{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T08:06:01Z","timestamp":1792829161907,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ricerca Finalizzata from the Italian Ministry of Health grant number","award":["GR-2011-02348129"],"award-info":[{"award-number":["GR-2011-02348129"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The left ventricle (LV) constantly changes its shape and function as a response to pathological conditions, and this process is known as remodeling. In the presence of aortic stenosis (AS), the degenerative process is not limited to the aortic valve but also involves the remodeling of LV. Statistical shape analysis (SSA) offers a powerful tool for the visualization and quantification of the geometrical and functional patterns of any anatomic changes. In this paper, a SSA method was developed to determine shape descriptors of the LV under different degrees of AS and thus to shed light on the mechanistic link between shape and function. A total of n=86 patients underwent computed tomography (CT) for the evaluation of valvulopathy were segmented to obtain the LV surface and then were automatically aligned to a reference template by rigid registrations and transformations. Shape modes of the anatomical LV variation induced by the degree of AS were assessed by principal component analysis (PCA). The first shape mode represented nearly 50% of the total variance of LV shape in our patient population and was mainly associated to a spherical LV geometry. At Pearson\u2019s analysis, the first shape mode was positively correlated to both the end-diastolic volume (p&lt;0.01, R=0.814) and end-systolic volume (p&lt;0.01, and R=0.922), suggesting LV impairment in patients with severe AS. A predictive model built with PCA-related shape modes achieved better performance in stratifying the occurrence of adverse events with respect to a baseline model using clinical demographic data as risk predictors. This study demonstrated the potential of SSA approaches to detect the association of complex 3D shape features with functional LV parameters.<\/jats:p>","DOI":"10.3390\/bioengineering8050066","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T11:10:06Z","timestamp":1620904206000},"page":"66","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["On the Left Ventricular Remodeling of Patients with Stenotic Aortic Valve: A Statistical Shape Analysis"],"prefix":"10.3390","volume":"8","author":[{"given":"Salvatore","family":"Cutugno","sequence":"first","affiliation":[{"name":"Dipartimento di Ingegneria (DING), Universit\u00e0 degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Ingrassia","sequence":"additional","affiliation":[{"name":"Dipartimento di Ingegneria (DING), Universit\u00e0 degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Nigrelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Ingegneria (DING), Universit\u00e0 degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4841-2560","authenticated-orcid":false,"given":"Salvatore","family":"Pasta","sequence":"additional","affiliation":[{"name":"Dipartimento di Ingegneria (DING), Universit\u00e0 degli Studi di Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1038\/nrcardio.2010.202","article-title":"Epidemiology of valvular heart disease in the adult","volume":"8","author":"Iung","year":"2011","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.105.552844","article-title":"Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis","volume":"113","author":"Allison","year":"2006","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.jacc.2013.05.015","article-title":"Aortic stenosis in the elderly: Disease prevalence and number of candidates for transcatheter aortic valve replacement: A meta-analysis and modeling study","volume":"62","author":"Osnabrugge","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Keshavarz-Motamed, Z., Garc\u00eda, J., Gaillard, E., Capoulade, R., Le Ven, F., Cloutier, G., Kadem, L., and Pibarot, P. (2014). Non-invasive determination of left ventricular workload in patients with aortic stenosis using magnetic resonance imaging and Doppler echocardiography. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0086793"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2911","DOI":"10.1007\/s10439-017-1915-4","article-title":"In Vivo Strain Analysis of Dilated Ascending Thoracic Aorta by ECG-Gated CT Angiographic Imaging","volume":"45","author":"Pasta","year":"2017","journal-title":"Ann. Biomed. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.compbiomed.2015.09.011","article-title":"Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair","volume":"66","author":"Rinaudo","year":"2015","journal-title":"Comput. Biol. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1111\/echo.13236","article-title":"Aortic Valve Disease and Vascular Mechanics: Two-Dimensional Speckle Tracking Echocardiographic Analysis","volume":"33","author":"Leite","year":"2016","journal-title":"Echocardiography"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.compbiomed.2018.07.013","article-title":"Comparison of hemodynamic and structural indices of ascending thoracic aortic aneurysm as predicted by 2-way FSI, CFD rigid wall simulation and patient-specific displacement-based FEA","volume":"100","author":"Mendez","year":"2018","journal-title":"Comput. Biol. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E92","DOI":"10.1111\/aor.12866","article-title":"Three-dimensional parametric modeling of bicuspid aortopathy and comparison with computational flow predictions","volume":"41","author":"Pasta","year":"2017","journal-title":"Artif. Organs"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pasta, S., Cannata, S., Gentile, G., Ingrassia, T., Nigrelli, V., and Gandolfo, C. (2020). CAD Modeling for Evaluating LVOT Obstruction in Transcatheter Mitral Valve Replacement. Design Tools and Methods in Industrial Engineering. ADM 2019, Spinger. Lecture Notes in Mechanical Engineering.","DOI":"10.1007\/978-3-030-31154-4_66"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1038\/nrcardio.2011.154","article-title":"Cardiac remodeling at the population level\u2013risk factors, screening, and outcomes","volume":"8","author":"Gjesdal","year":"2011","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cosentino, F., Raffa, G.M., Gentile, G., Agnese, V., Bellavia, D., Pilato, M., and Pasta, S. (2020). Statistical Shape Analysis of Ascending Thoracic Aortic Aneurysm: Correlation between Shape and Biomechanical Descriptors. J. Pers. Med., 10.","DOI":"10.3390\/jpm10020028"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s11548-012-0787-1","article-title":"4D statistical shape modeling of the left ventricle in cardiac MR images","volume":"8","author":"Roohi","year":"2013","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1109\/JBHI.2017.2652449","article-title":"Statistical shape modeling of the left ventricle: Myocardial infarct classification challenge","volume":"22","author":"Suinesiaputra","year":"2018","journal-title":"IEEE J. Biomed. Health Inform."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.athoracsur.2020.03.017","article-title":"Stress and Aortic Strain Associations with Biomarkers of Ascending Thoracic Aortic Aneurysm","volume":"110","author":"Pasta","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1109\/JBHI.2014.2370952","article-title":"Big heart data: Advancing health informatics through data sharing in cardiovascular imaging","volume":"19","author":"Suinesiaputra","year":"2015","journal-title":"IEEE J. Biomed. Health Inform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","article-title":"ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"38","author":"Baumgartner","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.injury.2018.03.004","article-title":"Virtual simulation of an osseointegrated trans-humeral prosthesis: A falling scenario","volume":"49","author":"Mirulla","year":"2018","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ingrassia, T., Nigrelli, V., Ricotta, V., and Tartamella, C. (2017). Process parameters influence in additive manufacturing. Advances on Mechanics, Design Engineering and Manufacturing, Spinger. Lecture Notes in Mechanical Engineering.","DOI":"10.1007\/978-3-319-45781-9_27"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/0954411915574012","article-title":"Mechanics of pericardial effusion: A simulation study","volume":"229","author":"Scardulla","year":"2015","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s13239-018-0358-x","article-title":"Modeling Right Ventricle Failure After Continuous Flow Left Ventricular Assist Device: A Biventricular Finite-Element and Lumped-Parameter Analysis","volume":"9","author":"Scardulla","year":"2018","journal-title":"Cardiovasc. Eng. Technol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/MAT.0000000000000683","article-title":"Biomechanical Determinants of Right Ventricular Failure in Pulmonary Hypertension","volume":"64","author":"Scardulla","year":"2018","journal-title":"ASAIO J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/0954411915617984","article-title":"Evaluation of ventricular wall stress and cardiac function in patients with dilated cardiomyopathy","volume":"230","author":"Scardulla","year":"2016","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5465","DOI":"10.1016\/j.jmatprotec.2009.05.001","article-title":"Residual stresses and FCP prediction in FSW through a continuous FE model","volume":"209","author":"Fratini","year":"2009","journal-title":"J. Mater. Process. Technol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s00170-011-3510-4","article-title":"Residual stresses in friction stir welded parts of complex geometry","volume":"59","author":"Fratini","year":"2012","journal-title":"Int. J. Adv. Manuf. Technol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ingrassia, T., Nalbone, L., Nigrelli, V., Pisciotta, D., and Ricotta, V. (2017). Influence of the metaphysis positioning in a new reverse shoulder prosthesis. Advances on Mechanics, Design Engineering and Manufacturing, Spinger. Lecture Notes in Mechanical Engineering.","DOI":"10.1007\/978-3-319-45781-9_47"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bruse, J.L., for the Modeling of Congenital Hearts Alliance (MOCHA) Collaborative Group, McLeod, K., Biglino, G., Ntsinjana, H.N., Capelli, C., Hsia, T.-Y., Sermesant, M., Pennec, X., and Taylor, A.M. (2016). A statistical shape modelling framework to extract 3D shape biomarkers from medical imaging data: Assessing arch morphology of repaired coarctation of the aorta. BMC Med. Imaging, 16.","DOI":"10.1186\/s12880-016-0142-z"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/0002-9149(60)90084-9","article-title":"Heart failure from the point of view of quantitative anatomy","volume":"5","author":"Linzbach","year":"1960","journal-title":"Am. J. Cardiol."},{"key":"ref_29","first-page":"100547","article-title":"Left Ventricular Sphericity Index is a reproducible bedside echocardiographic measure of geometric change between acute phase Takotsubo\u2019s syndrome and acute anterior myocardial infarction","volume":"29","author":"Khanna","year":"2018","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.amjcard.2004.07.110","article-title":"Relation of left ventricular sphericity to 10-year survival after acute myocardial infarction","volume":"94","author":"Wong","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1161\/CIRCULATIONAHA.106.657270","article-title":"Theoretical impact of the injection of material into the myocardium: A finite element model simulation","volume":"114","author":"Wall","year":"2006","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1161\/CIRCULATIONAHA.112.126920","article-title":"Preterm heart in adult life: Cardiovascular magnetic resonance reveals distinct differences in left ventricular mass, geometry, and function","volume":"127","author":"Augustine","year":"2013","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zhang, X., Cowan, B.R., Bluemke, D.A., Finn, J.P., Fonseca, C.G., Kadish, A.H., Lee, D.C., Lima, J.A.C., Suinesiaputra, A., and Young, A.A. (2014). Atlas-based quantification of cardiac remodeling due to myocardial infarction. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110243"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.media.2015.11.004","article-title":"Shape analysis of hypertrophic and hypertensive heart disease using MRI-based 3D surface models of left ventricular geometry","volume":"29","author":"Ardekani","year":"2016","journal-title":"Med. Image Anal."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Piras, P., Evangelista, A., Gabriele, S., Nardinocchi, P., Teresi, L., Torromeo, C., Schiariti, M.S.M., Varano, V., and Puddu, P.E. (2014). 4D-analysis of left ventricular heart cycle using procrustes motion analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0086896"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.athoracsur.2016.06.041","article-title":"Looks Do Matter! Aortic Arch Shape After Hypoplastic Left Heart Syndrome Palliation Correlates with Cavopulmonary Outcomes","volume":"103","author":"Bruse","year":"2017","journal-title":"Ann. Thorac. Surg."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/8\/5\/66\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:00:25Z","timestamp":1760162425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/8\/5\/66"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,13]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["bioengineering8050066"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering8050066","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,13]]}}}