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Títol:	Patient-specific estimates of vascular and placental properties in growth-restricted fetuses based on a model of the fetal circulation
Autor/a:	Bijnens, Bart; García Cañadilla, Patricia, 1985-; Crispi Brillas, Fàtima; Cruz-Lemini, Mónica; Triunfo, Stefania; Nadal, Alfons; Valenzuela Alcaraz, Brenda; Rudenick, Paula A.; Gratacós Solsona, Eduard
Abstract:	Introduction: Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood-flow redistribution in order to maintain perfusion to the brain. However, some hemodynamic parameters that might be more directly related to staging of the disease cannot be measured non-invasively in clinical practice. For this, we developed a patient-specific model of the fetal circulation to estimate vascular properties of each individual. Methods: A lumped model of the fetal circulation was developed and personalized using measured echographic data from 37 normal and IUGR fetuses to automatically estimate model-based parameters. A multivariate regression analysis was performed to evaluate the association between the Doppler pulsatility indices (PI) and the model-based parameters. The correlation between model-based parameters and the placental lesions was analyzed in a set of 13 IUGR placentas. A logistic regression analysis was done to assess the added value of the model-based parameters relative to Doppler indices, for the detection of fetuses with adverse perinatal outcome. Results: The estimated model-based placental and brain resistances were respectively increased and reduced in IUGR fetuses while placental compliance was increased in IUGR fetus. Umbilical and middle cerebral arteries PIs were most associated with both placental resistance and compliance, while uterine artery PI was more associated with the placental compliance. The logistic regression analysis showed that the model added significant information to the traditional analysis of Doppler waveforms for predicting adverse outcome in IUGR. Discussion: The proposed patient-specific computational model seems to be a good approach to assess hemodynamic parameters than cannot be measured clinically.
Abstract:	This study was partly supported by grants from Ministerio de Economia y Competitividad (ref. SAF2012-37196); the Instituto de Salud Carlos III (ref. (PI11/01709, PI12/00801, PI14/00226) integrado en el Plan Nacional de I+D+I y cofinanciado por el ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER) “Otra manera de hacer Europa”; the EU FP7 for research, technological development and demonstration under grant agreement VP2HF (no 611823); The Cerebra Foundation for the Brain Injured Child (Carmarthen, Wales, UK); Obra Social “la Caixa” (Barcelona, Spain); P.G.C. was supported by the Programa de Ayudas Predoctorales de Formación en investigación en Salud (FI12/00362) from the Instituto Carlos III, Spain . M.C.L. and B.V.A. wish to express their gratitude to the Mexican National Council for Science and Technology (CONACyT, Mexico City, Mexico) for supporting their predoctoral stay at Hospital Clinic, Barcelona, Spain.
Matèries:	-Computational model -Fetal circulation -Doppler -Placental resistance
Drets:	© Elsevier http://dx.doi.org/10.1016/j.placenta.2015.07.130
Tipus de document:	Article Article - Versió acceptada
Publicat per:	Elsevier
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