Adelaide De Vecchi

• Aeronautical Engineering
• King's College London

Atrial fibrillation (AF), impacting nearly 50 million individuals globally, is a major contributor to ischaemic strokes, predominantly originating from the left atrial appendage (LAA). Current clinical scores like CHA₂DS₂-VASc, while useful, provide limited insight into the pro-thrombotic mechanisms of Virchow's triad—blood stasis, endothelial dama...

Atrial fibrillation (AF) is the most common heart arrhythmia, linked to a five‐fold increase in stroke risk. The left atrial appendage (LAA), prone to blood stasis, is a common thrombus formation site in AF patients. The LAA can be classified into four morphologies: broccoli, cactus, chicken wing and windsock. Stroke risk prediction in AF typically...

We evaluated the performance of statistical shape models (SSMs) derived from short-axis (SAX) cardiac magnetic resonance imaging (CMR) to estimate pulmonary capillary wedge pressure (PCWP) in a cohort of 68 cases with heart failure with preserved ejection fraction (HFpEF) and dyspnea. We obtained a 5% improvement in performance (R2 = 0.36) using 3...

The last decade has witnessed a substantial growth in percutaneous treatment options for heart valve disease. The development in these innovative therapies has been mirrored by advances in multi-detector computed tomography (MDCT). MDCT plays a central role in obtaining detailed pre-procedural anatomical information, helping to inform clinical deci...

Accurate prenatal diagnosis of coarctation of the aorta (CoA) is challenging due to high false positive rate burden and poorly understood aetiology. Despite associations with abnormal blood flow dynamics, fetal arch anatomy changes and alterations in tissue properties, its underlying mechanisms remain a longstanding subject of debate hindering diag...

Atrial Fibrillation (AF) is the most common type of cardiac arrhythmia. Most AF-related thrombi originate within the left atrial appendage (LAA). This study investigated the key factors influencing thrombus formation in the LAA using global sensitivity analysis (GSA) based on computational fluid dynamics (CFD) simulations. GSA was conducted to asse...

Pulmonary Hypertension (PH) is a progressive condition affecting the right heart, defined by a mean pulmonary arterial pressure (mPAP) greater than 20 mmHg. Measuring mPAP with a pressure catheter is the gold standard for diagnosing PH despite its associated costs and risks. As an alternative, this work investigates the inference of mPAP from pulmo...

Accurate velocity reconstruction is essential for assessing coronary artery disease. We propose a Gaussian process method to reconstruct the velocity profile using the sparse data of the positron emission particle tracking (PEPT) in a biological environment, which allows the measurement of tracer particle velocity to infer fluid velocity fields. We...

Background Atrial fibrillation (AF) is an age-related cardiac arrythmia that underlies one third of all strokes, with thromboemboli commonly originating from the left atrial appendage (LAA). Personalised in-silico modelling of Virchow’s triad (blood stasis, hypercoagulability and endothelial damage) can improve stroke risk assessment metrics, such...

This paper proposes a fully-automated technique for estimation of an antenatal risk score for Coarctation of the Aorta (CoA) from fetal T2-weighted 3D cardiac magnetic resonance imaging (CMR). Our framework combines automated multi-class fetal cardiac vessel segmentation based on two fully-labelled atlases (control and CoA) with statistical shape a...

Communication between clinicians and patients and communication within clinical teams is widely recognized as a tool through which improved patient outcomes can be achieved. As emerging technologies, there is a notable lack of commentary on the role of immersive virtual reality (VR) and augmented reality (AR) in enhancing medical communication. Thi...

Atrial fibrillation (AF) is a widespread cardiac disease associated with a high risk of thromboembolic stroke. Clinically applicable stroke-risk stratification schemes can be improved with a mechanistic understanding of the underlying thrombogenicity induced by AF – blood stasis, hypercoagulability and endothelial damage – known as Virchow’s triad....

Coarctation of the aorta (CoA) is a prevalent congenital heart defect. Its prenatal diagnosis is challenging, with high false positive rates. The exact cause of CoA is yet not fully understood. Recent research has provided novel insights into the anatomical determinants of CoA based on the in-utero arch anatomy. However, it is also recognized that...

The gold-standard for pulmonary hypertension (PH) diagnosis is invasive right-heart catheterisation, a technique ill-suited for general patient screening. Noninvasive markers of PH are thus of direct clinical value. Using 4D Flow Magnetic Resonance Imaging (MRI), a recent empirical correlation has been observed between the duration of a blood vorte...

Statistical shape modelling and classification methods are used to study characteristic disease phenotypes, to derive novel shape biomarkers, and to extract insights into disease mechanisms. Linear classification models are commonly chosen due to their ability to provide a single score, as well as easy-to-interpret characteristic shapes. In disease...

Atrial fibrillation (AF) underlies almost one third of all ischaemic strokes, with the left atrial appendage (LAA) identified as the primary thromboembolic source. Current stroke risk stratification approaches, such as the CHA2DS2-VASc score, rely mostly on clinical comorbidities, rather than thrombogenic mechanisms such as blood stasis, hypercoagu...

Atrial fibrillation (AF) is associated with a significantly increased risk of stroke due to the presence of three pro-thrombotic mechanisms known as Virchow’s triad – blood stasis, endothelial damage and hypercoagulability – which primarily occur in the left atrial appendage (LAA). In-silico evaluation of each factor can improve upon the current em...

Background Atrial fibrillation (AF) is responsible for almost one third of all strokes, with the left atrial appendage (LAA) being the primary thromboembolic source due to localised stimulation of prothrombotic mechanisms; blood stasis, hypercoagulability and endothelial damage, known as Virchow's triad. Aim We propose an in-silico modelling pipel...

Introduction Transcatheter mitral valve replacement is a promising alternative to open-heart surgery in elderly patients. Patients with severe mitral annulus calcification (MAC) are a particularly high-risk population, where postprocedural complications can have catastrophic effects. Amongst these, obstruction of the left ventricular outflow tract...

Neonatal coarctation of the aorta (CoA) is a common congenital heart defect. Its antenatal diagnosis remains challenging, and its pathophysiology is poorly understood. We present a novel statistical shape modeling (SSM) pipeline to study the role and predictive value of arch shape in CoA in utero. Cardiac magnetic resonance imaging (CMR) data of 11...

Background Atrial fibrillation (AF) is responsible for almost one third of all strokes, with the left atrial appendage (LAA) being the primary thromboembolic source due to localised stimulation of prothrombotic mechanisms; blood stasis, hypercoagulability and endothelial damage, known as Virchow's triad. Aim We propose an in-silico modelling pipel...

Atrial fibrillation (AF) is associated with a significantly increased risk of stroke due to the presence of three pro-thrombotic mechanisms known as Virchow's triad-blood stasis, endothelial damage and hypercoagulability-which primarily occur in the left atrial appendage (LAA). In-silico evaluation of each factor can improve upon the current empiri...

The staged surgical palliation of the hypoplastic left heart syndrome (HLHS) has revolutionised the treatment of this otherwise fetal congenital heart disease. One of the major barriers to a systematic risk assessment is the considerable variability in the approach to surgery that still exists between centres. This multiplicity of treatment choices...

Aortic surgeries in congenital conditions, such as hypoplastic left heart syndrome (HLHS), aim to restore and maintain the conduit and reservoir functions of the aorta. We proposed a method to assess these two functions based on 4D flow MRI, and we applied it to study the aorta in pre-Fontan HLHS. Ten pre-Fontan HLHS patients and six age-matched co...

In this paper, a time-periodic MGRIT algorithm is proposed as a means to reduce the time-to-solution of numerical algorithms by exploiting the time periodicity inherent to many applications in science and engineering. The time-periodic MGRIT algorithm is applied to a variety of linear and nonlinear single- and multiphysics problems that are periodi...

Atrial fibrillation (AF) is a major cause of stroke and there has been much interest in the underlying mechanisms leading to this higher risk of thrombus formation. The latter risk correlates with four morphologies of the left atrial appendage (LAA), i.e. chicken wing (CW), broccoli (BR), cactus (CA) and windsock (WS). We present a mechanistic stud...

In this paper, a time-periodic MGRIT algorithm is proposed as a means to reduce the time-to-solution of numerical algorithms by exploiting the time periodicity inherent to many applications in science and engineering. The time-periodic MGRIT algorithm is applied to a variety of linear and nonlinear single- and multiphysics problems that are periodi...

Recent dose reduction techniques have made retrospective computed tomography (CT) scans more applicable and extracting myocardial function from cardiac computed tomography (CCT) images feasible. However, hyperparameters of generic image intensity-based registration techniques, which are used for tracking motion, have not been systematically optimis...

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): NIHR i4i funded 3D Heart project Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z] Onbehalf 3D Heart Project Background/Introduction: Virtual Reality (VR) for surgical and interventional planning in the treatment of Congenital Heart Disease (CHD) is an...

Atrial fibrillation (AF) is a widespread arrhythmia responsible for deterioration of left atrial (LA) mechanical function. Sinus rhythm (SR) can be restored by terminating AF using catheter ablation (CA) therapy. CA often targets fibrotic tissue by creating scar tissue which is similar to fibrosis. We hypothesise that myocardial strain can be used...

Intracardiac blood flow is driven by differences in relative pressure, and assessing these is critical in understanding cardiac disease. Non-invasive image-based methods exist to assess relative pressure, however, the complex flow and dynamically moving fluid domain of the intracardiac space limits assessment. Recently, we proposed a method, νWERP,...

Atrial fibrillation (AF) diminishes left atrial (LA) mechanical function and impairs blood flow. The latter can lead to blood stasis and increased risk of thrombus formation and stroke. We investigate this risk by studying the effects of LA flow in sinus rhythm (SR) and AF on blood coagulation dynamics. Patient-specific computational fluid dynamics...

Personalised medicine is based on the principle that each body is unique and will respond to therapies differently. In cardiology, characterising patient specific cardiovascular properties would help in personalising care. One promising approach for characterising these properties relies on performing computational analysis of multimodal imaging da...

Despite medical advancements, the prognosis of patients with heart failure remains poor. While echocardiography and cardiac magnetic resonance imaging remain at the forefront of diagnosing and monitoring patients with heart failure, cardiac computed tomography (CT) has largely been considered to have a limited role. With the advancements in scanner...

Vortices in AF: The video shows the velocity magnitude field overlaid with red velocity vectors on a plane cut intersecting the MV, RPV, LPV and the LAA for patient A in AF. The video shows a single relatively slow vortex moving anti-clockwise in the middle of the LA cavity.

Vortices in SR: The video shows the velocity magnitude field overlaid with red velocity vectors on a plane cut intersecting the MV, RPV, LPV and the LAA for patient A in SR. The video shows multiple fast moving, short-lived vortices created at peak systole, one is seen between the LPV and RPV (left) and another one near the LAA (top right). This is...

Introduction: Atrial fibrillation (AF) is a widespread cardiac arrhythmia that commonly affects the left atrium (LA), causing it to quiver instead of contracting effectively. This behavior is triggered by abnormal electrical impulses at a specific site in the atrial wall. Catheter ablation (CA) treatment consists of isolating this driver site by bu...

Abstract Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models...

Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) results from progressive thrombotic occlusion of the pulmonary arteries. It is treated by surgical removal of the occlusion, with success rates depending on the degree of microvascular remodeling. Surgical eligibility is influenced by the contributions of both the thrombus occlusio...

Background: Children with a single systemic right ventricle, such as in hypoplastic left heart syndrome (HLHS), frequently experience reduced exercise capacity. Elucidating the causes could help with optimising treatment strategies. Methods: Prospective data from 10 consecutive symptomatic patients with HLHS undergoing clinical cardiac magnetic...

Current state-of-the-art imaging techniques can provide quantitative information to characterize ventricular function within the limits of the spatiotemporal resolution achievable in a realistic acquisition time. These imaging data can be used to personalize computer models, which in turn can help treatment planning by quantifying biomarkers that c...

Ageing has important deleterious effects on the cardiovascular system. We sought to compare intra-ventricular kinetic energy (KE) in healthy subjects of varying ages to subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. 4D flow MRI was acquired in 35 healthy subjects (ag...

We demonstrate a new method to recover 4D blood flow over the entire ventricle from partial blood velocity measurements using multiple 3D+t colour Doppler images and ventricular wall motion estimated using 3D+t BMode images. We apply our approach to realistic simulated data to ascertain the ability of the method to deal with incomplete data, as typ...

Accurate measurement of blood pressure is important because it is a biomarker for cardiovascular disease. Diagnostic catheterization is routinely used for pressure acquisition in vessels despite being subject to significant measurement errors. To investigate these errors, this study compares pressure measurement using two different techniques in vi...

We propose a new method to recover 3D time-resolved velocity vectors within the left ventricle (LV) using a combination of multiple registered 3D colour Doppler images and LV wall motion. Incorporation of wall motion, calculated from 3D B-Mode images, and the use of a multi-scale reconstruction framework allow recovery of 3D velocity over the entir...

Cardiac diseases represent one of the primary causes of mortality and result in a substantial decrease in quality of life. Optimal surgical planning and long-term treatment are crucial for a successful and cost-effective patient care. Recently developed state-of-the-art imaging techniques supply a wealth of detailed data to support diagnosis. This...

Pediatric patients with hypoplastic left heart syndrome rely solely on the right ventricle, resulting in anatomic maladaptations that can significantly compromise diastolic efficiency and lead to heart failure. Clinical indices to evaluate diastole are generally derived from the adult left ventricle, limiting their relevance to patients with hypopl...

The loss of cardiac pump function accounts for a significant increase in both mortality and morbidity in Western society, where there is currently a one in four lifetime risk, and costs associated with acute and long-term hospital treatments are accelerating. The significance of cardiac disease has motivated the application of state-of-the-art clin...

LVAD implantation is often used to assist patients suffering heart failure. These devices profoundly alter ventricular behaviour, however, the precise impact on the myocardium and on ventricular blood flow remains unknown. We have developed an anatomically accurate coupled fluidmechanical model of the left ventricle under LVAD support to enhance un...

Three-dimensional numerical simulations are presented of flow past a curved body at a Reynolds number of 100. The geometry consists of a circular cross-sectioned body, whose centreline axis is prescribed by a quarter ring with a horizontal extension. This plane of curvature of the body is aligned to the free-stream flow direction such that the oute...

The fundamental mechanism of vortex shedding past a curved cylinder has been investigated at a Reynolds number of 100 using three-dimensional spectral/hp computations. Two different configurations are presented herein:in both cases the main component of the geometry is a circular cylinder whose centreline is a quarter of a ring and the inflow direc...

Three-dimensional spectral/hp computations have been performed to study the fundamental mechanisms of vortex shedding in the wake of curved circular cylinders at Reynolds numbers of 100 and 500. The basic shape of the body is a circular cylinder whose centreline sweeps through a quarter section of a ring and the inflow direction lies on the plane o...