CMR–based Modelling of the Left Ventricle: a Tool for Functional Assessment and Surgical Decision Support

The most challenging objective of the clinical decision making in the management of patients with myocardial dysfunction is to choose the best option for improving myocardial function and clinical outcome. The present work aims at developing patient-specific computational models to assist cardiologists and cardiac surgeons in defining the severity and extent of disease in patients with left ventricular (LV) dysfunction, with or without mitral regurgitation, and in supporting clinical decision making and planning of the optimal treatment for left ventricle-valve repair. Two software were developed: the Functional Assessment Tool (FAT) provides cardiologists with the automatic extraction of quantitative MRI-derived parameters about LV performance; the Functional Predictive Tool (FPT) allows cardiac surgeons for easy and fast simulations of post-operative scenarios for different surgical choices. FAT validation, focused on LV dimension and function indices, demonstrated a good ability in detecting endoand epicardium and provided results comparable to the gold standard. Preliminary simulations of surgical procedures using FTP allowed to calculated segmental circumferential and radial strains with sufficient accuracy. Future developments will include the tuning of simulation parameters used accordingly with the feedback of clinicians and the effects of changes in peripheral resistances and heart rate, typically associated to post-operative scenarios.