Abstract: Cardiovascular Diseases, specially those affecting the Left Ventricle (LV), are the leading cause of death in developed countries with approximately a 30% of all global deaths. In order to address this public health concern, physicians focus on diagnosis and therapy planning. On one hand, early and accurate detection of Regional Wall Motion Abnormalities (RWMA) significantly contributes to a quick diagnosis and prevents the patient to reach more severe stages. On the other hand, a thouroughly knowledge of the normal gross anatomy of the LV, as well as, the distribution of its muscular fibers is crucial for designing specific interventions and therapies (such as pacemaker implanction). Statistical models obtained from the analysis of different imaging modalities allow the computation of the normal ranges of variation within a given population. Normality models are a valuable tool for the definition of objective criterions quantifying the degree of (anomalous) deviation of the LV function and anatomy for a given subject. The creation of statistical models involve addressing three main issues: extraction of data from images, definition of a common domain for comparison of data across patients and designing appropriate statistical analysis schemes. In this PhD thesis we present generic image processing tools for the creation of statistical models of the LV anatomy and function. On one hand, we use differential geometry concepts to define a computational framework (the Normalized Parametric Domain, NPD) suitable for the comparison and fusion of several clinical scores obtained over the LV. On the other hand, we present a variational approach (the Harmonic Phase Flow, HPF) for the estimation of myocardial motion that provides dense and continuous vector fields without overestimating motion at injured areas. These tools are used for the creation of statistical models. Regarding anatomy, we obtain an atlas jointly modelling, both, LV gross anatomy and fiber architecture. Regarding function, we compute normality patterns of scores characterizing the (global and local) LV function and explore, for the first time, the configuration of local scores better suited for RWMA detection.

Abstract: Cardiac magnetic resonance imaging (Cardiac MRI) has become a gold standard diagnostic technique for the assessment of cardiac mechanics, allowing the non-invasive calculation of left ventric- ular long axis longitudinal shortening (LVLS) and absolute myocardial torsion (AMT) between basal and apical left ventricular slices, a movement directly related to the helicoidal anatomic disposition of the myocardial fibers. The aim of this study is to determine AMT and LVLS behaviour and normal values from a group of healthy subjects. A group of 21 healthy volunteers (15 males) (age: 23–55 y.o., mean:30.7 ± 7.5) were prospectively included in an obser- vational study by Cardiac MRI. Left ventricular rotation (degrees) was calculated by custom-made software (Harmonic Phase Flow) in consecutive LV short axis planes tagged cine-MRI sequences. AMT was determined from the difference between basal and apical planes LV rotations. LVLS (%) was determined from the LV longitudinal and horizontal axis cine-MRI images. All the 21 cases studied were interpretable, although in three cases the value of the LV apical rotation could not be determined. The mean rotation of the basal and apical planes at end-systole were -3.71° ± 0.84° and 6.73° ± 1.69° (n:18) respectively, resulting in a LV mean AMT of 10.48° ± 1.63° (n:18). End-systolic mean LVLS was 19.07 ± 2.71%. Cardiac MRI allows for the calculation of AMT and LVLS, fundamental functional components of the ventricular twist mechanics conditioned, in turn, by the anatomical helical layout of the myocardial fibers. These values provide complementary information about systolic ventricular function in relation to the traditional parameters used in daily practice.

Abstract: Presentamos una experiencia en Aprendizaje Basado en Proyectos (ABP) realizada los últimos cuatro años en Gráficos por Computador 2, asignatura de Ingeniería Informática, de la Escuela Técnica Superior de Ingeniería (ETSE) de la Universidad Autónoma de Barcelona (UAB). Utilizamos un entorno Moodle adaptado por nosotros llamado Caronte para poder gestionar la documentación generada en ABP. Primero se presenta la asignatura, basada en dos itinerarios para cursarla: ABP y TPPE (Teoría, Problemas, Prácticas, Examen). El alumno debe escoger uno de ellos. Ambos itinerarios generan una cantidad importante de documentación (entregas de trabajos y prácticas, correcciones, ejercicios, etc.) a gestionar. En la comunicación presentamos los espacios electrónicos Moodle de ambos itinerarios. Finalmente, mostramos los resultados de encuestas realizadas a los alumnos para finalmente exponer las conclusiones de la experiencia en ABP y el uso de Moodle, así como plantear mejoras y temas de discusión.

Abstract: Early diagnosis and accurate treatment of Left Ventricle (LV) dysfunction significantly increases the patient survival. Impairment of LV contractility due to cardiovascular diseases is reflected in its motion patterns. Recent advances in medical imaging, such as Magnetic Resonance (MR), have encouraged research on 3D simulation and modelling of the LV dynamics. Most of the existing 3D models [1] consider just the gross anatomy of the LV and restore a truncated ellipse which deforms along the cardiac cycle. The contraction mechanics of any muscle strongly depends on the spatial orientation of its muscular fibers since the motion that the muscle undergoes mainly takes place along the fibers. It follows that such simplified models do not allow evaluation of the heart electro-mechanical function and coupling, which has recently risen as the key point for understanding the LV functionality [2]. In order to thoroughly understand the LV mechanics it is necessary to consider the complete anatomy of the LV given by the orientation of the myocardial fibres in 3D space as described by Torrent Guasp [3].
We propose developing a 3D patient-sensitive model of the LV integrating, for the first time, the ven- tricular band anatomy (fibers orientation), the LV gross anatomy and its functionality. Such model will represent the LV function as a natural consequence of its own ventricular band anatomy. This might be decisive in restoring a proper LV contraction in patients undergoing pace marker treatment.
The LV function is defined as soon as the propagation of the contractile electromechanical pulse has been modelled. In our experiments we have used the wave equation for the propagation of the electric pulse. The electromechanical wave moves on the myocardial surface and should have a conductivity tensor oriented along the muscular fibers. Thus, whatever mathematical model for electric pulse propa- gation [4] we consider, the complete anatomy of the LV should be extracted.
The LV gross anatomy is obtained by processing multi slice MR images recorded for each patient. Information about the myocardial fibers distribution can only be extracted by Diffusion Tensor Imag- ing (DTI), which can not provide in vivo information for each patient. As a first approach, we have
Figure 1: Scheme for the Left Ventricle Patient-Sensitive Model.
computed an average model of fibers from several DTI studies of canine hearts. This rough anatomy is the input for our electro-mechanical propagation model simulating LV dynamics. The average fiber orientation is updated until the simulated LV motion agrees with the experimental evidence provided by the LV motion observed in tagged MR (TMR) sequences. Experimental LV motion is recovered by applying image processing, differential geometry and interpolation techniques to 2D TMR slices [5]. The pipeline in figure 1 outlines the interaction between simulations and experimental data leading to our patient-tailored model.

Abstract: Distortion of Left Ventricle (LV) external anatomy is related to some dysfunctions, such as hypertrophy. The architecture of myocardial fibers determines LV electromechanical activation patterns as well as mechanics. Thus, their joined modelling would allow the design of specific interventions (such as peacemaker implantation and LV remodelling) and therapies (such as resynchronization). On one hand, accurate modelling of external anatomy requires either a dense sampling or a continuous infinite dimensional approach, which requires non-Euclidean statistics. On the other hand, computation of fiber models requires statistics on Riemannian spaces. Most approaches compute separate statistical models for external anatomy and fibers architecture. In this work we propose a general mathematical framework based on differential geometry concepts for computing a statistical model including, both, external and fiber anatomy. Our framework provides a continuous approach to external anatomy supporting standard statistics. We also provide a straightforward formula for the computation of the Riemannian fiber statistics. We have applied our methodology to the computation of complete anatomical atlas of canine hearts from diffusion tensor studies. The orientation of fibers over the average external geometry agrees with the segmental description of orientations reported in the literature.