ORIGINAL RESEARCH published: 22 March 2022 doi: 10.3389/fcvm.2022.828556 Frontiers in Cardiovascular Medicine | www.frontiersin.org 1 March 2022 | Volume 9 | Article 828556 Edited by: Muralidhar Padala, Emory University, United States Reviewed by: Brooks Lane, Emory University, United States Gediminas Gaidulis, Emory University, United States Milan Toma, New York Institute of Technology College of Osteopathic Medicine, United States *Correspondence: Lukas Obermeier lukas.obermeier@charite.de †These authors share last authorship Specialty section: This article was submitted to Cardiovascular Imaging, a section of the journal Frontiers in Cardiovascular Medicine Received: 03 December 2021 Accepted: 03 February 2022 Published: 22 March 2022 Citation: Obermeier L, Vellguth K, Schlief A, Tautz L, Bruening J, Knosalla C, Kuehne T, Solowjowa N and Goubergrits L (2022) CT-Based Simulation of Left Ventricular Hemodynamics: A Pilot Study in Mitral Regurgitation and Left Ventricle Aneurysm Patients. Front. Cardiovasc. Med. 9:828556. doi: 10.3389/fcvm.2022.828556 CT-Based Simulation of Left Ventricular Hemodynamics: A Pilot Study in Mitral Regurgitation and Left Ventricle Aneurysm Patients Lukas Obermeier 1*, Katharina Vellguth 1, Adriano Schlief 1, Lennart Tautz 1,2, Jan Bruening 1, Christoph Knosalla 3,4,5, Titus Kuehne 1,4,6, Natalia Solowjowa 3† and Leonid Goubergrits 1,7† 1 Institute of Computer-Assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany, 2 Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany, 3 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany, 4 DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany, 5 Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Berlin, Germany, 6 Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany, 7 Einstein Center Digital Future, Berlin, Germany Background: Cardiac CT (CCT) is well suited for a detailed analysis of heart structures due to its high spatial resolution, but in contrast to MRI and echocardiography, CCT does not allow an assessment of intracardiac ﬂow. Computational ﬂuid dynamics (CFD) can complement this shortcoming. It enables the computation of hemodynamics at a high spatio-temporal resolution based on medical images. The aim of this proposed study is to establish a CCT-based CFD methodology for the analysis of left ventricle (LV) hemodynamics and to assess the usability of the computational framework for clinical practice. Materials and Methods: The methodology is demonstrated by means of four cases selected from a cohort of 125 multiphase CCT examinations of heart failure patients. These cases represent subcohorts of patients with and without LV aneurysm and with severe and no mitral regurgitation (MR). All selected LVs are dilated and characterized by a reduced ejection fraction (EF). End-diastolic and end-systolic image data was used to reconstruct LV geometries with 2D valves as well as the ventricular movement. The intraventricular hemodynamics were computed with a prescribed-motion CFD approach and evaluated in terms of large-scale ﬂow patterns, energetic behavior, and intraventricular washout. Results: In the MR patients, a disrupted E-wave jet, a fragmentary diastolic vortex formation and an increased speciﬁc energy dissipation in systole are observed. In all cases, regions with an impaired washout are visible. The results furthermore indicate that considering several cycles might provide a more detailed view of the washout process. The pre-processing times and computational expenses are in reach of clinical feasibility. Conclusion: The proposed CCT-based CFD method allows to compute patient-speciﬁc intraventricular hemodynamics and thus complements the informative value of CCT. The method can be applied to any CCT data of