Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approachCitation formats

TY - JOUR

T1 - Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach

AU - Carson, Jason M.

AU - Warrander, Lynne

AU - Johnstone, Edward

AU - Van Loon, Raol

PY - 2020/1/13

Y1 - 2020/1/13

N2 - Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness.Dopplerwaveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated, but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, e.g. wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared to the two patients who had normal pregnancy outcomes.

AB - Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness.Dopplerwaveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated, but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, e.g. wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared to the two patients who had normal pregnancy outcomes.

KW - uterine artery waveforms

KW - pregnancy

KW - personalized haemodynamic models

KW - parameter estimation

KW - preeclampsia

U2 - 10.1002/cnm.3267

DO - 10.1002/cnm.3267

M3 - Article

JO - International Journal for Numerical Methods in Biomedical Engineering

JF - International Journal for Numerical Methods in Biomedical Engineering

SN - 2040-7939

ER -