@article{8767533,
  abstract     = {{Background: Shear wave elastography (SWE) is a promising technique to non-invasively assess myocardial stiffness based on the propagation speed of mechanical waves. However, a high wave propagation speed can either be attributed to an elevated intrinsic myocardial stiffness or to a preload-induced increase in operational stiffness. Objective: Our objective was to find a way to discriminate intrinsic myocardial stiffening from stiffening caused by an increased pressure in SWE. Methods: We used the finite element method to study the shear wave propagation patterns when stiffness and/or pressure is elevated, compared to normal stiffness and pressure. Numerical findings were verified in a few human subjects. Results: The transmural wave speed gradient was able to distinguish changes in intrinsic stiffness from those induced by differing hemodynamic load (a speed of +/- 3.2 m/s in parasternal short-axis (PSAX) view was associated with a wave speed gradient of -0.17 +/- 0.15 m/s/mm when pressure was elevated compared to 0.04 +/- 0.05 m/s/mm when stiffness was elevated). The gradient however decreased when stiffness increased (decrease with a factor 3 in PSAX when stiffness doubled at 20 mmHg). The human data analysis confirmed the presence of a wave speed gradient in a patient with elevated ventricular pressure. Conclusion: Cardiac SWE modeling is a useful tool to gain additional insights into the complex wave physics and to guide post-processing. The transmural differences in wave speed may help to distinguish loading-induced stiffening from intrinsic stiffness changes. Significance: The transmural wave speed gradient has potential as a new diagnostic parameter for future clinical studies.}},
  author       = {{Caenen, Annette and Bezy, Stephanie and Petrescu, Aniela and Werner, Annegret and Voigt, Jens-Uwe and Dhooge, Jan and Segers, Patrick}},
  issn         = {{0018-9294}},
  journal      = {{IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING}},
  keywords     = {{Biomedical Engineering,operational stiffness,intrinsic stiffness,hemodynamic loading,finite element model,Cardiac shear wave elastography}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{259--270}},
  title        = {{Transmural wave speed gradient may distinguish intrinsic myocardial stiffening from preload-induced changes in operational stiffness in shear wave elastography}},
  url          = {{http://doi.org/10.1109/tbme.2022.3188441}},
  volume       = {{70}},
  year         = {{2023}},
}

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