18
JAmSocEchocardiogr. 2013Sep;26(9):1013-32.
Expert consensus for multi-modality imaging evaluation of
cardiovascular complications of radiotherapy in adults: a
report from the European Association of Cardiovascular Ima-
gingand theAmericanSocietyof Echocardiography.
Lancellotti P, NkomoVT, Badano LP, Bergler J, Bogaert J, Davin L, Cosyns B, CouckeP, Dulgheru
R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port
SC, Scherrer-CrosbieM, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC; European Society
of CardiologyWorking Groups on Nuclear Cardiology and Cardiac Computed Tomography and
CardiovascularMagneticResonance;AmericanSocietyofNuclearCardiology, Society forCardio-
vascularMagneticResonance, andSocietyof CardiovascularComputedTomography.
Abstract
Cardiac toxicity isoneof themost concerningsideeffectsof anti-cancer therapy. Thegain in life
expectancy obtainedwith anti-cancer therapy canbe compromisedby increasedmorbidity and
mortality associatedwith its cardiac complications. While radiosensitivity of the heart was ini-
tially recognizedonly in theearly1970s, theheart is regarded in thecurrenteraasoneof themost
critical dose-limitingorgans in radiotherapy. Several clinical studieshave identifiedadverseclini-
cal consequencesof radiation-inducedheartdisease (RIHD)on theoutcomeof long-termcancer
survivors. A comprehensive review of potential cardiac complications related to radiotherapy is
warranted. An evidence-based review of several imaging approaches used to detect, evaluate,
andmonitor RIHD isdiscussed. Recommendations for the early identificationandmonitoringof
cardiovascular complicationsof radiotherapybycardiac imagingarealsoproposed.
PLoSOne. 2013Jun3;8(6):e65146.
Simulation of left atrial function using amulti-scalemodel of
thecardiovascular system
Pironet A, DaubyPC, PaemeS, KostaS, ChaseJG, DesaiveT.
Abstract
During a full cardiac cycle, the left atrium successively behaves as a reservoir, a conduit and a
pump. This complex behaviormakes it unrealistic to apply the time-varying elastance theory to
characterize the leftatrium, first, because this theoryhasknown limitations, andsecond, because
it is still uncertain whether the load independence hypothesis holds. In this study, we aim to
bypass this uncertainty by relyingon another kindofmathematicalmodel of the cardiac cham-
bers. In thepresentwork,wedescribeboth the left atriumand the left ventriclewithamulti-scale
model. Themulti-scalepropertyof thismodel comes from the fact that pressure insideacardiac
chamber isderived fromamodel of thesarcomerebehavior.Macroscopicmodel parametersare
identified from reference dog hemodynamic data. Themulti-scalemodel of the cardiovascular
system including the left atrium is then simulated to show that the physiological roles of the
left atriumare correctly reproduced. This includeabiphasicpressurewaveandaneight-shaped
pressure-volume loop.Wealso test the validityof ourmodel innonbasal conditionsby reprodu-
cingapreload reductionexperiment by inferior venacavaocclusionwith themodel.Wecompute
the variation of eight indices before and after this experiment and obtain the same variation as
experimentally observed for seven out of the eight indices. In summary, themulti-scalemathe-
matical model presented in this work is able to correctly account for the three roles of the left
atrium and also exhibits a realistic left atrial pressure-volume loop. Furthermore, themodel has
been previously presented and validated for the left ventricle. Thismakes it a proper alternative
to the time-varyingelastance theory if the focus isset onprecisely representing the left atrial and
left ventricular behaviors.
Multi-scale cardiovascular systemmodel. A curve describing intracellular calcium concentration is used as
input toa sarcomeremodel. Forcegeneratedby the sarcomeres is converted topressureusingageometrical
model. This approach is applied to both the left ventricle and the left atrium. These two compartments are
inserted inaclosed-loopcardiovascular systemmodel.
