1
|
Ložek M, Kovanda J, Kubuš P, Vrbík M, Lhotská L, Lumens J, Delhaas T, Janoušek J. How to assess and treat right ventricular electromechanical dyssynchrony in post-repair tetralogy of Fallot: insights from imaging, invasive studies, and computational modelling. Europace 2024; 26:euae024. [PMID: 38266248 PMCID: PMC10838147 DOI: 10.1093/europace/euae024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND AIMS Right bundle branch block (RBBB) and resulting right ventricular (RV) electromechanical discoordination are thought to play a role in the disease process of subpulmonary RV dysfunction that frequently occur post-repair tetralogy of Fallot (ToF). We sought to describe this disease entity, the role of pulmonary re-valvulation, and the potential added value of RV cardiac resynchronization therapy (RV-CRT). METHODS Two patients with repaired ToF, complete RBBB, pulmonary regurgitation, and significantly decreased RV function underwent echocardiography, cardiac magnetic resonance, and an invasive study to evaluate the potential for RV-CRT as part of the management strategy. The data were used to personalize the CircAdapt model of the human heart and circulation. Resulting Digital Twins were analysed to quantify the relative effects of RV pressure and volume overload and to predict the effect of RV-CRT. RESULTS Echocardiography showed components of a classic RV dyssynchrony pattern which could be reversed by RV-CRT during invasive study and resulted in acute improvement in RV systolic function. The Digital Twins confirmed a contribution of electromechanical RV dyssynchrony to RV dysfunction and suggested improvement of RV contraction efficiency after RV-CRT. The one patient who underwent successful permanent RV-CRT as part of the pulmonary re-valvulation procedure carried improvements that were in line with the predictions based on his Digital Twin. CONCLUSION An integrative diagnostic approach to RV dysfunction, including the construction of Digital Twins may help to identify candidates for RV-CRT as part of the lifetime management of ToF and similar congenital heart lesions.
Collapse
Affiliation(s)
- Miroslav Ložek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
- Department of Biomedical Informatics, 1st Faculty of Medicine, Charles University in Prague, Kateřinská 1660/32, 121 08 Prague, Czech Republic
| | - Jan Kovanda
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Peter Kubuš
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Michal Vrbík
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| | - Lenka Lhotská
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Jugoslávských partyzánů 1580/3, 160 00 Prague, Czech Republic
| | - Joost Lumens
- Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands
| | - Tammo Delhaas
- Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Universiteitssingel 50, 6200 MD Maastricht, The Netherlands
| | - Jan Janoušek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic
| |
Collapse
|
2
|
Tamargo M, Martínez-Legazpi P, Espinosa MÁ, Lyon A, Méndez I, Gutiérrez-Ibañes E, Fernández AI, Prieto-Arévalo R, González-Mansilla A, Arts T, Delhaas T, Mombiela T, Sanz-Ruiz R, Elízaga J, Yotti R, Tschöpe C, Fernández-Avilés F, Lumens J, Bermejo J. Increased Chamber Resting Tone Is a Key Determinant of Left Ventricular Diastolic Dysfunction. Circ Heart Fail 2023; 16:e010673. [PMID: 38113298 PMCID: PMC10729900 DOI: 10.1161/circheartfailure.123.010673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/22/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Twitch-independent tension has been demonstrated in cardiomyocytes, but its role in heart failure (HF) is unclear. We aimed to address twitch-independent tension as a source of diastolic dysfunction by isolating the effects of chamber resting tone (RT) from impaired relaxation and stiffness. METHODS We invasively monitored pressure-volume data during cardiopulmonary exercise in 20 patients with hypertrophic cardiomyopathy, 17 control subjects, and 35 patients with HF with preserved ejection fraction. To measure RT, we developed a new method to fit continuous pressure-volume measurements, and first validated it in a computational model of loss of cMyBP-C (myosin binding protein-C). RESULTS In hypertrophic cardiomyopathy, RT (estimated marginal mean [95% CI]) was 3.4 (0.4-6.4) mm Hg, increasing to 18.5 (15.5-21.5) mm Hg with exercise (P<0.001). At peak exercise, RT was responsible for 64% (53%-76%) of end-diastolic pressure, whereas incomplete relaxation and stiffness accounted for the rest. RT correlated with the levels of NT-proBNP (N-terminal pro-B-type natriuretic peptide; R=0.57; P=0.02) and with pulmonary wedge pressure but following different slopes at rest and during exercise (R2=0.49; P<0.001). In controls, RT was 0.0 mm Hg and 1.2 (0.3-2.8) mm Hg in HF with preserved ejection fraction patients and was also exacerbated by exercise. In silico, RT increased in parallel to the loss of cMyBP-C function and correlated with twitch-independent myofilament tension (R=0.997). CONCLUSIONS Augmented RT is the major cause of LV diastolic chamber dysfunction in hypertrophic cardiomyopathy and HF with preserved ejection fraction. RT transients determine diastolic pressures, pulmonary pressures, and functional capacity to a greater extent than relaxation and stiffness abnormalities. These findings support antimyosin agents for treating HF.
Collapse
Affiliation(s)
- María Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED, Spain (P.M.-L.)
| | - M. Ángeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Irene Méndez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ana I. Fernández
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Raquel Prieto-Arévalo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Theo Arts
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Carsten Tschöpe
- Berlin Institute of Health/Center for Regenerative Therapy (BCRT) at Charite, and Department of Cardiology, Campus Virchow (CVK), Charité Universitätsmedizin, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany (C.T.)
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (A.L., T.A., T.D., J.L.)
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Spain (M.T., P.M.-L., M.A.E., I.M., E.G.-I., A.I.F., R.P.-A., A.G.-M., T.M., R.S.-R., J.E., R.Y., F.F.-A., J.B.)
| |
Collapse
|
3
|
Rodero C, Baptiste TMG, Barrows RK, Lewalle A, Niederer SA, Strocchi M. Advancing clinical translation of cardiac biomechanics models: a comprehensive review, applications and future pathways. FRONTIERS IN PHYSICS 2023; 11:1306210. [PMID: 38500690 PMCID: PMC7615748 DOI: 10.3389/fphy.2023.1306210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Cardiac mechanics models are developed to represent a high level of detail, including refined anatomies, accurate cell mechanics models, and platforms to link microscale physiology to whole-organ function. However, cardiac biomechanics models still have limited clinical translation. In this review, we provide a picture of cardiac mechanics models, focusing on their clinical translation. We review the main experimental and clinical data used in cardiac models, as well as the steps followed in the literature to generate anatomical meshes ready for simulations. We describe the main models in active and passive mechanics and the different lumped parameter models to represent the circulatory system. Lastly, we provide a summary of the state-of-the-art in terms of ventricular, atrial, and four-chamber cardiac biomechanics models. We discuss the steps that may facilitate clinical translation of the biomechanics models we describe. A well-established software to simulate cardiac biomechanics is lacking, with all available platforms involving different levels of documentation, learning curves, accessibility, and cost. Furthermore, there is no regulatory framework that clearly outlines the verification and validation requirements a model has to satisfy in order to be reliably used in applications. Finally, better integration with increasingly rich clinical and/or experimental datasets as well as machine learning techniques to reduce computational costs might increase model reliability at feasible resources. Cardiac biomechanics models provide excellent opportunities to be integrated into clinical workflows, but more refinement and careful validation against clinical data are needed to improve their credibility. In addition, in each context of use, model complexity must be balanced with the associated high computational cost of running these models.
Collapse
Affiliation(s)
- Cristobal Rodero
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tiffany M. G. Baptiste
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Rosie K. Barrows
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alexandre Lewalle
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Steven A. Niederer
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
| | - Marina Strocchi
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| |
Collapse
|
4
|
Leyva F, Zegard A, Patel P, Stegemann B, Marshall H, Ludman P, Walton J, de Bono J, Boriani G, Qiu T. Timing of cardiac resynchronization therapy implantation. Europace 2023; 25:euad059. [PMID: 36944529 PMCID: PMC10227865 DOI: 10.1093/europace/euad059] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023] Open
Abstract
AIMS The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation. METHODS AND RESULTS A database covering the population of England (56.3 million in 2019) was used to quantify clinical outcomes after CRT implantation in relation to first HFHs. From 2010 to 2019, 64 968 patients [age: 71.4 ± 11.7 years; 48 606 (74.8%) male] underwent CRT implantation, 57% in the absence of a previous HFH, 12.9% during the first HFH, and 30.1% after ≥1 HFH. Over 4.54 (2.80-6.71) years [median (interquartile range); 272 989 person-years], the time in years from the first HFH to CRT implantation was associated with a higher risk of total mortality [hazard ratio (HR); 95% confidence intervals (95% CI)] (1.15; 95% CI 1.14-1.16, HFH (HR: 1.26; 95% CI 1.24-1.28), and the combined endpoint of total mortality or HFH (HR: 1.19; 95% CI 1.27-1.20) than CRT in patients with no previous HFHs, after co-variate adjustment. Total mortality (HR: 1.67), HFH (HR: 2.63), and total mortality or HFH (HR: 1.92) (all P < 0.001) were highest in patients undergoing CRT ≥2 years after the first HFH. CONCLUSION In this study of a healthcare system covering an entire nation, delays from a first HFH to CRT implantation were associated with progressively worse long-term clinical outcomes. The best clinical outcomes were observed in patients with no previous HFH and in those undergoing CRT implantation during the first HFH. CONDENSED ABSTRACT The optimum timing of CRT implantation is unknown. In this study of 64 968 consecutive patients, delays from a first heart failure hospitalization (HFH) to CRT implantation were associated with progressively worse long-term clinical outcomes. Each year from a first HFH to CRT implantation was associated with a 21% higher risk of total mortality and a 34% higher risk of HFH. The best outcomes after CRT were observed in patients with no previous HFHs and in those undergoing implantation during their first HFH.
Collapse
Affiliation(s)
- Francisco Leyva
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
| | - Abbasin Zegard
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peysh Patel
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Berthold Stegemann
- Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Howard Marshall
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Peter Ludman
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Jamie Walton
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Joseph de Bono
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università, 4, 41121, Modena, Italy
| | - Tian Qiu
- Department of Cardiology, University Hospitals Birmingham, Queen Elizabeth, Mindelsohn Way, Birmingham B15 2GW, UK
| |
Collapse
|
6
|
Lyon A, Dupuis LJ, Arts T, Crijns HJGM, Prinzen FW, Delhaas T, Heijman J, Lumens J. Differentiating the effects of β-adrenergic stimulation and stretch on calcium and force dynamics using a novel electromechanical cardiomyocyte model. Am J Physiol Heart Circ Physiol 2020; 319:H519-H530. [PMID: 32734816 DOI: 10.1152/ajpheart.00275.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiac electrophysiology and mechanics are strongly interconnected. Calcium is crucial in this complex interplay through its role in cellular electrophysiology and sarcomere contraction. We aim to differentiate the effects of acute β-adrenergic stimulation (β-ARS) and cardiomyocyte stretch (increased sarcomere length) on calcium-transient dynamics and force generation, using a novel computational model of cardiac electromechanics. We implemented a bidirectional coupling between the O'Hara-Rudy model of human ventricular electrophysiology and the MechChem model of sarcomere mechanics through the buffering of calcium by troponin. The coupled model was validated using experimental data from large mammals or human samples. Calcium transient and force were simulated for various degrees of β-ARS and initial sarcomere lengths. The model reproduced force-frequency, quick-release, and isotonic contraction experiments, validating the bidirectional electromechanical interactions. An increase in β-ARS increased the amplitudes of force (augmented inotropy) and calcium transient, and shortened both force and calcium-transient duration (lusitropy). An increase in sarcomere length increased force amplitude even more, but decreased calcium-transient amplitude and increased both force and calcium-transient duration. Finally, a gradient in relaxation along the thin filament may explain the nonmonotonic decay in cytosolic calcium observed with high tension. Using a novel coupled human electromechanical model, we identified differential effects of β-ARS and stretch on calcium and force. Stretch mostly contributed to increased force amplitude and β-ARS to the reduction of calcium and force duration. We showed that their combination, rather than individual contributions, is key to ensure force generation, rapid relaxation, and low diastolic calcium levels.NEW & NOTEWORTHY This work identifies the contribution of electrical and mechanical alterations to regulation of calcium and force under exercise-like conditions using a novel human electromechanical model integrating ventricular electrophysiology and sarcomere mechanics. By better understanding their individual and combined effects, this can uncover arrhythmogenic mechanisms in exercise-like situations. This publicly available model is a crucial step toward understanding the complex interplay between cardiac electrophysiology and mechanics to improve arrhythmia risk prediction and treatment.
Collapse
Affiliation(s)
- Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Lauren J Dupuis
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.,Department of Bioinformatics-BiGCaT, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Theo Arts
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|