RESUMEN
Atrial fibrillation (AF) is the most common cardiac arrhythmia. At present, cardiac ablation is the main treatment procedure for AF. To guide and plan this procedure, it is essential for clinicians to obtain patient-specific 3D geometrical models of the atria. For this, there is an interest in automatic image segmentation algorithms, such as deep learning (DL) methods, as opposed to manual segmentation, an error-prone and time-consuming method. However, to optimize DL algorithms, many annotated examples are required, increasing acquisition costs. The aim of this work is to develop automatic and high-performance computational models for left and right atrium (LA and RA) segmentation from a few labelled MRI volumetric images with a 3D Dual U-Net algorithm. For this, a supervised domain adaptation (SDA) method is introduced to infer knowledge from late gadolinium enhanced (LGE) MRI volumetric training samples (80 LA annotated samples) to a network trained with balanced steady-state free precession (bSSFP) MR images of limited number of annotations (19 RA and LA annotated samples). The resulting knowledge-transferred model SDA outperformed the same network trained from scratch in both RA (Dice equals 0.9160) and LA (Dice equals 0.8813) segmentation tasks.
RESUMEN
Atrial fibrillation (AF) is the most common human arrhythmia, forming thrombi mostly in the left atrial appendage (LAA). However, the relation between LAA morphology, blood patterns and clot formation is not yet fully understood. Furthermore, the impact of anatomical structures like the pulmonary veins (PVs) have not been thoroughly studied due to data acquisition difficulties. In-silico studies with flow simulations provide a detailed analysis of blood flow patterns under different boundary conditions, but a limited number of cases have been reported in the literature. To address these gaps, we investigated the influence of PVs on LA blood flow patterns and thrombus formation risk through computational fluid dynamics simulations conducted on a sizeable cohort of 130 patients, establishing the largest cohort of patient-specific LA fluid simulations reported to date. The investigation encompassed an in-depth analysis of several parameters, including pulmonary vein orientation (e.g., angles) and configuration (e.g., number), LAA and LA volumes as well as their ratio, flow, and mass-less particles. Our findings highlight the total number of particles within the LAA as a key parameter for distinguishing between the thrombus and non-thrombus groups. Moreover, the angles between the different PVs play an important role to determine the flow going inside the LAA and consequently the risk of thrombus formation. The alignment between the LAA and the main direction of the left superior pulmonary vein, or the position of the right pulmonary vein when it exhibits greater inclination, had an impact to distinguish the control group vs. the thrombus group. These insights shed light on the intricate relationship between PV configuration, LAA morphology, and thrombus formation, underscoring the importance of comprehensive blood flow pattern analyses.