A High-Fidelity Three-Dimensional Computational Model of a Patient with Hypertrophic Cardiomyopathy

Abstract

•Echocardiography and CMR are used for diagnosis of HCM.•Learning echocardiography requires advanced and repetitive training.•A 3D model can enhance understanding of cardiac anatomy and pathophysiology. IntroductionHypertrophic cardiomyopathy (HCM) is a genetic disease characterized by concentric left ventricular hypertrophy with preserved or increased ejection fraction.1Marian A.J. Braunwald E. Hypertrophic cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy.Circ Res. 2017; 121: 749-770Crossref PubMed Scopus (456) Google Scholar Disease progression is highly variable. While some patients remain asymptomatic for years, others rapidly progress toward end-stage heart failure and sudden cardiac death.2Maron B.J. Clinical course and management of hypertrophic cardiomyopathy.N Engl J Med. 2018; 379: 655-668Crossref PubMed Scopus (282) Google Scholar Patients with end-stage HCM characterized by progressive left ventricular dysfunction and restrictive ventricular filling are candidates for orthotopic heart transplantation (OHT).3Torres M.F. Perez-Villa F. Heart transplantation in patients with hypertrophic cardiomyopathy.Glob Cardiol Sci Pract. 2018; 2018: 32PubMed Google Scholar Echocardiography and cardiovascular magnetic resonance (CMR) are used to establish the diagnosis and during follow-up for disease progression.2Maron B.J. Clinical course and management of hypertrophic cardiomyopathy.N Engl J Med. 2018; 379: 655-668Crossref PubMed Scopus (282) Google Scholar While echocardiography is a cost-effective and accessible diagnostic tool, learning echocardiography requires advanced and repetitive training.4Popescu B.A. Stefanidis A. Fox K.F. Cosyns B. Delgado V. Di Salvo G.D. et al.Training, competence, and quality improvement in echocardiography: the European Association of Cardiovascular Imaging Recommendations: update 2020 [published correction appears in Eur Heart J Cardiovasc Imaging 2021;22:187].Eur Heart J Cardiovasc Imaging. 2020; 21: 1305-1319Crossref PubMed Scopus (10) Google Scholar Conventional educational strategies for teaching echocardiography rely on idealized cardiac models5Maresky H.S. Oikonomou A. Ali I. Ditkofsky N. Pakkal M. Ballyk B. Virtual reality and cardiac anatomy: exploring immersive three-dimensional cardiac imaging, a pilot study in undergraduate medical anatomy education.Clin Anat. 2019; 32: 238-243Crossref PubMed Scopus (89) Google Scholar or models computed from in vivo imaging techniques.6James R.C. Monsky W.L. Jorgensen N.W. Seslar S.P. Virtual-reality guided versus fluoroscopy-guided transseptal puncture in a cardiac phantom.J Invasive Cardiol. 2020; 32: 76-81PubMed Google Scholar While these models are anatomically correct, they lack variability in the surface anatomy, internal structures, and pathology a learner would expect to see between human hearts.7Meineri M. Qua-Hiansen J. Garijo J.M. Ansari B. Ruggeri G.M. Ender J. et al.Evaluation of a patient-specific, low-cost, 3-dimensional-printed transesophageal echocardiography human heart phantom.J Cardiothorac Vasc Anesth. 2021; 35: 208-215Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar As an initial step toward being able to augment our real-time understanding of the anatomic and pathophysiologic features of end-stage HCM beyond transthoracic echocardiography (TTE) and contrast-enhanced CMR, we describe a novel approach using microcomputed tomography (μCT). This modality provides a much higher resolution, of both the internal and surface cardiac anatomy, to create a three-dimensional (3D) printed model and virtual reality scene.The overarching aim of our work is to develop an integrated, immersive, and interactive educational platform that uses multimodal digital tools to enhance the knowledge and understanding of cardiac anatomy, physiology, and pathophysiology for medical students, residents, fellows, and faculty across multiple medical and bioengineering disciplines.Case PresentationA 12-y