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BackgroundDespite modern pharmacotherapy and advanced implantable cardiac devices, overall prognosis and quality of life of HF patients remain poor. This is in part due to insufficient patient stratification and lack of individualized therapy planning, resulting in less effective treatments and a significant number of non-responders.Methods and ResultsState-of-the-art clinical phenotyping was acquired, including magnetic resonance imaging (MRI) and biomarker assessment. An individualized, multi-scale model of heart function covering cardiac anatomy, electrophysiology, biomechanics and hemodynamics was estimated using a robust framework. The model was computed on n=46 HF patients, showing for the first time that advanced multi-scale models can be fitted consistently on large cohorts. Novel multi-scale parameters derived from the model of all cases were analyzed and compared against clinical parameters, cardiac imaging, lab tests and survival scores to evaluate the explicative power of the model and its potential for better patient stratification. Model validation was pursued by comparing clinical parameters that were not used in the fitting process against model parameters.ConclusionThis paper illustrates how advanced multi-scale models can complement cardiovascular imaging and how they could be applied in patient care. Based on obtained results, it becomes conceivable that, after thorough validation, such heart failure models could be applied for patient management and therapy planning in the future, as we illustrate in one patient of our cohort who received CRT-D implantation.

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Objectives: The objective of this study was to evaluate an artificial intelligence (AI)-based prototype algorithm for the fully automated per lobe segmentation and emphysema quantification (EQ) on chest-computed tomography as it compares to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification of chronic obstructive pulmonary disease (COPD) patients. Methods: Patients (n=137) who underwent chest-computed tomography acquisition and spirometry within 6 months were retrospectively included in this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study. Patient-specific spirometry data, which included forced expiratory volume in 1 second, forced vital capacity, and the forced expiratory volume in 1 second/forced vital capacity ratio (Tiffeneau-Index), were used to assign patients to their respective GOLD stage I to IV. Lung lobe segmentation was carried out using AI-RAD Companion software prototype (Siemens Healthineers), a deep convolution image-to-image network and emphysema was quantified in each lung lobe to detect the low attenuation volume. Results: A strong correlation between the whole-lung-EQ and the GOLD stages was found (ρ=0.88, P<0.0001). The most significant correlation was noted in the left upper lobe (ρ=0.85, P<0.0001), and the weakest in the left lower lobe (ρ=0.72, P<0.0001) and right middle lobe (ρ=0.72, P<0.0001). Conclusions: AI-based per lobe segmentation and its EQ demonstrate a very strong correlation with the GOLD severity stages of COPD patients. Furthermore, the low attenuation volume of the left upper lobe not only showed the strongest correlation to GOLD severity but was also able to most clearly distinguish mild and moderate forms of COPD. This is particularly relevant due to the fact that early disease processes often elude conventional pulmonary function diagnostics. Earlier detection of COPD is a crucial element for positively altering the course of disease progression through various therapeutic options.

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Clinical applications of computational cardiac models require precise personalization, i.e. fitting model parameters to capture patient's physiology. However, due to parameter non-identifiability, limited data, uncertainty in the clinical measurements, and modeling assumptions, various combinations of parameter values may exist that yield the same quality of fit. Hence, there is a need for quantifying the uncertainty in estimated parameters and to ascertain the uniqueness of the found solution. This paper presents a stochastic method to estimate the parameters of an image-based electromechanical model of the heart and their uncertainty due to noise in measurements. First, Bayesian inference is applied to fully estimate the posterior probability density function (PDF) of the model. To that end, Markov Chain Monte Carlo sampling is used, which is made computationally tractable by employing a fast surrogate model based on Polynomial Chaos Expansion, instead of the true forward model. Then, we use the mean-shift algorithm to automatically find the modes of the PDF and select the most likely one while being robust to noise. The approach is used to estimate global active stress and passive stiffness from invasive pressure and image-based volume quantification. Experiments on eight patients showed that not only our approach yielded goodness of fits equivalent to a well-established deterministic method, but we could also demonstrate the non-uniqueness of the problem and report uncertainty estimates, crucial information for subsequent clinical assessments of the personalized models.

The modeling of three-dimensional scene geometry from temporal point cloud streams is of particular interest for a variety of computer vision applications. With the advent of RGB-D imaging devices that deliver dense, metric and textured 6-D data in real-time, on-the-fly reconstruction of static environments has come into reach. In this paper, we propose a system for real-time point cloud mapping based on an efficient implementation of the iterative closest point (ICP) algorithm on the graphics processing unit (GPU). In order to achieve robust mappings at real-time performance, our nearest neighbor search evaluates both geometric and photometric information in a direct manner. For acceleration of the search space traversal, we exploit the inherent computing parallelism of GPUs. In this work, we have investigated the fitness of the random ball cover (RBC) data structure and search algorithm, originally proposed for high-dimensional problems, for 6-D data. In particular, we introduce a scheme that enables both fast RBC construction and queries. The proposed system is validated on an indoor scene modeling scenario. For dense data from the Microsoft Kinect sensor (640×480 px), our implementation achieved ICP runtimes of < 20 ms on an off-the-shelf consumer GPU.

A key requirement for recent advances in computational modeling to be clinically applicable is the ability to fit models to patient data. Various personalization techniques have been proposed for isolated sub-components of complex models of heart physiology. However, no work has been presented that focuses on personalizing full electromechanical (EM) models in a streamlined, consistent and automatic fashion, which has been evaluated on a large population. We present an integrated system for full EM personalization from routinely acquired clinical data. The importance of mechanical parameters is analyzed in a comprehensive sensitivity study, revealing that myocyte contraction and Young's modulus are the main determinants of model output variation, what lead to the proposed personalization strategy. On a large, physiologically diverse set of 15 patients, we demonstrate the effectiveness of our framework by comparing measured and calculated parameters, yielding left ventricular ejection fraction and stroke volume errors of 6.6% and 9.2 mL, respectively.