72 | Chapter 4 global under- or overestimation of ventricular tissue properties but is not expected to have a significant effect on the heterogeneity in RVfw tissue properties. The deformation measurements were obtained from four different heartbeats. We did not correct for any measurement errors, such as timing errors between the four echo views, beatto-beat variability, or respiration. Future studies could investigate how to design an objective function using strain indices or other measurements, such as valve timings, blood flow velocity or ejection fraction, to develop a more efficient fitting algorithm with an objective function invariant of measurement uncertainties. Future Work A longitudinal study, in which follow-up data is included, should be performed to reveal whether and how this disease substrate progresses in individuals, and whether any kind of disease evolution could be used for prediction of arrhythmic outcome in a clinical setting. The majority of this retrospective study cohort consisted of PKP2 mutation carriers. Future prospective verification studies are needed to confirm our findings and to determine whether our results can be extrapolated to AC patients with a different genetic background. The CircAdapt model is not limited to modelling AC disease substrates, so future work could also explore to which extent this framework is applicable to identify disease substrates in other cardiac pathologies. CONCLUSION We presented a patient-specific modelling approach and showed its ability to reproduce regional ventricular deformation patterns and to estimate the underlying tissue properties in AC mutation carriers. Patient-specific simulations revealed that regional RV deformation abnormalities were related to reduced contractile function and tissue compliance. In most subjects, a characteristic apex-to-base heterogeneity of tissue abnormalities was present, whereby the basal region of the RVfw was most affected. Tissue abnormalities were most pronounced in the subjects with a clinically more advanced disease stage. Future studies should investigate whether simulation-based characterization of patient-specific disease substrates can be used for personalised prediction of AC disease progression or arrhythmic events.
RkJQdWJsaXNoZXIy MTk4NDMw