1
|
Trayanova NA, Lyon A, Shade J, Heijman J. Computational modeling of cardiac electrophysiology and arrhythmogenesis: toward clinical translation. Physiol Rev 2024; 104:1265-1333. [PMID: 38153307 DOI: 10.1152/physrev.00017.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023] Open
Abstract
The complexity of cardiac electrophysiology, involving dynamic changes in numerous components across multiple spatial (from ion channel to organ) and temporal (from milliseconds to days) scales, makes an intuitive or empirical analysis of cardiac arrhythmogenesis challenging. Multiscale mechanistic computational models of cardiac electrophysiology provide precise control over individual parameters, and their reproducibility enables a thorough assessment of arrhythmia mechanisms. This review provides a comprehensive analysis of models of cardiac electrophysiology and arrhythmias, from the single cell to the organ level, and how they can be leveraged to better understand rhythm disorders in cardiac disease and to improve heart patient care. Key issues related to model development based on experimental data are discussed, and major families of human cardiomyocyte models and their applications are highlighted. An overview of organ-level computational modeling of cardiac electrophysiology and its clinical applications in personalized arrhythmia risk assessment and patient-specific therapy of atrial and ventricular arrhythmias is provided. The advancements presented here highlight how patient-specific computational models of the heart reconstructed from patient data have achieved success in predicting risk of sudden cardiac death and guiding optimal treatments of heart rhythm disorders. Finally, an outlook toward potential future advances, including the combination of mechanistic modeling and machine learning/artificial intelligence, is provided. As the field of cardiology is embarking on a journey toward precision medicine, personalized modeling of the heart is expected to become a key technology to guide pharmaceutical therapy, deployment of devices, and surgical interventions.
Collapse
Affiliation(s)
- Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aurore Lyon
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Julie Shade
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland, United States
| | - Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Tikenoğullar i OZ, Peirlinck M, Chubb H, Dubin AM, Kuhl E, Marsden AL. Effects of cardiac growth on electrical dyssynchrony in the single ventricle patient. Comput Methods Biomech Biomed Engin 2024; 27:1011-1027. [PMID: 37314141 PMCID: PMC10719423 DOI: 10.1080/10255842.2023.2222203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/15/2023]
Abstract
Single ventricle patients, including those with hypoplastic left heart syndrome (HLHS), typically undergo three palliative heart surgeries culminating in the Fontan procedure. HLHS is associated with high rates of morbidity and mortality, and many patients develop arrhythmias, electrical dyssynchrony, and eventually ventricular failure. However, the correlation between ventricular enlargement and electrical dysfunction in HLHS physiology remains poorly understood. Here we characterize the relationship between growth and electrophysiology in HLHS using computational modeling. We integrate a personalized finite element model, a volumetric growth model, and a personalized electrophysiology model to perform controlled in silico experiments. We show that right ventricle enlargement negatively affects QRS duration and interventricular dyssynchrony. Conversely, left ventricle enlargement can partially compensate for this dyssynchrony. These findings have potential implications on our understanding of the origins of electrical dyssynchrony and, ultimately, the treatment of HLHS patients.
Collapse
Affiliation(s)
- O. Z. Tikenoğullar i
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - M. Peirlinck
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - H. Chubb
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - A. M. Dubin
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
| | - E. Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - A. L. Marsden
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
- Department of Pediatrics (Cardiology), Stanford University, Stanford, California, USA
- Department of Bioengineering, Stanford University, Stanford, California, USA
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, California, USA
| |
Collapse
|
3
|
Myklebust L, Maleckar MM, Arevalo H. Fibrosis modeling choice affects morphology of ventricular arrhythmia in non-ischemic cardiomyopathy. Front Physiol 2024; 15:1370795. [PMID: 38567113 PMCID: PMC10986182 DOI: 10.3389/fphys.2024.1370795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction: Patients with non-ischemic cardiomyopathy (NICM) are at risk for ventricular arrhythmias, but diagnosis and treatment planning remain a serious clinical challenge. Although computational modeling has provided valuable insight into arrhythmic mechanisms, the optimal method for simulating reentry in NICM patients with structural disease is unknown. Methods: Here, we compare the effects of fibrotic representation on both reentry initiation and reentry morphology in patient-specific cardiac models. We investigate models with heterogeneous networks of non-conducting structures (cleft models) and models where fibrosis is represented as a dense core with a surrounding border zone (non-cleft models). Using segmented cardiac magnetic resonance with late gadolinium enhancement (LGE) of five NICM patients, we created 185 3D ventricular electrophysiological models with different fibrotic representations (clefts, reduced conductivity and ionic remodeling). Results: Reentry was induced by electrical pacing in 647 out of 3,145 simulations. Both cleft and non-cleft models can give rise to double-loop reentries meandering through fibrotic regions (Type 1-reentry). When accounting for fibrotic volume, the initiation sites of these reentries are associated with high local fibrotic density (mean LGE in cleft models: p< 0.001, core volume in non-cleft models: p = 0.018, negative binomial regression). In non-cleft models, Type 1-reentries required slow conduction in core tissue (non-cleftsc models) as opposed to total conduction block. Incorporating ionic remodeling in fibrotic regions can give rise to single- or double-loop rotors close to healthy-fibrotic interfaces (Type 2-reentry). Increasing the cleft density or core-to-border zone ratio in cleft and non-cleftc models, respectively, leads to increased inducibility and a change in reentry morphology from Type 2 to Type 1. Conclusions: By demonstrating how fibrotic representation affects reentry morphology and location, our findings can aid model selection for simulating arrhythmogenesis in NICM.
Collapse
|
4
|
Laubenbacher R, Mehrad B, Shmulevich I, Trayanova N. Digital twins in medicine. NATURE COMPUTATIONAL SCIENCE 2024; 4:184-191. [PMID: 38532133 PMCID: PMC11102043 DOI: 10.1038/s43588-024-00607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
Medical digital twins, which are potentially vital for personalized medicine, have become a recent focus in medical research. Here we present an overview of the state of the art in medical digital twin development, especially in oncology and cardiology, where it is most advanced. We discuss major challenges, such as data integration and privacy, and provide an outlook on future advancements. Emphasizing the importance of this technology in healthcare, we highlight the potential for substantial improvements in patient-specific treatments and diagnostics.
Collapse
Affiliation(s)
- R Laubenbacher
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | - B Mehrad
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - N Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
5
|
Trayanova NA, Prakosa A. Up digital and personal: How heart digital twins can transform heart patient care. Heart Rhythm 2024; 21:89-99. [PMID: 37871809 PMCID: PMC10872898 DOI: 10.1016/j.hrthm.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 10/25/2023]
Abstract
Precision medicine is the vision of health care where therapy is tailored to each patient. As part of this vision, digital twinning technology promises to deliver a digital representation of organs or even patients by using tools capable of simulating personal health conditions and predicting patient or disease trajectories on the basis of relationships learned both from data and from biophysics knowledge. Such virtual replicas would update themselves with data from monitoring devices and medical tests and assessments, reflecting dynamically the changes in our health conditions and the responses to treatment. In precision cardiology, the concepts and initial applications of heart digital twins have slowly been gaining popularity and the trust of the clinical community. In this article, we review the advancement in heart digital twinning and its initial translation to the management of heart rhythm disorders.
Collapse
Affiliation(s)
- Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland.
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
6
|
Ghonim S, Babu-Narayan SV. Use of Cardiovascular Magnetic Resonance for Risk Stratification in Repaired Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:393-403. [PMID: 38161667 PMCID: PMC10755838 DOI: 10.1016/j.cjcpc.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/30/2023] [Indexed: 01/03/2024]
Abstract
The risk of premature death in adult patients with repaired tetralogy of Fallot is real and not inconsiderable. From the third decade of life, the incidence of malignant ventricular arrhythmia (VA) is known to exponentially rise. Progressive adverse mechanoelectrical modelling because of years of volume and/or pressure overload from residual pulmonary valve dysfunction and ventricular scar creates the perfect catalyst for VA. Although potentially lifesaving, implantable cardiac defibrillators are associated with substantial psychological and physical morbidity. Better selection of patients most at risk of VA, so that implantable cardiac defibrillators are not inflicted on patients who will never need them, is therefore crucial and has inspired research on this topic for several decades. Cardiovascular magnetic resonance (CMR) enables noninvasive, radiation-free clinical assessment of anatomy and function, making it ideal for the lifelong surveillance of patients with congenital heart disease. Gold standard measurements of ventricular volumes and systolic function can be derived from CMR. Tissue characterization using CMR can identify a VA substrate and provides insight into myocardial disease. We detail risk factors for VA identified using currently available CMR techniques. We also discuss emerging and advanced CMR techniques that have not all yet translated into routine clinical practice. We review how CMR-defined predictors of VA in repaired tetralogy of Fallot can be incorporated into risk scores with other clinical factors to improve the accuracy of risk prediction and to allow for pragmatic clinical application. Finally, we discuss what the future may hold.
Collapse
Affiliation(s)
- Sarah Ghonim
- Adult Congenital Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
- National Heart Lung Institute, Imperial College London, London, United Kingdom
| | - Sonya V. Babu-Narayan
- Adult Congenital Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
- National Heart Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
7
|
Zhang Y, Zhang K, Prakosa A, James C, Zimmerman SL, Carrick R, Sung E, Gasperetti A, Tichnell C, Murray B, Calkins H, Trayanova NA. Predicting ventricular tachycardia circuits in patients with arrhythmogenic right ventricular cardiomyopathy using genotype-specific heart digital twins. eLife 2023; 12:RP88865. [PMID: 37851708 PMCID: PMC10584370 DOI: 10.7554/elife.88865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiac disease that leads to ventricular tachycardia (VT), a life-threatening heart rhythm disorder. Treating ARVC remains challenging due to the complex underlying arrhythmogenic mechanisms, which involve structural and electrophysiological (EP) remodeling. Here, we developed a novel genotype-specific heart digital twin (Geno-DT) approach to investigate the role of pathophysiological remodeling in sustaining VT reentrant circuits and to predict the VT circuits in ARVC patients of different genotypes. This approach integrates the patient's disease-induced structural remodeling reconstructed from contrast-enhanced magnetic-resonance imaging and genotype-specific cellular EP properties. In our retrospective study of 16 ARVC patients with two genotypes: plakophilin-2 (PKP2, n = 8) and gene-elusive (GE, n = 8), we found that Geno-DT accurately and non-invasively predicted the VT circuit locations for both genotypes (with 100%, 94%, 96% sensitivity, specificity, and accuracy for GE patient group, and 86%, 90%, 89% sensitivity, specificity, and accuracy for PKP2 patient group), when compared to VT circuit locations identified during clinical EP studies. Moreover, our results revealed that the underlying VT mechanisms differ among ARVC genotypes. We determined that in GE patients, fibrotic remodeling is the primary contributor to VT circuits, while in PKP2 patients, slowed conduction velocity and altered restitution properties of cardiac tissue, in addition to the structural substrate, are directly responsible for the formation of VT circuits. Our novel Geno-DT approach has the potential to augment therapeutic precision in the clinical setting and lead to more personalized treatment strategies in ARVC.
Collapse
Affiliation(s)
- Yingnan Zhang
- Department of Biomedical Engineering, Johns Hopkins UniversityBaltimoreUnited States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins UniversityBaltimoreUnited States
| | - Kelly Zhang
- Department of Biomedical Engineering, Johns Hopkins UniversityBaltimoreUnited States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins UniversityBaltimoreUnited States
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins UniversityBaltimoreUnited States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins UniversityBaltimoreUnited States
| | - Cynthia James
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | | | - Richard Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | - Eric Sung
- Department of Biomedical Engineering, Johns Hopkins UniversityBaltimoreUnited States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins UniversityBaltimoreUnited States
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins HospitalBaltimoreUnited States
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins UniversityBaltimoreUnited States
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins UniversityBaltimoreUnited States
| |
Collapse
|
8
|
Bhagirath P, Campos FO, Postema PG, Kemme MJB, Wilde AAM, Prassl AJ, Neic A, Rinaldi CA, Götte MJW, Plank G, Bishop MJ. Arrhythmogenic vulnerability of re-entrant pathways in post-infarct ventricular tachycardia assessed by advanced computational modelling. Europace 2023; 25:euad198. [PMID: 37421339 PMCID: PMC10481251 DOI: 10.1093/europace/euad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Substrate assessment of scar-mediated ventricular tachycardia (VT) is frequently performed using late gadolinium enhancement (LGE) images. Although this provides structural information about critical pathways through the scar, assessing the vulnerability of these pathways for sustaining VT is not possible with imaging alone.This study evaluated the performance of a novel automated re-entrant pathway finding algorithm to non-invasively predict VT circuit and inducibility. METHODS Twenty post-infarct VT-ablation patients were included for retrospective analysis. Commercially available software (ADAS3D left ventricular) was used to generate scar maps from 2D-LGE images using the default 40-60 pixel-signal-intensity (PSI) threshold. In addition, algorithm sensitivity for altered thresholds was explored using PSI 45-55, 35-65, and 30-70. Simulations were performed on the Virtual Induction and Treatment of Arrhythmias (VITA) framework to identify potential sites of block and assess their vulnerability depending on the automatically computed round-trip-time (RTT). Metrics, indicative of substrate complexity, were correlated with VT-recurrence during follow-up. RESULTS Total VTs (85 ± 43 vs. 42 ± 27) and unique VTs (9 ± 4 vs. 5 ± 4) were significantly higher in patients with- compared to patients without recurrence, and were predictive of recurrence with area under the curve of 0.820 and 0.770, respectively. VITA was robust to scar threshold variations with no significant impact on total and unique VTs, and mean RTT between the four models. Simulation metrics derived from PSI 45-55 model had the highest number of parameters predictive for post-ablation VT-recurrence. CONCLUSION Advanced computational metrics can non-invasively and robustly assess VT substrate complexity, which may aid personalized clinical planning and decision-making in the treatment of post-infarction VT.
Collapse
Affiliation(s)
- Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
- Department of Cardiology, St Thomas' Hospital, London SE1 7EH, UK
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Aurel Neic
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK
| |
Collapse
|
9
|
Zhang Y, Zhang K, Prakosa A, James C, Zimmerman SL, Carrick R, Sung E, Gasperetti A, Tichnell C, Murray B, Calkins H, Trayanova N. Predicting Ventricular Tachycardia Circuits in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy using Genotype-specific Heart Digital Twins. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.31.23290587. [PMID: 37398074 PMCID: PMC10312861 DOI: 10.1101/2023.05.31.23290587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiac disease that leads to ventricular tachycardia (VT), a life-threatening heart rhythm disorder. Treating ARVC remains challenging due to the complex underlying arrhythmogenic mechanisms, which involve structural and electrophysiological (EP) remodeling. Here, we developed a novel genotype-specific heart digital twin (Geno-DT) approach to investigate the role of pathophysiological remodeling in sustaining VT reentrant circuits and to predict the VT circuits in ARVC patients of different genotypes. This approach integrates the patient's disease-induced structural remodeling reconstructed from contrast-enhanced magnetic-resonance imaging and genotype-specific cellular EP properties. In our retrospective study of 16 ARVC patients with two genotypes: plakophilin-2 (PKP2, n = 8) and gene-elusive (GE, n = 8), we found that Geno-DT accurately and non-invasively predicted the VT circuit locations for both genotypes (with 100%, 94%, 96% sensitivity, specificity, and accuracy for GE patient group, and 86%, 90%, 89% sensitivity, specificity, and accuracy for PKP2 patient group), when compared to VT circuit locations identified during clinical EP studies. Moreover, our results revealed that the underlying VT mechanisms differ among ARVC genotypes. We determined that in GE patients, fibrotic remodeling is the primary contributor to VT circuits, while in PKP2 patients, slowed conduction velocity and altered restitution properties of cardiac tissue, in addition to the structural substrate, are directly responsible for the formation of VT circuits. Our novel Geno-DT approach has the potential to augment therapeutic precision in the clinical setting and lead to more personalized treatment strategies in ARVC.
Collapse
Affiliation(s)
- Yingnan Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Kelly Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stefan L Zimmerman
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Richard Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Natalia Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
10
|
Hawson J, Joshi S, Al-Kaisey A, Das SK, Anderson RD, Morton J, Kumar S, Kistler P, Kalman J, Lee G. Utility of cardiac imaging in patients with ventricular tachycardia. Indian Pacing Electrophysiol J 2023; 23:63-76. [PMID: 36958589 PMCID: PMC10160788 DOI: 10.1016/j.ipej.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
Ventricular tachycardia (VT) is a life-threatening arrhythmia that may be idiopathic or result from structural heart disease. Cardiac imaging is critical in the diagnostic workup and risk stratification of patients with VT. Data gained from cardiac imaging provides information on likely mechanisms and sites of origin, as well as risk of intervention. Pre-procedural imaging can be used to plan access route(s) and identify patients where post-procedural intensive care may be required. Integration of cardiac imaging into electroanatomical mapping systems during catheter ablation procedures can facilitate the optimal approach, reduce radiation dose, and may improve clinical outcomes. Intraprocedural imaging helps guide catheter position, target substrate, and identify complications early. This review summarises the contemporary imaging modalities used in patients with VT, and their uses both pre-procedurally and intra-procedurally.
Collapse
Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Subodh Joshi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Souvik K Das
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
11
|
Laudenschlager S, Cai XC. An inner-outer subcycling algorithm for parallel cardiac electrophysiology simulations. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3677. [PMID: 36573938 DOI: 10.1002/cnm.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/16/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
This paper explores cardiac electrophysiological simulations of the monodomain equations and introduces a novel subcycling time integration algorithm to exploit the structure of the ionic model. The aim of this work is to improve upon the efficiency of parallel cardiac monodomain simulations by using our subcycling algorithm in the computation of the ionic model to handle the local sharp changes of the solution. This will reduce the turnaround time for the simulation of basic cardiac electrical function on both idealized and patient-specific geometry. Numerical experiments show that the proposed approach is accurate and also has close to linear parallel scalability on a computer with more than 1000 processor cores. Ultimately, the reduction in simulation time can be beneficial in clinical applications, where multiple simulations are often required to tune a model to match clinical measurements.
Collapse
Affiliation(s)
| | - Xiao-Chuan Cai
- Department of Mathematics, University of Macau, Macau, China
| |
Collapse
|
12
|
Laredo M, Duthoit G, Sacher F, Anselme F, Audinet C, Bessière F, Bordachar P, Bouzeman A, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Extramiana F, Fauchier L, Hermida A, Gandjbakhch E, Garcia R, Gourraud JB, Guenancia C, Guy-Moyat B, Irles D, Iserin L, Jourda F, Koutbi L, Labombarda F, Ladouceur M, Lagrange P, Lellouche N, Mansourati J, Marquié C, Martins R, Massoulié G, Mathiron A, Maury P, Messali A, Milhem A, Mondoly P, Nguyen C, Ninni S, Pasquié JL, Pierre B, Pujadas P, Sellal JM, Thambo JB, Walton C, Winum P, Zakine C, Zhao A, Jouven X, Combes N, Marijon E, Waldmann V. Rapid ventricular tachycardia in patients with tetralogy of Fallot and implantable cardioverter-defibrillator: Insights from the DAI-T4F nationwide registry. Heart Rhythm 2023; 20:252-260. [PMID: 36309156 DOI: 10.1016/j.hrthm.2022.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In repaired tetralogy of Fallot (TOF), little is known about characteristics of patients with rapid ventricular tachycardia (VT). Also, whether patients with a first episode of nonrapid VT may subsequently develop rapid VT or ventricular fibrillation (VF) has not been addressed. OBJECTIVES The objectives of this study were to compare patients with rapid VT/VF with those with nonrapid VT and to assess the evolution of VT cycle lengths (VTCLs) overtime. METHODS Data were analyzed from a nationwide registry including all patients with TOF and implantable cardioverter-defibrillator (ICD) since 2000. Patients with ≥1 VT episode with VTCL ≤250 ms (240 beats/min) formed the rapid VT/VF group. RESULTS Of 144 patients (mean age 42.0 ± 12.7 years; 104 [72%] men), 61 (42%) had at least 1 VT/VF episode, including 28 patients with rapid VT/VF (46%), during a median follow-up of 6.3 years (interquartile range 2.2-10.3 years). Compared with patients in the nonrapid VT group, those in the rapid VT/VF group were significantly younger at ICD implantation (35.2 ± 12.6 years vs 41.5 ± 11.2 years; P = .04), had more frequently a history of cardiac arrest (8 [29%] vs 2 [6%]; P = .02), less frequently a history of atrial arrhythmia (11 [42%] vs 22 [69%]; P = .004), and higher right ventricular ejection fraction (43.3% ± 10.3% vs 36.6% ± 11.2%; P = .04). The median VTCL of VT/VF episodes was 325 ms (interquartile range 235-429 ms). None of the patients with a first documented nonrapid VT episode had rapid VT/VF during follow-up. CONCLUSION Patients with TOF and rapid VT/VF had distinct clinical characteristics. The relatively low variation of VTCL over time suggests a room for catheter ablation without a backup ICD in selected patients with well-tolerated VT.
Collapse
Affiliation(s)
- Mikael Laredo
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Guillaume Duthoit
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Frédéric Sacher
- LIRYC Institute, Bordeaux University Hospital, Bordeaux, France
| | | | | | | | | | | | | | | | - Morgane Chassignolle
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France
| | - Gaël Clerici
- Saint Pierre University Hospital, La Réunion, France
| | | | | | | | | | | | | | | | | | - Estelle Gandjbakhch
- Unité de Rythmologie, Cardiology institute, Sorbonne University, AP-HP, La Pitié-Salpêtrière University Hospital, Paris, France
| | | | | | | | | | | | - Laurence Iserin
- Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | - Magalie Ladouceur
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Jouven
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | | | - Eloi Marijon
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France.
| | | |
Collapse
|
13
|
Galappaththige S, Gray RA, Costa CM, Niederer S, Pathmanathan P. Credibility assessment of patient-specific computational modeling using patient-specific cardiac modeling as an exemplar. PLoS Comput Biol 2022; 18:e1010541. [PMID: 36215228 PMCID: PMC9550052 DOI: 10.1371/journal.pcbi.1010541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/02/2022] [Indexed: 11/07/2022] Open
Abstract
Reliable and robust simulation of individual patients using patient-specific models (PSMs) is one of the next frontiers for modeling and simulation (M&S) in healthcare. PSMs, which form the basis of digital twins, can be employed as clinical tools to, for example, assess disease state, predict response to therapy, or optimize therapy. They may also be used to construct virtual cohorts of patients, for in silico evaluation of medical product safety and/or performance. Methods and frameworks have recently been proposed for evaluating the credibility of M&S in healthcare applications. However, such efforts have generally been motivated by models of medical devices or generic patient models; how best to evaluate the credibility of PSMs has largely been unexplored. The aim of this paper is to understand and demonstrate the credibility assessment process for PSMs using patient-specific cardiac electrophysiological (EP) modeling as an exemplar. We first review approaches used to generate cardiac PSMs and consider how verification, validation, and uncertainty quantification (VVUQ) apply to cardiac PSMs. Next, we execute two simulation studies using a publicly available virtual cohort of 24 patient-specific ventricular models, the first a multi-patient verification study, the second investigating the impact of uncertainty in personalized and non-personalized inputs in a virtual cohort. We then use the findings from our analyses to identify how important characteristics of PSMs can be considered when assessing credibility with the approach of the ASME V&V40 Standard, accounting for PSM concepts such as inter- and intra-user variability, multi-patient and “every-patient” error estimation, uncertainty quantification in personalized vs non-personalized inputs, clinical validation, and others. The results of this paper will be useful to developers of cardiac and other medical image based PSMs, when assessing PSM credibility. Patient-specific models are computational models that have been personalized using data from a patient. After decades of research, recent computational, data science and healthcare advances have opened the door to the fulfilment of the enormous potential of such models, from truly personalized medicine to efficient and cost-effective testing of new medical products. However, reliability (credibility) of patient-specific models is key to their success, and there are currently no general guidelines for evaluating credibility of patient-specific models. Here, we consider how frameworks and model evaluation activities that have been developed for generic (not patient-specific) computational models, can be extended to patient specific models. We achieve this through a detailed analysis of the activities required to evaluate cardiac electrophysiological models, chosen as an exemplar field due to its maturity and the complexity of such models. This is the first paper on the topic of reliability of patient-specific models and will help pave the way to reliable and trusted patient-specific modeling across healthcare applications.
Collapse
Affiliation(s)
- Suran Galappaththige
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Richard A. Gray
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Caroline Mendonca Costa
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Steven Niederer
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Pras Pathmanathan
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland, United States of America
- * E-mail:
| |
Collapse
|
14
|
Massarella D, Alonso-Gonzalez R. Updates in the management of congenital heart disease in adult patients. Expert Rev Cardiovasc Ther 2022; 20:719-732. [PMID: 36128784 DOI: 10.1080/14779072.2022.2125870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Adults with congenital heart disease represent a highly diverse, ever-growing population. Optimal approaches to management of problems such as arrhythmia, sudden cardiac death, heart failure, transplant, application of advanced therapies and unrepaired shunt lesions are incompletely established. Efforts to strengthen our understanding of these complex clinical challenges and inform evidence-based practices are ongoing. AREAS COVERED This narrative review summarizes evidence underpinning current approaches to congenital heart disease management while highlighting areas requiring further investigation. A search of literature published in 'Medline,' 'EMBASE,' and 'PubMed' using search terms 'congenital heart disease,' 'arrhythmia,' 'sudden cardiac death,' 'heart failure,' 'heart transplant,' 'advanced heart failure therapy,' 'ventricular assist device (VAD),' 'mechanical circulatory support (MSC),' 'intracardiac shunt' and combinations thereof was undertaken. EXPERT OPINION Application of novel technologies in the diagnosis and management of arrhythmia has and will continue to improve outcomes in this population. Sudden death remains a prevalent problem with many persistent unknowns. Heart failure is a leading cause of morbidity and mortality. Improved access to specialist care, advanced therapies and cardiac transplant is needed. The emerging field of cardio-obstetrics will continue to define state-of-the-art care for the reproductive health of women with heart disease.
Collapse
Affiliation(s)
- Danielle Massarella
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Hawson J, Al-Kaisey A, Anderson RD, Watts T, Morton J, Kumar S, Kistler P, Kalman J, Lee G. Substrate-based approaches in ventricular tachycardia ablation. Indian Pacing Electrophysiol J 2022; 22:273-285. [PMID: 36007824 PMCID: PMC9649336 DOI: 10.1016/j.ipej.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Catheter ablation for ventricular tachycardia (VT) in patients with structural heart disease is now part of standard care. Mapping and ablation of the clinical VT is often limited when the VT is noninducible, nonsustained or not haemodynamically tolerated. Substrate-based ablation strategies have been developed in an aim to treat VT in this setting and, subsequently, have been shown to improve outcomes in VT ablation when compared to focused ablation of mapped VTs. Since the initial description of linear ablation lines targeting ventricular scar, many different approaches to substrate-based VT ablation have been developed. Strategies can broadly be divided into three categories: 1) targeting abnormal electrograms, 2) anatomical targeting of conduction channels between areas of myocardial scar, and 3) targeting areas of slow and/or decremental conduction, identified with “functional” substrate mapping techniques. This review summarises contemporary substrate-based ablation strategies, along with their strengths and weaknesses.
Collapse
Affiliation(s)
- Joshua Hawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital and Westmead Applied Research Centre, Westmead, New South Wales, Australia; Western Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Kistler
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
16
|
Loke YH, Capuano F, Kollar S, Cibis M, Kitslaar P, Balaras E, Reiber JHC, Pedrizzetti G, Olivieri L. Abnormal Diastolic Hemodynamic Forces: A Link Between Right Ventricular Wall Motion, Intracardiac Flow, and Pulmonary Regurgitation in Repaired Tetralogy of Fallot. Front Cardiovasc Med 2022; 9:929470. [PMID: 35911535 PMCID: PMC9329698 DOI: 10.3389/fcvm.2022.929470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objective The effect of chronic pulmonary regurgitation (PR) on right ventricular (RV) dysfunction in repaired Tetralogy of Fallot (RTOF) patients is well recognized by cardiac magnetic resonance (CMR). However, the link between RV wall motion, intracardiac flow and PR has not been established. Hemodynamic force (HDF) represents the global force exchanged between intracardiac blood volume and endocardium, measurable by 4D flow or by a novel mathematical model of wall motion. In our study, we used this novel methodology to derive HDF in a cohort of RTOF patients, exclusively using routine CMR imaging. Methods RTOF patients and controls with CMR imaging were retrospectively included. Three-dimensional (3D) models of RV were segmented, including RV outflow tract (RVOT). Feature-tracking software (QStrain 2.0, Medis Medical Imaging Systems, Leiden, Netherlands) captured endocardial contours from long/short-axis cine and used to reconstruct RV wall motion. A global HDF vector was computed from the moving surface, then decomposed into amplitude/impulse of three directional components based on reference (Apical-to-Basal, Septal-to-Free Wall and Diaphragm-to-RVOT direction). HDF were compared and correlated against CMR and exercise stress test parameters. A subset of RTOF patients had 4D flow that was used to derive vorticity (for correlation) and HDF (for comparison against cine method). Results 68 RTOF patients and 20 controls were included. RTOF patients had increased diastolic HDF amplitude in all three directions (p<0.05). PR% correlated with Diaphragm-RVOT HDF amplitude/impulse (r = 0.578, p<0.0001, r = 0.508, p < 0.0001, respectively). RV ejection fraction modestly correlated with global HDF amplitude (r = 0.2916, p = 0.031). VO2-max correlated with Septal-to-Free Wall HDF impulse (r = 0.536, p = 0.007). Diaphragm-to-RVOT HDF correlated with RVOT vorticity (r = 0.4997, p = 0.001). There was no significant measurement bias between Cine-derived HDF and 4D flow-derived HDF by Bland-Altman analysis. Conclusion RTOF patients have abnormal diastolic HDF that is correlated to PR, RV function, exercise capacity and vorticity. HDF can be derived from conventional cine, and is a potential link between RV wall motion and intracardiac flow from PR in RTOF patients.
Collapse
Affiliation(s)
- Yue-Hin Loke
- Department of Cardiology, Children’s National Hospital, Washington, DC, United States
- 3D Cardiac Visualization Laboratory, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, United States
| | - Francesco Capuano
- Department of Fluid Mechanics, Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
| | - Sarah Kollar
- Department of Cardiology, Children’s National Hospital, Washington, DC, United States
| | - Merih Cibis
- Medis Medical Imaging Systems, Leiden, Netherlands
| | | | - Elias Balaras
- Laboratory for Computational Physics and Fluid Mechanics, Department of Mechanical and Aerospace Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC, United States
| | | | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - Laura Olivieri
- 3D Cardiac Visualization Laboratory, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, United States
- Department of Cardiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
17
|
O'Hara RP, Binka E, Prakosa A, Zimmerman SL, Cartoski MJ, Abraham MR, Lu DY, Boyle PM, Trayanova NA. Personalized computational heart models with T1-mapped fibrotic remodeling predict sudden death risk in patients with hypertrophic cardiomyopathy. eLife 2022; 11:73325. [PMID: 35076018 PMCID: PMC8789259 DOI: 10.7554/elife.73325] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is associated with risk of sudden cardiac death (SCD) due to ventricular arrhythmias (VAs) arising from the proliferation of fibrosis in the heart. Current clinical risk stratification criteria inadequately identify at-risk patients in need of primary prevention of VA. Here, we use mechanistic computational modeling of the heart to analyze how HCM-specific remodeling promotes arrhythmogenesis and to develop a personalized strategy to forecast risk of VAs in these patients. We combine contrast-enhanced cardiac magnetic resonance imaging and T1 mapping data to construct digital replicas of HCM patient hearts that represent the patient-specific distribution of focal and diffuse fibrosis and evaluate the substrate propensity to VA. Our analysis indicates that the presence of diffuse fibrosis, which is rarely assessed in these patients, increases arrhythmogenic propensity. In forecasting future VA events in HCM patients, the imaging-based computational heart approach achieved 84.6%, 76.9%, and 80.1% sensitivity, specificity, and accuracy, respectively, and significantly outperformed current clinical risk predictors. This novel VA risk assessment may have the potential to prevent SCD and help deploy primary prevention appropriately in HCM patients.
Collapse
Affiliation(s)
- Ryan P O'Hara
- Department of Biomedical Engineering, Johns Hopkins University
| | - Edem Binka
- Division of Pediatric Cardiology, Johns Hopkins University
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University
| | | | - Mark J Cartoski
- Division of Pediatric Cardiology, Alfred I. duPont Hospital for Children
| | | | - Dai-Yin Lu
- Division of Cardiology, University of California, San Francisco
| | | | | |
Collapse
|
18
|
O’Hara RP, Prakosa A, Binka E, Lacy A, Trayanova NA. Arrhythmia in hypertrophic cardiomyopathy: Risk prediction using contrast enhanced MRI, T1 mapping, and personalized virtual heart technology. J Electrocardiol 2022; 74:122-127. [PMID: 36183522 PMCID: PMC9729380 DOI: 10.1016/j.jelectrocard.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM), a disease with myocardial fibrosis manifestation, is a common cause of sudden cardiac death (SCD) due to ventricular arrhythmias (VA). Current clinical risk stratification criteria are inadequate in identifying patients who are at risk for VA and in need of an implantable cardioverter defibrillator (ICD) for primary prevention. OBJECTIVE We aimed to develop a risk prediction approach based on imaging biomarkers from the combination of late gadolinium contrast-enhanced (LGE) MRI and T1 mapping. We then aimed to compare the prediction to a virtual heart computational risk assessment approach based on LGE-T1 virtual heart models. METHODS The methodology involved combining short-axis LGE-MRI with post-contrast T1 maps to define personalized thresholds for diffuse and dense fibrosis. The combined LGE-T1 maps were used to evaluate imaging biomarkers for VA risk prediction. The risk prediction capability of the biomarkers was compared with that of the LGE-T1 virtual heart arrhythmia inducibility simulation. VA risk prediction performance from both approaches was compared to clinical outcome (presence of clinical VA). RESULTS Image-based biomarkers, including hypertrophy, signal intensity heterogeneity, and fibrotic border complexity, could not discriminate high vs low VA risk. LGE-T1 virtual heart technology outperformed all the image-based biomarker metrics and was statistically significant in predicting VA risk in HCM. CONCLUSIONS We combined two MR imaging techniques to analyze imaging biomarkers in HCM. Raw and processed image-based biomarkers cannot discriminate patients with VA from those without VA. Hybrid LGE-T1 virtual heart models could correctly predict VA risk for this cohort and may improve SCD risk stratification to better identify HCM patients for primary preventative ICD implantation.
Collapse
Affiliation(s)
- Ryan P. O’Hara
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States of America
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States of America
| | - Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States of America
| | - Audrey Lacy
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States of America
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, United States of America,Corresponding author at: 3400 N Charles Street, Hackerman Hall 216, Baltimore, MD 21218, United States of America. (N.A. Trayanova)
| |
Collapse
|
19
|
Khamzin S, Dokuchaev A, Bazhutina A, Chumarnaya T, Zubarev S, Lyubimtseva T, Lebedeva V, Lebedev D, Gurev V, Solovyova O. Machine Learning Prediction of Cardiac Resynchronisation Therapy Response From Combination of Clinical and Model-Driven Data. Front Physiol 2022; 12:753282. [PMID: 34970154 PMCID: PMC8712879 DOI: 10.3389/fphys.2021.753282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Up to 30–50% of chronic heart failure patients who underwent cardiac resynchronization therapy (CRT) do not respond to the treatment. Therefore, patient stratification for CRT and optimization of CRT device settings remain a challenge. Objective: The main goal of our study is to develop a predictive model of CRT outcome using a combination of clinical data recorded in patients before CRT and simulations of the response to biventricular (BiV) pacing in personalized computational models of the cardiac electrophysiology. Materials and Methods: Retrospective data from 57 patients who underwent CRT device implantation was utilized. Positive response to CRT was defined by a 10% increase in the left ventricular ejection fraction in a year after implantation. For each patient, an anatomical model of the heart and torso was reconstructed from MRI and CT images and tailored to ECG recorded in the participant. The models were used to compute ventricular activation time, ECG duration and electrical dyssynchrony indices during intrinsic rhythm and BiV pacing from the sites of implanted leads. For building a predictive model of CRT response, we used clinical data recorded before CRT device implantation together with model-derived biomarkers of ventricular excitation in the left bundle branch block mode of activation and under BiV stimulation. Several Machine Learning (ML) classifiers and feature selection algorithms were tested on the hybrid dataset, and the quality of predictors was assessed using the area under receiver operating curve (ROC AUC). The classifiers on the hybrid data were compared with ML models built on clinical data only. Results: The best ML classifier utilizing a hybrid set of clinical and model-driven data demonstrated ROC AUC of 0.82, an accuracy of 0.82, sensitivity of 0.85, and specificity of 0.78, improving quality over that of ML predictors built on clinical data from much larger datasets by more than 0.1. Distance from the LV pacing site to the post-infarction zone and ventricular activation characteristics under BiV pacing were shown as the most relevant model-driven features for CRT response classification. Conclusion: Our results suggest that combination of clinical and model-driven data increases the accuracy of classification models for CRT outcomes.
Collapse
Affiliation(s)
- Svyatoslav Khamzin
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Arsenii Dokuchaev
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Anastasia Bazhutina
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| | - Tatiana Chumarnaya
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Stepan Zubarev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | | | - Dmitry Lebedev
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Olga Solovyova
- Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.,Ural Federal University, Yekaterinburg, Russia
| |
Collapse
|
20
|
Grosse-Wortmann L, Madriago EJ. Getting Closer to Predicting SCD in TOF. JACC Cardiovasc Imaging 2021; 15:269-270. [PMID: 34801450 DOI: 10.1016/j.jcmg.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Lars Grosse-Wortmann
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
| | - Erin J Madriago
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
21
|
Sung E, Etoz S, Zhang Y, Trayanova NA. Whole-heart ventricular arrhythmia modeling moving forward: Mechanistic insights and translational applications. BIOPHYSICS REVIEWS 2021; 2:031304. [PMID: 36281224 PMCID: PMC9588428 DOI: 10.1063/5.0058050] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Ventricular arrhythmias are the primary cause of sudden cardiac death and one of the leading causes of mortality worldwide. Whole-heart computational modeling offers a unique approach for studying ventricular arrhythmias, offering vast potential for developing both a mechanistic understanding of ventricular arrhythmias and clinical applications for treatment. In this review, the fundamentals of whole-heart ventricular modeling and current methods of personalizing models using clinical data are presented. From this foundation, the authors summarize recent advances in whole-heart ventricular arrhythmia modeling. Efforts in gaining mechanistic insights into ventricular arrhythmias are discussed, in addition to other applications of models such as the assessment of novel therapeutics. The review emphasizes the unique benefits of computational modeling that allow for insights that are not obtainable by contemporary experimental or clinical means. Additionally, the clinical impact of modeling is explored, demonstrating how patient care is influenced by the information gained from ventricular arrhythmia models. The authors conclude with future perspectives about the direction of whole-heart ventricular arrhythmia modeling, outlining how advances in neural network methodologies hold the potential to reduce computational expense and permit for efficient whole-heart modeling.
Collapse
Affiliation(s)
- Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Sevde Etoz
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Yingnan Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland 21218, USA
- Author to whom correspondence should be addressed: . Tel.: 410-516-4375
| |
Collapse
|
22
|
Shade JK, Prakosa A, Popescu DM, Yu R, Okada DR, Chrispin J, Trayanova NA. Predicting risk of sudden cardiac death in patients with cardiac sarcoidosis using multimodality imaging and personalized heart modeling in a multivariable classifier. SCIENCE ADVANCES 2021; 7:eabi8020. [PMID: 34321202 PMCID: PMC8318376 DOI: 10.1126/sciadv.abi8020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/11/2021] [Indexed: 05/13/2023]
Abstract
Cardiac sarcoidosis (CS), an inflammatory disease characterized by formation of granulomas in the heart, is associated with high risk of sudden cardiac death (SCD) from ventricular arrhythmias. Current "one-size-fits-all" guidelines for SCD risk assessment in CS result in insufficient appropriate primary prevention. Here, we present a two-step precision risk prediction technology for patients with CS. First, a patient's arrhythmogenic propensity arising from heterogeneous CS-induced ventricular remodeling is assessed using a novel personalized magnetic-resonance imaging and positron-emission tomography fusion mechanistic model. The resulting simulations of arrhythmogenesis are fed, together with a set of imaging and clinical biomarkers, into a supervised classifier. In a retrospective study of 45 patients, the technology achieved testing results of 60% sensitivity [95% confidence interval (CI): 57-63%], 72% specificity [95% CI: 70-74%], and 0.754 area under the receiver operating characteristic curve [95% CI: 0.710-0.797]. It outperformed clinical metrics, highlighting its potential to transform CS risk stratification.
Collapse
Affiliation(s)
- Julie K Shade
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Dan M Popescu
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
- Department of Applied Math and Statistics, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - Rebecca Yu
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
| | - David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA.
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| |
Collapse
|
23
|
Forsch N, Govil S, Perry JC, Hegde S, Young AA, Omens JH, McCulloch AD. Computational analysis of cardiac structure and function in congenital heart disease: Translating discoveries to clinical strategies. JOURNAL OF COMPUTATIONAL SCIENCE 2021; 52:101211. [PMID: 34691293 PMCID: PMC8528218 DOI: 10.1016/j.jocs.2020.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Increased availability and access to medical image data has enabled more quantitative approaches to clinical diagnosis, prognosis, and treatment planning for congenital heart disease. Here we present an overview of long-term clinical management of tetralogy of Fallot (TOF) and its intersection with novel computational and data science approaches to discovering biomarkers of functional and prognostic importance. Efforts in translational medicine that seek to address the clinical challenges associated with cardiovascular diseases using personalized and precision-based approaches are then discussed. The considerations and challenges of translational cardiovascular medicine are reviewed, and examples of digital platforms with collaborative, cloud-based, and scalable design are provided.
Collapse
Affiliation(s)
- Nickolas Forsch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Sachin Govil
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - James C Perry
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Sanjeet Hegde
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King’s College London, London, UK
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, NZ
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Deparment of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Deparment of Medicine, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
24
|
Diller GP, Arvanitaki A, Opotowsky AR, Jenkins K, Moons P, Kempny A, Tandon A, Redington A, Khairy P, Mital S, Gatzoulis MΑ, Li Y, Marelli A. Lifespan Perspective on Congenital Heart Disease Research: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 77:2219-2235. [PMID: 33926659 DOI: 10.1016/j.jacc.2021.03.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
More than 90% of patients with congenital heart disease (CHD) are nowadays surviving to adulthood and adults account for over two-thirds of the contemporary CHD population in Western countries. Although outcomes are improved, surgery does not cure CHD. Decades of longitudinal observational data are currently motivating a paradigm shift toward a lifespan perspective and proactive approach to CHD care. The aim of this review is to operationalize these emerging concepts by presenting new constructs in CHD research. These concepts include long-term trajectories and a life course epidemiology framework. Focusing on a precision health, we propose to integrate our current knowledge on the genome, phenome, and environome across the CHD lifespan. We also summarize the potential of technology, especially machine learning, to facilitate longitudinal research by embracing big data and multicenter lifelong data collection.
Collapse
Affiliation(s)
- Gerhard-Paul Diller
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK; National Register for Congenital Heart Defects, Berlin, Germany.
| | - Alexandra Arvanitaki
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK; First Department of Cardiology, American Hellenic Educational Progressive Association University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Alexander R Opotowsky
- The Cincinnati Adult Congenital Heart Disease Program, Cincinnati Children's Hospital, Cincinnati, Ohio, USA; Heart Institute, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Moons
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Alexander Kempny
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK
| | - Animesh Tandon
- Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas, USA; Department of Radiology, University of Texas Southwestern Children's Medical Center, Dallas, Texas, USA
| | - Andrew Redington
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Α Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield National Health Service Foundation Trust, Imperial College London, London, UK
| | - Yue Li
- Department of Computer Science, McGill University, Montréal, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), Department of Medicine, McGill University, Montréal, Québec, Canada.
| |
Collapse
|
25
|
Late gadolinium enhancement in patients with Tetralogy of Fallot: A systematic review. Eur J Radiol 2021; 136:109521. [PMID: 33450661 DOI: 10.1016/j.ejrad.2021.109521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study is to review the literature concerning myocardial late gadolinium enhancement (LGE) with cardiac magnetic resonance in patients with Tetralogy of Fallot (ToF), with regards to its prevalence, characteristics and clinical relevance. METHODS We performed a systematic search, aiming to retrieve original articles that evaluated LGE in ToF, running a search string on MEDLINE and EMBASE in November 2019 and November 2020. Papers were then selected by two independent, blinded readers based on title and abstract, and then on full-text reading, and articles which did not include LGE evaluation were excluded. From each included paper two readers extracted descriptive data concerning technical parameters of LGE acquisition, LGE description and clinical significance. RESULTS 18 articles were eventually included in our review. The included studies observed that a higher amount of right ventricular LGE relates with higher right ventricular volumes, lower ejection fraction and a higher pulmonary regurgitant fraction, thus acting as a marker of progressive impairment of myocardial function. Moreover, LGE in ToF patients correlated with the onset of arrhythmias, and with serum biomarkers indicative of myocardial stress and fibrosis. CONCLUSIONS LGE could be used in the follow-up repaired ToF patients as its appraisal can provide information concerning cardiac dysfunction. Moreover, it may be ideal to aim towards a common framework for standardizing assessment and quantification of LGE in ToF patients.
Collapse
|
26
|
Bifulco SF, Akoum N, Boyle PM. Translational applications of computational modelling for patients with cardiac arrhythmias. Heart 2020; 107:heartjnl-2020-316854. [PMID: 33303478 PMCID: PMC10896425 DOI: 10.1136/heartjnl-2020-316854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/04/2022] Open
Abstract
Cardiac arrhythmia is associated with high morbidity, and its underlying mechanisms are poorly understood. Computational modelling and simulation approaches have the potential to improve standard-of-care therapy for these disorders, offering deeper understanding of complex disease processes and sophisticated translational tools for planning clinical procedures. This review provides a clinician-friendly summary of recent advancements in computational cardiology. Organ-scale models automatically generated from clinical-grade imaging data are used to custom tailor our understanding of arrhythmia drivers, estimate future arrhythmogenic risk and personalise treatment plans. Recent mechanistic insights derived from atrial and ventricular arrhythmia simulations are highlighted, and the potential avenues to patient care (eg, by revealing new antiarrhythmic drug targets) are covered. Computational approaches geared towards improving outcomes in resynchronisation therapy have used simulations to elucidate optimal patient selection and lead location. Technology to personalise catheter ablation procedures are also covered, specifically preliminary outcomes form early-stage or pilot clinical studies. To conclude, future developments in computational cardiology are discussed, including improving the representation of patient-specific fibre orientations and fibrotic remodelling characterisation and how these might improve understanding of arrhythmia mechanisms and provide transformative tools for patient-specific therapy.
Collapse
Affiliation(s)
- Savannah F Bifulco
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Nazem Akoum
- Department of Cardiology, University of Washington, Seattle, Washington, USA
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
- Institute for Stem Cell & Regenerative Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
27
|
Sung E, Prakosa A, Aronis KN, Zhou S, Zimmerman SL, Tandri H, Nazarian S, Berger RD, Chrispin J, Trayanova NA. Personalized Digital-Heart Technology for Ventricular Tachycardia Ablation Targeting in Hearts With Infiltrating Adiposity. Circ Arrhythm Electrophysiol 2020; 13:e008912. [PMID: 33198484 DOI: 10.1161/circep.120.008912] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infiltrating adipose tissue (inFAT) is a newly recognized proarrhythmic substrate for postinfarct ventricular tachycardias (VT) identifiable on contrast-enhanced computed tomography. This study presents novel digital-heart technology that incorporates inFAT from contrast-enhanced computed tomography to noninvasively predict VT ablation targets and assesses the capability of the technology by comparing its predictions with VT ablation procedure data from patients with ischemic cardiomyopathy. METHODS Digital-heart models reflecting patient-specific inFAT distributions were reconstructed from contrast-enhanced computed tomography. The digital-heart identification of fat-based ablation targeting (DIFAT) technology evaluated the rapid-pacing-induced VTs in each personalized inFAT-based substrate. DIFAT targets that render the inFAT substrate noninducible to VT, including VTs that arise postablation, were determined. DIFAT predictions were compared with corresponding clinical ablations to assess the capabilities of the technology. RESULTS DIFAT was developed and applied retrospectively to 29 ischemic cardiomyopathy patients with contrast-enhanced computed tomography. DIFAT ablation volumes were significantly less than the estimated clinical ablation volumes (1.87±0.35 versus 7.05±0.88 cm3, P<0.0005). DIFAT targets overlapped with clinical ablations in 79% of patients, mostly in the apex (72%) and inferior/inferolateral (74%). In 3 patients, DIFAT targets colocalized with redo ablations delivered years after the index procedure. CONCLUSIONS DIFAT is a novel digital-heart technology for individualized VT ablation guidance designed to eliminate VT inducibility following initial ablation. DIFAT predictions colocalized well with clinical ablation locations but provided significantly smaller lesions. DIFAT also predicted VTs targeted in redo procedures years later. As DIFAT uses widely accessible computed tomography, its integration into clinical workflows may augment therapeutic precision and reduce redo procedures.
Collapse
Affiliation(s)
- Eric Sung
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Adityo Prakosa
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Konstantinos N Aronis
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Shijie Zhou
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Stefan L Zimmerman
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Department of Radiological Sciences (S.L.Z.), Johns Hopkins Hospital, Baltimore, MD
| | - Harikrishna Tandri
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Saman Nazarian
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.N.)
| | - Ronald D Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Natalia A Trayanova
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| |
Collapse
|
28
|
Corrado C, Avezzù A, Lee AWC, Mendoca Costa C, Roney CH, Strocchi M, Bishop M, Niederer SA. Using cardiac ionic cell models to interpret clinical data. WIREs Mech Dis 2020; 13:e1508. [PMID: 33027553 DOI: 10.1002/wsbm.1508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 01/24/2023]
Abstract
For over 100 years cardiac electrophysiology has been measured in the clinic. The electrical signals that can be measured span from noninvasive ECG and body surface potentials measurements through to detailed invasive measurements of local tissue electrophysiology. These electrophysiological measurements form a crucial component of patient diagnosis and monitoring; however, it remains challenging to quantitatively link changes in clinical electrophysiology measurements to biophysical cellular function. Multi-scale biophysical computational models represent one solution to this problem. These models provide a formal framework for linking cellular function through to emergent whole organ function and routine clinical diagnostic signals. In this review, we describe recent work on the use of computational models to interpret clinical electrophysiology signals. We review the simulation of human cardiac myocyte electrophysiology in the atria and the ventricles and how these models are being used to link organ scale function to patient disease mechanisms and therapy response in patients receiving implanted defibrillators, \cardiac resynchronisation therapy or suffering from atrial fibrillation and ventricular tachycardia. There is a growing use of multi-scale biophysical models to interpret clinical data. This allows cardiologists to link clinical observations with cellular mechanisms to better understand cardiopathophysiology and identify novel treatment strategies. This article is categorized under: Cardiovascular Diseases > Computational Models Cardiovascular Diseases > Biomedical Engineering Cardiovascular Diseases > Molecular and Cellular Physiology.
Collapse
|
29
|
Monaci S, Strocchi M, Rodero C, Gillette K, Whitaker J, Rajani R, Rinaldi CA, O'Neill M, Plank G, King A, Bishop MJ. In-silico pace-mapping using a detailed whole torso model and implanted electronic device electrograms for more efficient ablation planning. Comput Biol Med 2020; 125:104005. [PMID: 32971325 DOI: 10.1016/j.compbiomed.2020.104005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pace-mapping is a commonly used electrophysiological (EP) procedure which aims to identify exit sites of ventricular tachycardia (VT) by matching ventricular activation patterns (assessed by QRS morphology) at specific pacing locations with activation during VT. However, long procedure durations and the need for VT induction render this technique non-optimal. To demonstrate the potential of in-silico pace-mapping, using stored electrogram (EGM) recordings of clinical VT from implanted devices to guide pre-procedural ablation planning. METHOD Six scar-related VT episodes were simulated in a 3D torso model reconstructed from computed tomography (CT) imaging data, including three different infarct anatomies mapped from infarcted porcine imaging data. In-silico pace-mapping was performed to localise VT exit sites and isthmuses by using 12-lead electrocardiogram (ECG) signals and different combinations of EGM sensing vectors from implanted devices, through the creation of conventional correlation maps and reference-less maps. RESULTS Our in-silico platform was successful in identifying VT exit sites for a variety of different VT morphologies from both ECG correlation maps and corresponding EGM maps, with the latter dependent upon the number of sensing vectors used. We also showed the added utility of both ECG and EGM reference-less pace-mapping for the identification of slow-conducting isthmuses, uncovering the optimal algorithm parameters. Finally, EGM-based pace-mapping was shown to be more dependent upon the mapped surface (epicardial/endocardial), relative to the VT origin. CONCLUSIONS In-silico pace-mapping can be used along with EGMs from implanted devices to localise VT ablation targets in pre-procedural planning.
Collapse
Affiliation(s)
| | | | | | | | | | - Ronak Rajani
- King's College London, London, United Kingdom; Guy's and St Thomas' Hospital, London, United Kingdom
| | - Christopher A Rinaldi
- King's College London, London, United Kingdom; Guy's and St Thomas' Hospital, London, United Kingdom
| | | | | | - Andrew King
- King's College London, London, United Kingdom
| | | |
Collapse
|
30
|
Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
31
|
Kapa S, Chung M, Gopinathannair R, Noseworthy P, Eckhardt L, Leal M, Wan E, Wang PJ. Year in Review in Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2020; 13:e008733. [PMID: 32423252 DOI: 10.1161/circep.120.008733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past year, there have been numerous advances in our understanding of arrhythmia mechanisms, diagnosis, and new therapies. We have seen advances in basic cardiac electrophysiology with data suggesting that secretoneurin may be a biomarker for patients at risk of ventricular arrhythmias, and we have learned of the potential role of an NPR-C (natriuretic peptide receptor-C) in atrial fibrosis and the role of an atrial specific 2-pore potassium channel TASK-1 as a therapeutic target for atrial fibrillation. We have seen studies demonstrating the role of sensory neurons in sleep apnea-related atrial fibrillation and the association between bariatric surgery and atrial fibrillation ablation outcomes. Artificial intelligence applied to electrocardiography has yielded estimates of age, sex, and overall health. We have seen new tools for collection of patient-centered outcomes following catheter ablation. There have been significant advances in the ability to identify ventricular tachycardia termination sites through high-density mapping of deceleration zones. We have learned that right ventricular dysfunction may be a predictor of survival benefit after implantable cardioverter-defibrillator implantation in patients with nonischemic cardiomyopathy. We have seen further insights into the role of His bundle pacing on improving outcomes. As our understanding of cardiac laminopathies advances, we may have new tools to predict arrhythmic event rates in gene carriers. Finally, we have seen numerous advances in the treatment of arrhythmias in patients with congenital heart disease.
Collapse
Affiliation(s)
- Suraj Kapa
- Department of Medicine, Mayo Clinic, Rochester, MN (S.K., P.N.)
| | - Mina Chung
- Department of Medicine, Cleveland Clinic, OH (M.C.)
| | | | | | - Lee Eckhardt
- Department of Medicine, University of Wisconsin, Madison (L.E., M.L.)
| | - Miguel Leal
- Department of Medicine, University of Wisconsin, Madison (L.E., M.L.)
| | - Elaine Wan
- Department of Medicine, Columbia University, New York, NY (E.W.)
| | - Paul J Wang
- Department of Medicine, Stanford University, CA (P.J.W.)
| |
Collapse
|
32
|
Trayanova NA, Doshi AN, Prakosa A. How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post-infarction patients. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2020; 12:e1477. [PMID: 31917524 DOI: 10.1002/wsbm.1477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
Abstract
Precision Cardiology is a targeted strategy for cardiovascular disease prevention and treatment that accounts for individual variability. Computational heart modeling is one of the novel approaches that have been developed under the umbrella of Precision Cardiology. Personalized computational modeling of patient hearts has made strides in the development of models that incorporate the individual geometry and structure of the heart as well as other patient-specific information. Of these developments, one of the potentially most impactful is the research aimed at noninvasively predicting the targets of ablation of lethal arrhythmia, ventricular tachycardia (VT), using patient-specific models. The approach has been successfully applied to patients with ischemic cardiomyopathy in proof-of-concept studies. The goal of this paper is to review the strategies for computational VT ablation guidance in ischemic cardiomyopathy patients, from model developments to the intricacies of the actual clinical application. To provide context in describing the road these computational modeling applications have undertaken, we first review the state of the art in VT ablation in the clinic, emphasizing the benefits that personalized computational prediction of ablation targets could bring to the clinical electrophysiology practice. This article is characterized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine.
Collapse
Affiliation(s)
- Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Ashish N Doshi
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
| | - Adityo Prakosa
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|