Applied Sciences  
Article  
Comprehensive Assessment of Left Intraventricular  
Hemodynamics Using a Finite Element Method:  
An Application to Dilated Cardiomyopathy Patients  
[PERSON] 1,2,3R, [PERSON] 1,3,4, [PERSON] 1,3,5, [PERSON] 6,7R, [PERSON] 6, [PERSON] 8,9, [PERSON] 3,10, [PERSON] 3,11,12R and [PERSON] 1,3,5,*  
Biomedical Imaging Center, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago 7820436, Chile; [EMAIL_ADDRESS] (P.F. ); [EMAIL_ADDRESS] (J.S. ); [EMAIL_ADDRESS] (C.M.) Electrical Engineering Department, School of Engineering, Pontificia Universidad Catolica de Chile, Santiago 7820436, Chile  
Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago 7820436, Chile; [EMAIL_ADDRESS] (M.J.); [EMAIL_ADDRESS] (D.H.)  
School of Biomedical Engineering, Universidad de Valparaiso, Valparaiso 2362905, Chile  
Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 833023, Chile  
Guy's and St Thomas' NHS Foundation Trust, London SE1 7 EH, UK; [EMAIL_ADDRESS] (B.R. ); [EMAIL_ADDRESS] (E.K.) School of Imaging Sciences and Biomedical Engineering, Faculty of Science of Life and Medicine, King's College London, London WC2R 2 LS, UK  
Division of Biomedical Engineering and Imaging Sciences, Department of Biomedical Engineering, King's College London, London WC2R 2 LS, UK; [EMAIL_ADDRESS]  
Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, North Campus Research Center, Ann Arbor, MI 48109, USA  
[PERSON] [PERSON]; [PERSON], [PERSON]; [PERSON] [PERSON]; [PERSON], [PERSON]; [PERSON] [PERSON]; [PERSON] [PERSON]; [PERSON] [PERSON] Comprehensive Assessment of Left Intraventricular  
Hemodynamics Using a Finite Element Method: An Application to Dilated Cardiomyopathy Patients. Applied Sciences  
process that alters the heart's size, geometry, and function is associated with increased hemodynamic demands, which cause abnormal mechanical stress in the muscle [3; 4]. The progression is associated with an incremented risk of heart failure and sudden cardiac death [5]. However, poor survival and high mortality rate reveal that effective treatment of DCM-related heart failure remains challenging. Pharmacological and resynchronization therapies have improved DCM treatment by halting disease progression and leading to reverse remodeling [1]. The preferred imaging technique for assessing the heat in DCM patients is cardiovascular magnetic resonance (CMR). CMR allows the acquisition of anatomical, cine, and velocity images, including 4D Flow MR [5; 6; 7; 8]. 4D Flow allows a qualitative and quantitative analysis of several hemodynamic parameters. It has been applied extensively in the great vessels, particularly in the aorta [9; 10; 11] and in the left ventricle (LV) for assessing intraventricular flow in some cardiovascular diseases [12; 13; 14; 15; 16; 17; 18; 19]. Previous studies have demonstrated that lower kinetic energy values in diastole are associated with the deterioration of ventricular filling, induced by morphological alteration commonly found in Fontan patients, mitral regurgitation, and LV dysfunction or remodeling [13; 14; 15]. Additionally, turbulent kinetic energy has shown a stronger association with the ventricle's remodeling in patients with Tetralogy of Fallot and higher values in DCM patients compared with normal subjects [16]. Vortex formation has been studied qualitatively (vortex size and location) and quantitatively (Lagrangian Coherent Structures and the curl of velocity) [17; 18; 19; 20]. These studies suggest that parameters associated with the 3D intraventricular flow may be critical for LV filling and ejection and could be relevant to the development of dilation, dysfunction, and prognosis in patients with heart diseases. While these measures have a potential role in describing intraventricular flow, the difficulties of implementing them have led to the analysis of only a few combinations of these parameters in a single cohort of patients [13; 14; 15; 17; 19].