Haykal, R. | bioRxiv Science

bioRxiv2025

Effect of Wall Motion Sampling on CFD-Derived Left Atrial Flow Metrics

The temporal resolution of medical imaging sequences used to drive patient-specific computational fluid dynamics (CFD) simulations remains limited, typically providing 10-20 frames per cardiac cycle. Therefore, temporal interpolation to reconstruct left atrial (LA) wall motion and boundary conditions is required, but its impact on hemodynamic predictions has not been systematically characterized. To investigate this, we constructed high-temporal-resolution reference wall-motion data using electromechanical (EM) simulations on five patient-specific atrial geometries with a history of atrial fibrillation. We then generated temporally downsampled datasets to emulate clinical frame rates (5, 10, 20, and 40 frames per cycle) and performed CFD simulations to isolate the effects of temporal undersampling on hemodynamic metrics. The focus was placed on kinetic energy, KE, and residence time, TR, particularly in the left atrial appendage (LAA), where thrombosis is most likely to occur. We employed an immersed boundary method to prescribe the wall motion and computed blood TR through a passive scalar transport equation. Results indicate that while global LA hemodynamic indices were marginally affected by the frame rate (errors < 9%), LAA metrics were more sensitive with errors up to 31% compared to reference values. The results based on 20 and 40 frames per cycle yielded favorable agreement with reference results, while 5-and 10-frame reconstructions showed larger, though not systematically biased, deviations from the reference. Importantly, patient ranking by blood-stasis indices was largely preserved. The analysis suggests that patientspecific LA reconstructions derived from dynamic CT imaging provide a reliable basis for estimating LAA blood-stasis indices. Higher frame rates ([≥] 20 per cycle) offer improved quantitative accuracy, while lower temporal resolutions may remain informative for patient stratification purposes, where relative ranking is more relevant than absolute accuracy.

bioengineering↗

bioRxiv2025

Systematic computational assessment of atrial function impairment due to fibrotic remodeling in electromechanical properties

Cardiac fibrosis is a pathological condition associated with many cardiovascular diseases. Atrial fibrosis leads to reduced atrial function, resulting in diminished blood flow and an increased risk of stroke. This reduced function arises from altered myocardial electrophysiological and mechanical properties. Identifying the relative importance of these fibrosis-associated properties can reveal the most significant determinants of left atrial function impairment. In this study, we used a computational framework to investigate the relative importance of various fibrosis-associated properties. Our model, a 3D electromechanical framework coupled with a 0D circulatory model, incorporated patient-specific geometries and fibrosis distributions from clinical imaging data. Nine parameters related to fibrotic remodeling (conduction velocity, ion channel expression levels, cell- and tissue-scale contractility, and stiffness) were analyzed using two sensitivity analysis schemes: a one-factor-at-a-time setup, allowing for the analysis of isolated effects, and a fractional factorial design, enabling the examination of combined effects. As output, we tracked various metrics derived from model-predicted pressure-volume loops. Impairment of L-type calcium current (ICaL) was most detrimental (up to 64% reduction in A-loop area). Conversely, reduced inward rectifier current (IK1) led to improved atrial function (up to 27% increase in A-loop area). Fractional factorial design analysis revealed that combination with other parameter changes blunted the impact of reduced ICaL but amplified the impact of reduced IK1. Further analysis of spatiotemporal distributions linked these effects to changes in intracellular calcium handling. Future research focusing on IK1 and ICaL could be highly significant for clinical and scientific advances. Modeling work can potentially help evaluate left atrial function among larger patient cohorts, focusing on strain analysis. Our work could also be extended to spatiotemporal simulations of blood flow and thrombosis, shedding light onto the mechanisms underlying atriogenic stroke. Author summaryCardiac fibrosis is a process where healthy heart muscle is replaced with non-conductive, non-contractile tissue. This change disrupts how the heart beats and contracts. In the left atrium, fibrosis is strongly linked to atrial fibrillation and a higher risk of stroke, the latter due to impaired pumping and altered blood flow. In this study, we used a detailed computer model of the heart, based on real patient-specific left atrial shapes and fibrosis patterns, to understand how different fibrosis-related changes affect atrial function. We tested nine features of the hearts electrical and mechanical behavior that are known to change during fibrosis, aiming to identify which ones have the most impact on the atrial function. We found that reducing the L-type calcium current -- an important signal for muscle contraction -- caused the greatest decrease in atrial performance. Surprisingly, reducing the inward rectifier potassium current actually improved it. These effects were tied to changes in calcium handling inside heart cells. Our findings highlight promising directions for future heart disease research and treatment.

systems biology↗