, but can lead to severe disorders when imbalanced. This process is regulated by the coagulation cascade, a biochemical network that controls the enzyme thrombin, which converts soluble fibrinogen into the fibrin fibers that constitute clots. Coagulation cascade models are typically complex and involve dozens of partial differential equations (PDEs) representing various chemical species transport, reaction kinetics, and diffusion. Solving these PDE systems computationally is challenging, due to their large size and multi-scale nature. We propose a multi-fidelity strategy to increase the efficiency of coagulation cascade simulations. Leveraging the slower dynamics of molecular diffusion, we transform the governing PDEs into ordinary differential equations (ODEs) representing the evolution of species concentrations versus blood residence time. We then Taylor-expand the ODE solution around the zero-diffusivity limit to obtain spatiotemporal maps of species concentrations in terms of the statistical moments of residence time, [Formula], and provide the governing PDEs for [Formula]. This strategy replaces a high-fidelity system of N PDEs representing the coagulation cascade of N chemical species by N ODEs and p PDEs governing the residence time statistical moments. The multi-fidelity order(p) allows balancing accuracy and computational cost, providing a speedup of over N/p compared to high-fidelity models. Using a simplified coagulation network and an idealized aneurysm geometry with a pulsatile flow as a benchmark, we demonstrate favorable accuracy for low-order models of p = 1 and p = 2. These models depart from the high-fidelity solution by under 16% (p = 1) and 5% (p = 2) after 20 cardiac cycles. The favorable accuracy and low computational cost of multi-fidelity models could enable unprecedented coagulation analyses in complex flow scenarios and extensive reaction networks. Furthermore, it can be generalized to advance our understanding of other systems biology networks affected by blood flow.

bioengineering↗

Pulmonary vein flow split effects in patient-specific simulations of left atrial flow

Disruptions to left atrial (LA) blood flow, such as those caused by atrial fibrillation (AF), can lead to thrombosis in the left atrial appendage (LAA) and an increased risk of systemic embolism. LA hemodynamics are influenced by various factors, including LA anatomy and function, and pulmonary vein (PV) inflow conditions. In particular, the PV flow split can vary significantly among and within patients depending on multiple factors. In this study, we investigated how changes in PV flow split affect LA flow transport, focusing on blood stasis in the LAA, using a high-fidelity patient-specific computational fluid dynamics (CFD) model. We analyzed LA anatomies from eight patients with varying atrial function, including three with AF and either a LAA thrombus or a history of TIAs. Using four different flow splits (60/40% and 55/45% through right and left PVs, even flow rate, and same velocity through each PV), we found that flow patterns are sensitive to PV flow split variations, particularly in planes parallel to the mitral valve. Changes in PV flow split also had a significant impact on blood stasis and could contribute to increased risk for thrombosis inside the LAA, particularly in patients with AF and previous LAA thrombus or a history of TIAs. Our study highlights the importance of considering patient-specific PV flow split variations when assessing LA hemodynamics and identifying patients at increased risk for thrombosis and stroke.

bioengineering↗

Non-Newtonian Patient-specific Simulations of Left Atrial Hemodynamics

The lack of mechanically effective contraction of the left atrium (LA) during atrial fibrillation (AF) disturbs blood flow, increasing the risk of thrombosis and ischemic stroke. Thrombosis is most likely in the left atrial appendage (LAA), a small narrow sac where blood is prone to stagnate. Slow flow promotes the formation of erythrocyte aggregates in the LAA, also known as rouleaux, causing viscosity gradients that are usually disregarded in patient-specific simulations. To evaluate these non-Newtonian effects, we built atrial models derived from 4D computed tomography scans of patients and carried out computational fluid dynamics simulations using the Carreau-Yasuda constitutive relation. We examined six patients, three of whom had AF and LAA thrombosis or a history of transient ischemic attacks (TIAs). We modeled the effects of hematocrit and rouleaux formation kinetics by varying the parameterization of the Carreau-Yasuda relation and modulating non-Newtonian viscosity changes based on residence time. Comparing non-Newtonian and Newtonian simulations indicates that slow flow in the LAA increases blood viscosity, altering secondary swirling flows and intensifying blood stasis. While some of these effects can be subtle when examined using instantaneous metrics like shear rate or kinetic energy, they are manifested in the blood residence time, which accumulates over multiple heartbeats. Our data also reveal that LAA blood stasis worsens when hematocrit increases, offering a potential new mechanism for the clinically reported correlation between hematocrit and stroke incidence. In summary, we submit that hematocrit-dependent non-Newtonian blood rheology should be considered in calculating patient-specific blood stasis indices by computational fluid dynamics.

bioengineering↗

Demonstration of Patient-Specific Simulations To Assess Left Atrial Appendage Thrombogenesis Risk

Atrial fibrillation (AF) alters left atrial (LA) hemodynamics, which can lead to thrombosis in the left atrial appendage (LAA), systemic embolism and stroke. A personalized risk-stratification of AF patients for stroke would permit improved balancing of preventive anticoagulation therapies against bleeding risk. We investigated how LA anatomy and function impact LA and LAA hemodynamics, and explored whether patient-specific analysis by computational fluid dynamics (CFD) can predict the risk of LAA thrombosis. We analyzed 4D-CT acquisitions of LA wall motion with an in-house immersed-boundary CFD solver. We considered six patients with diverse atrial function, three without a LAA thrombus (LAAT/TIA-neg), and three with either a LAA thrombus (removed digitally before running the simulations) or a history of transient ischemic attacks (LAAT/TIA-pos). We found that blood inside the left atrial appendage of LAAT/TIA-pos patients had marked alterations in residence time and kinetic energy when compared with LAAT/TIA-neg patients. In addition, we showed how the LA conduit, reservoir and booster functions distinctly affect LA and LAA hemodynamics. While the flow dynamics of fixed-wall and moving-wall simulations differ significantly, fixed-wall simulations risk-stratified our small cohort for LAA thrombosis only slightly worse than moving-wall simulations.

bioengineering↗