Pablo Lamata

• Wellcome Senior Research Fellow and Prof. in Biomedical Engineering
• Lecturer at King's College London

An unresolved issue in patients with diastolic dysfunction is that the estimation of myocardial stiffness cannot be decoupled from diastolic residual active tension (AT) because of the impaired ventricular relaxation during diastole. To address this problem, this paper presents a method for estimating diastolic mechanical parameters of the left ven...

Background: Preterm birth leads to an early switch from fetal to postnatal circulation before completion of left ventricular in utero development. In animal studies, this results in an adversely remodeled left ventricle. We determined whether preterm birth is associated with a distinct left ventricular structure and function in humans. Methods an...

To describe the assessment of the spatiotemporal distribution of relative aortic pressure quantifying the magnitude of its three major components. Nine healthy volunteers and three patients with aortic disease (bicuspid aortic valve, dissection, and Marfan syndrome) underwent 4D-flow CMR. Spatiotemporal pressure maps were computed from the CMR flow...

Background—Transvalvular peak pressure drops are routinely assessed noninvasively by echocardiography using the Bernoulli principle. However, the Bernoulli principle relies on several approximations that may not be appropriate, including that the majority of the pressure drop is because of the spatial acceleration of the blood ow, and the ejection...

Providing therapies tailored to each patient is the vision of precision medicine, enabled by the increasing ability to capture extensive data about individual patients. In this position paper, we argue that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the 'digital twi...

Large-cohort imaging and diagnostic studies often assess cardiac function but overlook underlying biological mechanisms. Cardiac digital twins (CDTs) are personalized physics-constrained and physiology-constrained in silico representations, uncovering multi-scale insights tied to these mechanisms. In this study, we constructed 3,461 CDTs from the U...

Background There is a clinical need in heart failure diagnostics to have a non-invasive measure of left ventricular (LV) filling pressure. Echocardiographic parameters may be used to differentiate between normal and elevated left ventricular (LV) filling pressure, but do not provide a quantitative estimate of the filling pressure. Purpose To estab...

Aim To establish an imaging-based method to quantify left ventricular (LV) diastolic pressures. Methods/results In 115 patients suspected of coronary artery disease, LV pressure was measured by micromanometers and images by echocardiography. LV filling pressure was measured as LV pre-atrial contraction pressure (pre-A PLV). Based on previous obser...

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...

Background A non-invasive clinical method for construction of the systolic part of the left ventricular (LV) pressure curve was recently introduced. There is, however, no clinical method available to construct the LV diastolic pressure curve. Purpose The aim of this study was construction of patient-specific LV diastolic pressure curves from echoc...

Introduction Cardiac anatomy, including heart size, position and orientation within the torso, is known to impact ECG morphology. Understanding the relationship between cardiac anatomy and ECG morphology through their main axes has the potential to lead to more accurate and reliable ECG biomarkers. Nevertheless, there is no standardised method for...

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...

We investigate the utility of diffusion generative models to efficiently synthesise datasets that effectively train deep learning models for image analysis. Specifically, we propose novel $\Gamma$-distribution Latent Denoising Diffusion Models (LDMs) designed to generate semantically guided synthetic cardiac ultrasound images with improved computat...

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...

Background: Left ventricular (LV) hypertrophy occurs in both aortic stenosis (AS) and systemic hypertension (HTN) in response to wall stress. However, differentiation of hypertrophy due to these 2 etiologies is lacking. The aim was to study the 3-dimensional geometric remodeling pattern in severe AS pre- and postsurgical aortic valve replacement a...

BACKGROUND It remains unknown to what extent intrinsic atrial cardiomyopathy or left ventricular diastolic dysfunction drive atrial remodeling and functional failure in heart failure with preserved ejection fraction (HFpEF). Computational 3-dimensional (3D) models fitted to cardiovascular magnetic resonance allow state-of-the-art anatomic and funct...

Smartphones possess the potential to become widely available stethoscopes for cardiac diagnosis due to their audio processing capabilities and widespread usage. However, the quality of signals collected by phones should be characterised and compared to the signals collected by clinical stethoscopes. To this ends, this study compares the characteris...

Background Preconception or antenatal lifestyle interventions in women with obesity may prevent adverse cardiovascular outcomes in the child, including cardiac remodelling. We undertook a systematic review of the existing data to examine the impact of randomised controlled trials of lifestyle interventions in pregnant women with obesity on offsprin...

Open surgical repair, often in the form of endarterectomy, is still the gold standard for steno-occlusive disease in the common femoral artery, despite the success of lower-risk endovascular alternatives in other peripheral arterial regions. Stenting in the common femoral artery is not widely adopted due to the proximity of the artery to the mobile...

This study aims at identifying risk-related patterns of left ventricular contraction dynamics via novel volume transient characterization. A multicenter cohort of AMI survivors (n = 1021) who underwent Cardiac Magnetic Resonance (CMR) after infarction was considered for the study. The clinical endpoint was the 12-month rate of major adverse cardiac...

Aims: Hypertensive patients of African-ancestry (Afr-a) have higher incidences of heart failure and worse clinical outcomes than hypertensive patients of European-ancestry (Eu-a), yet the underlying mechanisms remain misunderstood. This study investigated right (RV) and left (LV) ventricular remodeling alongside myocardial tissue derangements betw...

BACKGROUND Preeclampsia is a multiorgan disease of pregnancy that has short- and long-term implications for the woman and fetus, whose immediate impact is poorly understood. We present a novel multiorgan approach to magnetic resonance imaging (MRI) investigation of preeclampsia, with the acquisition of maternal cardiac, placental, and fetal brain a...

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...

Background: Left ventricular (LV) hypertrophy occurs in both aortic stenosis (AS) and systemic hypertension (HTN) in response to wall stress. However, differentiation of hypertrophy due to these two aetiologies is lacking, as well as an understanding of the impact of surgical aortic valve replacement (AVR). The aim was to study the 3-dimensional ge...

Large-cohort studies using cardiovascular imaging and diagnostic datasets have assessed cardiac anatomy, function, and outcomes, but typically do not reveal underlying biological mechanisms. Cardiac digital twins (CDTs) provide personalized physics- and physiology- constrained in-silico representations, enabling inference of multi-scale properties...

Computational models for cardiac electro-mechanics have been increasingly used to further understand heart function. Small cohort and single patient computational studies provide useful insight into cardiac pathophysiology and response to therapy. However, these smaller studies have limited capability to capture the high level of anatomical variabi...

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...

We propose a novel pipeline for the generation of synthetic ultrasound images via Denoising Diffusion Probabilistic Models (DDPMs) guided by cardiac semantic label maps. We show that these synthetic images can serve as a viable substitute for real data in the training of deep-learning models for ultrasound image analysis tasks such as cardiac segme...

Traditionally, congestive heart failure was phenotyped by echocardiography or other imaging techniques according to left ventricular ejection fraction (LVEF). The more recent echocardiographic modality speckle tracking strain is complementary to LVEF, as it is more sensitive to diagnose mild systolic dysfunction. Furthermore, when LV systolic dysfu...

Computational models of the heart are now being used to assess the effectiveness and feasibility of interventions through in-silico clinical trials (ISCTs). As the adoption and acceptance of ISCTs increases, best practices for reporting the methodology and analysing the results will emerge. Focusing in the area of cardiology, we aim to evaluate the...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): MRC. Background Cardiac catheterisation is the gold standard for assessing cardiac pressures. However, this is an invasive and costly procedure. A minimally invasive alternative may be to use the subharmonic signal of microbubble ultra...

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...

Atrial fibrillation (AF) is associated with stroke and heart failure, and poses a significant global health burden. Consequently, efforts remain ongoing in better characterising and understanding AF and its underlying mechanisms. This study explores cardiac energetics associated with AF by testing the hypothesis that left ventricular stroke work an...

Objective: Automated detection of foreshortening, a common challenge in routine 2-D echocardiography, has the potential to improve quality of acquisitions and reduce the variability of left ventricular measurements. Acquiring and labelling the required training data is challenging due to the time-intensive and highly subjective nature of foreshort...

Maternal obesity is known to increase the risk of congenital abnormalities and alter growth of the offspring.1 However, little is known about the impact of maternal obesity on baby’s cardiac development in the womb. Controversy remains over the relative roles of adverse nutritional exposures during pregnancy, inherited genes from mum, and a shared...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This project is supported by the Wellcome Trust and EPSRC Centre for Medical Engineering. Background QRS duration derived from 12-lead ECGs provides an estimate of the ventricular depolarization time and is an important metric to asses...

We propose a novel pipeline for the generation of synthetic images via Denoising Diffusion Probabilistic Models (DDPMs) guided by cardiac ultrasound semantic label maps. We show that these synthetic images can serve as a viable substitute for real data in the training of deep-learning models for medical image analysis tasks such as image segmentati...

This chapter deals with important considerations to factor in when translating technical advances in AI to real clinical workflows. The importance of considering existing workflows is emphasized, including identifying and addressing the right question and assessing positive and negative impacts on patients. The important issue of data provenance is...

Background Machine learning analysis of complex myocardial scar patterns affords the potential to enhance risk prediction of life-threatening arrhythmia in stable coronary artery disease (CAD).Objective To assess the utility of computational image analysis, alongside a machine learning (ML) approach, to identify scar microstructure features on late...

Aortic stenosis is a condition which is fatal if left untreated. Novel quantitative imaging techniques which better characterise transvalvular pressure drops are being developed but require refinement and validation. A customisable and cost-effective workbench valve phantom circuit capable of replicating valve mechanics and pathology was created. T...

Background Decisions in the management of aortic stenosis are based on the peak pressure drop, captured by Doppler echocardiography, whereas gold standard catheterization measurements assess the net pressure drop but are limited by associated risks. The relationship between these two measurements, peak and net pressure drop, is dictated by the pres...

Post-myocardial infarction (MI) patients are at risk of major adverse cardiac events (MACE), with risk stratification primarily based on global image-based biomarkers, such as ejection fraction, in current clinical practice. However, these metrics neglect more subtle and localized shape differences in 3D cardiac anatomy and function, which limit pr...

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...

During a cardiac cycle, the heart anatomy undergoes a series of complex 3D deformations, which can be analyzed to diagnose various cardiovascular pathologies including myocardial infarction. While volume-based metrics such as ejection fraction are commonly used in clinical practice to assess these deformations globally, they only provide limited in...

Background: Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) offers the potential to noninvasively characterize the phenotypic substrate for sudden cardiac death (SCD). Objectives: The authors assessed the utility of infarct characterization by CMR, including scar microstructure analysis, to predict SCD in patients with coronar...

Background: Maternal obesity during pregnancy is associated with poorer cardiovascular health (CVH) in children. A strategy to improve CVH in children could be to address preconception maternal obesity by means of a lifestyle intervention. We determined if a preconception lifestyle intervention in women with obesity improved offspring's CVH, asses...

Cardiac anatomy and function vary considerably across the human population with important implications for clinical diagnosis and treatment planning. Consequently, many computer-based approaches have been developed to capture this variability for a wide range of applications, including explainable cardiac disease detection and prediction, dimension...

Background Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patte...

Aims Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by dynamic obstruction of the left ventricular (LV) outflow tract (LVOT). Although this may be mediated by interplay between the hypertrophied septal wall, systolic anterior motion of the mitral valve, and papillary muscle abnormalities, the mechanistic role of LV shape is still n...

Magnetic Resonance Imaging (MRI) has been used as an effective tool for breast cancer evaluation due to its high sensitiveness to detect breast tumors. However, these MRIs are performed with the patient lying prone, while the tumor resection surgery is performed with the patient lying in supine position. The breast undergoes large deformations due...

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...

Previous patient-specific model calibration techniques have treated each patient independently, making the methods expensive for large-scale clinical adoption. In this work, we show how we can reuse simulations to accelerate the patient-specific model calibration pipeline. To represent anatomy, we used a Statistical Shape Model and to represent fun...

Left ventricular outflow tract obstruction (LVOTO) is common in hypertrophic cardiomyopathy (HCM), but relationships between anatomical metrics and obstruction are poorly understood. We aimed to develop machine learning methods to evaluate LVOTO in HCM patients and quantify relationships between anatomical metrics and obstruction. This retrospectiv...

Background Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of incident heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). This has been related to higher prevalence of HTN-related target organ damage, including high level of circulating cardiac troponins, which is not full...

Background Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). Compelling evidence suggests that left ventricular (LV) remodelling and hypertrophy are more prevalent in Afr-a than Eu-a hypertensives due to either a high clu...

Accurate geometric quantification of the human heart is a key step in the diagnosis of numerous cardiac diseases, and in the management of cardiac patients. Ultrasound imaging is the primary modality for cardiac imaging, however acquisition requires high operator skill, and its interpretation and analysis is difficult due to artifacts. Reconstructi...

Simpson's biplane rule (SBR) is considered the gold standard method for left ventricle (LV) volume quantification from echocardiography but relies on a summation-of-disks approach that makes assumptions about LV orientation and cross-sectional shape. We aim to identify key limiting factors in SBR and to develop a new robust standard for volume quan...

Aims Smartphones are equipped with a high-quality microphone which may be used as an electronic stethoscope. We aim to investigate the factors influencing quality of heart sound recorded using a smartphone by non-medical users. Methods and results An app named Echoes was developed for recording heart sounds using iPhone. Information on phone versi...

Management of chest wall defects after oncologic resection can be challenging, depending on the size and location of the defect, as well as the method of reconstruction. This report presents the first clinical case where patient-specific rib prostheses were created using a computer program and statistical shape model of human ribs. A 64-year-old ma...

Accurate geometric quantification of the human heart is a key step in the diagnosis of numerous cardiac diseases, and in the management of cardiac patients. Ultrasound imaging is the primary modality for cardiac imaging, however acquisition requires high operator skill, and its interpretation and analysis is difficult due to artifacts. Reconstructi...

Abstract Background Transvalvular pressure drops are assessed using Doppler echocardiography for the diagnosis of heart valve disease. However, this method is highly user-dependent and may overestimate transvalvular pressure drops by up to 54%. This work aimed to assess transvalvular pressure drops using velocity fields derived from blood speckle i...

Patients with advanced cancer undergoing chest wall resection may require reconstruction. Currently, rib prostheses are created by segmenting computed tomography images, which is time-consuming and labour intensive. The aim was to optimise the production of digital rib models based on a patient's age, weight, height and gender. A statistical shape...

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Background: Approximately 10% of infants are born preterm. Preterm birth leads to short and long-term changes in cardiac shape and function. By using a rat model of neonatal high-oxygen (80%O2) exposure, mimicking the premature hyperoxic transition to the extrauterine environment, we revealed a major role of the renin-angiotensin system peptide An...

Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of de...

The heart is the organ in charge of pumping blood to the rest of the body. But the heart can get sick, and we want to know how to best mend it. Sometimes, doctors can give medicines or do heart surgery to treat heart problems. But some medicines may not work for everyone, and surgeries can be very difficult. Now we have special computer games to be...

Introduction The CARP study aims to investigate placental function, cardiac function and fetal growth comprehensively during pregnancy, a time of maximal cardiac stress, to work towards disentangling the complex cardiac and placental interactions presenting in the aetiology of pre-eclampsia as well as predicting maternal Cardiovascular Disease (CVD...

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...

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): PIC from European Union"s Horizon 2020 Marie Skłodowska-Curie Actions ITN Background The wall thickness of the left ventricle (LV) is an important parameter in the diagnosis of hypertension and more specifically in hypertrophic cardiomyopathy. A...

Background Transvalvular pressure drops are assessed using Doppler echocardiography for the diagnosis of heart valve disease. However, this method is highly user-dependent and may overestimate transvalvular pressure drops by up to 54%. This work aimed to assess transvalvular pressure drops using velocity fields derived from blood speckle imaging (B...

Objectives This study aimed to identify novel 3-dimensional (3D) imaging end-systolic (ES) shape and contraction descriptors toward risk-related features and superior prognosis in acute myocardial infarction (AMI). Background Left ventricular ejection fraction (LVEF) and end-systolic volume (ESV) remain the main imaging biomarkers for post-AMI ris...

Aims: Statistical shape models (SSMs) of cardiac anatomy provide a new approach for analysis of cardiac anatomy. In adults, specific cardiac morphologies associate with cardiovascular risk factors and early disease stages. However, the relationships between morphology and risk factors in children remain unknown. We propose an SSM of the paediatric...

Aims Remodelling of the left ventricular (LV) shape is one of the hallmarks of non-ischaemic dilated cardiomyopathy (DCM) and may contribute to ventricular arrhythmias and sudden cardiac death. We sought to investigate a novel three dimensional (3D) shape analysis approach to quantify LV remodelling for arrhythmia prediction in DCM. Methods and re...

Ventricular-vascular interaction is central in the adaptation to cardiovascular disease. However, cardiomyopathy patients are predominantly monitored using cardiac biomarkers. The aim of this study is therefore to explore aortic function in dilated cardiomyopathy (DCM). Fourteen idiopathic DCM patients and 16 controls underwent cardiac magnetic res...

Objectives The purpose of this study was to establish whether an artificially intelligent (AI) system can be developed to automate stress echocardiography analysis and support clinician interpretation. Background Coronary artery disease is the leading global cause of mortality and morbidity and stress echocardiography remains one of the most commo...

Uni-dimensional Doppler echocardiography data provide the mainstay of quantative assessment of aortic stenosis, with the transvalvular pressure drop a key indicator of haemodynamic burden. Sophisticated methods of obtaining velocity data, combined with improved computational analysis, are facilitating increasingly robust and reproducible measuremen...

Introduction: “Le Coeur en Sabot” (or the boot-shaped heart) is a radiological description of the appearance of the heart on a plain radiograph of a patient with Tetralogy of Fallot. This highlights the importance of the shape of the heart. Maladaptive remodeling is known to occur in patients with repaired Tetralogy of Fallot (rToF) due to residual...

Lead position is an important factor in determining response to Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure (HF) patients. Multipoint pacing (MPP) enables pacing from multiple electrodes within the same lead, improving the potential outcome for patients. Virtual quadripolar lead designs were evaluated by simulating pacin...

Background Black African/African-Caribbean individuals with hypertension (BH) are at greater risk of heart failure than those of white European ethnicity (WH). The mechanisms underlying this dissimilarity remain poorly understood. Purpose To investigate the influence of ethnicity on left ventricular (LV) remodelling using multi-parametric cardiova...