1
|
Zhou S, Wang L, Huang X, Wang T, Tang Y, Liu Y, Xu M. Comprehensive bioinformatics analytics and in vivo validation reveal SLC31A1 as an emerging diagnostic biomarker for acute myocardial infarction. Aging (Albany NY) 2024; 16:8361-8377. [PMID: 38713173 PMCID: PMC11132003 DOI: 10.18632/aging.205199] [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: 07/07/2023] [Accepted: 10/15/2023] [Indexed: 05/08/2024]
Abstract
BACKGROUND Globally, Acute Myocardial Infarction (AMI) is a common cause of heart failure (HF), which has been a leading cause of mortality resulting from non-communicable diseases. On the other hand, increasing evidence suggests that the role of energy production within the mitochondria strongly links to the development and progression of heart diseases, while Cuproptosis, a newly identified cell death mechanism, has not yet been comprehensively analyzed from the aspect of cardiovascular medicine. MATERIALS AND METHODS 8 transcriptome profiles curated from the GEO database were integrated, from which a diagnostic model based on the Stacking algorithm was established. The efficacy of the model was evaluated in a multifaced manner (i.e., by Precision-Recall curve, Receiver Operative Characteristic curve, etc.). We also sequenced our animal models at the bulk RNA level and conducted qPCR and immunohistochemical staining, with which we further validated the expression of the key contributor gene to the model. Finally, we explored the immune implications of the key contributor gene. RESULTS A merged machine learning model containing 4 Cuproptosis-related genes (i.e., PDHB, CDKN2A, GLS, and SLC31A1) for robust AMI diagnosis was developed, in which SLC31A1 served as the key contributor. Through in vivo modeling, we validated the aberrant overexpression of SLC31A1 in AMI. Besides, further transcriptome analysis revealed that its high expression was correlated with significant potential immunological implications in the infiltration of many immune cell types, especially monocyte. CONCLUSIONS We constructed an AMI diagnostic model based on Cuproptosis-related genes and validated the key contributor gene in animal modeling. We also analyzed the effects on the immune system for its overexpression in AMI.
Collapse
Affiliation(s)
- Shujing Zhou
- Department of Clinical Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Longbin Wang
- Department of Clinical Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Xufeng Huang
- Department of Clinical Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ting Wang
- Department of Clinical Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| | - Yidan Tang
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ying Liu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China
| | - Ming Xu
- Department of Clinical Veterinary Medicine, Huazhong Agricultural University, Wuhan, China
| |
Collapse
|
2
|
Cicci L, Fresca S, Manzoni A, Quarteroni A. Efficient approximation of cardiac mechanics through reduced-order modeling with deep learning-based operator approximation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3783. [PMID: 37921217 DOI: 10.1002/cnm.3783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/14/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023]
Abstract
Reducing the computational time required by high-fidelity, full-order models (FOMs) for the solution of problems in cardiac mechanics is crucial to allow the translation of patient-specific simulations into clinical practice. Indeed, while FOMs, such as those based on the finite element method, provide valuable information on the cardiac mechanical function, accurate numerical results can be obtained at the price of very fine spatio-temporal discretizations. As a matter of fact, simulating even just a few heartbeats can require up to hours of wall time on high-performance computing architectures. In addition, cardiac models usually depend on a set of input parameters that are calibrated in order to explore multiple virtual scenarios. To compute reliable solutions at a greatly reduced computational cost, we rely on a reduced basis method empowered with a new deep learning-based operator approximation, which we refer to as Deep-HyROMnet technique. Our strategy combines a projection-based POD-Galerkin method with deep neural networks for the approximation of (reduced) nonlinear operators, overcoming the typical computational bottleneck associated with standard hyper-reduction techniques employed in reduced-order models (ROMs) for nonlinear parametrized systems. This method can provide extremely accurate approximations to parametrized cardiac mechanics problems, such as in the case of the complete cardiac cycle in a patient-specific left ventricle geometry. In this respect, a 3D model for tissue mechanics is coupled with a 0D model for external blood circulation; active force generation is provided through an adjustable parameter-dependent surrogate model as input to the tissue 3D model. The proposed strategy is shown to outperform classical projection-based ROMs, in terms of orders of magnitude of computational speed-up, and to return accurate pressure-volume loops in both physiological and pathological cases. Finally, an application to a forward uncertainty quantification analysis, unaffordable if relying on a FOM, is considered, involving output quantities of interest such as, for example, the ejection fraction or the maximal rate of change in pressure in the left ventricle.
Collapse
Affiliation(s)
- Ludovica Cicci
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Stefania Fresca
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Andrea Manzoni
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX-Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Mathematics Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
3
|
Yin X, Wang Y. Effect of pulmonary regurgitation on cardiac functions based on a human bi-ventricle model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 238:107600. [PMID: 37285726 DOI: 10.1016/j.cmpb.2023.107600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/27/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Assessing the severity of pulmonary regurgitation (PR) and identifying optimal clinically relevant indicators for its treatment is crucial, yet standards for quantifying PR remain unclear in clinical practice. Computational modelling of the heart is in the process of providing valuable insights and information for cardiovascular physiology research. However, the advancements of finite element computational models have not been widely applied to simulate cardiac outputs in patients with PR. Furthermore, a computational model that incorporates both the left ventricle (LV) and right ventricle (RV) can be valuable in assessing the relationship between left and right ventricular morphometry and septal motion in PR patients. To enhance our understanding of the effect of PR on cardiac functions and mechanical behaviour, we developed a human bi-ventricle model to simulate five cases with varying degrees of PR severity. METHODS This bi-ventricle model was built using a patient-specific geometry and a widely used myofibre architecture. The myocardial material properties were described by a hyperelastic passive constitutive law and a modified time-varying elastance active tension model. To simulate realistic cardiac functions and the dysfunction of the pulmonary valve in PR disease cases, open-loop lumped parameter models representing systemic and pulmonary circulatory systems were designed. RESULTS In the baseline case, pressures in the aorta and main pulmonary artery and ejection fractions of both the LV and RV were within normal physiological ranges reported in the literature. The end-diastolic volume (EDV) of the RV under varying degrees of PR was comparable to the reported cardiac magnetic resonance imaging data. Moreover, RV dilation and interventricular septum motion from the baseline to the PR cases were clearly observed through the long-axis and short-axis views of the bi-ventricle geometry. The RV EDV in the severe PR case increased by 50.3% compared to the baseline case, while the LV EDV decreased by 18.1%. The motion of the interventricular septum was consistent with the literature. Furthermore, ejection fractions of both the LV and RV decreased as PR became severe, with LV ejection fraction decreasing from 60.5% at baseline to 56.3% in the severe case and RV ejection fraction decreasing from 51.8% to 46.8%. Additionally, the average myofibre stress of the RV wall at end-diastole significantly increased due to PR, from 2.7±12.1 kPa at baseline to 10.9±26.5 kPa in the severe case. The average myofibre stress of the LV wall at end-diastole increased from 3.7±18.1 kPa to 4.3±20.3 kPa. CONCLUSIONS This study established a foundation for the computational modelling of PR. The simulated results showed that severe PR leads to reduced cardiac outputs in both the LV and RV, clearly observable septum motion, and a significant increase in the average myofibre stress in the RV wall. These findings demonstrate the potential of the model for further exploration of PR.
Collapse
Affiliation(s)
- Xueqing Yin
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom
| | - Yingjie Wang
- School of Mathematics and Statistics, University of Glasgow, Glasgow, United Kingdom.
| |
Collapse
|
4
|
Rabbani A, Gao H, Lazarus A, Dalton D, Ge Y, Mangion K, Berry C, Husmeier D. Image-based estimation of the left ventricular cavity volume using deep learning and Gaussian process with cardio-mechanical applications. Comput Med Imaging Graph 2023; 106:102203. [PMID: 36848766 DOI: 10.1016/j.compmedimag.2023.102203] [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: 09/02/2022] [Revised: 11/26/2022] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
In this investigation, an image-based method has been developed to estimate the volume of the left ventricular cavity using cardiac magnetic resonance (CMR) imaging data. Deep learning and Gaussian processes have been applied to bring the estimations closer to the cavity volumes manually extracted. CMR data from 339 patients and healthy volunteers have been used to train a stepwise regression model that can estimate the volume of the left ventricular cavity at the beginning and end of diastole. We have decreased the root mean square error (RMSE) of cavity volume estimation approximately from 13 to 8 ml compared to the common practice in the literature. Considering the RMSE of manual measurements is approximately 4 ml on the same dataset, 8 ml of error is notable for a fully automated estimation method, which needs no supervision or user-hours once it has been trained. Additionally, to demonstrate a clinically relevant application of automatically estimated volumes, we inferred the passive material properties of the myocardium given the volume estimates using a well-validated cardiac model. These material properties can be further used for patient treatment planning and diagnosis.
Collapse
Affiliation(s)
- Arash Rabbani
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom; School of Computing, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Hao Gao
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Alan Lazarus
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - David Dalton
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Yuzhang Ge
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Kenneth Mangion
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Colin Berry
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Dirk Husmeier
- School of Mathematics & Statistics, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| |
Collapse
|
5
|
Sethi Y, Patel N, Kaka N, Kaiwan O, Kar J, Moinuddin A, Goel A, Chopra H, Cavalu S. Precision Medicine and the future of Cardiovascular Diseases: A Clinically Oriented Comprehensive Review. J Clin Med 2023; 12:1799. [PMID: 36902588 PMCID: PMC10003116 DOI: 10.3390/jcm12051799] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023] Open
Abstract
Cardiac diseases form the lion's share of the global disease burden, owing to the paradigm shift to non-infectious diseases from infectious ones. The prevalence of CVDs has nearly doubled, increasing from 271 million in 1990 to 523 million in 2019. Additionally, the global trend for the years lived with disability has doubled, increasing from 17.7 million to 34.4 million over the same period. The advent of precision medicine in cardiology has ignited new possibilities for individually personalized, integrative, and patient-centric approaches to disease prevention and treatment, incorporating the standard clinical data with advanced "omics". These data help with the phenotypically adjudicated individualization of treatment. The major objective of this review was to compile the evolving clinically relevant tools of precision medicine that can help with the evidence-based precise individualized management of cardiac diseases with the highest DALY. The field of cardiology is evolving to provide targeted therapy, which is crafted as per the "omics", involving genomics, transcriptomics, epigenomics, proteomics, metabolomics, and microbiomics, for deep phenotyping. Research for individualizing therapy in heart diseases with the highest DALY has helped identify novel genes, biomarkers, proteins, and technologies to aid early diagnosis and treatment. Precision medicine has helped in targeted management, allowing early diagnosis, timely precise intervention, and exposure to minimal side effects. Despite these great impacts, overcoming the barriers to implementing precision medicine requires addressing the economic, cultural, technical, and socio-political issues. Precision medicine is proposed to be the future of cardiovascular medicine and holds the potential for a more efficient and personalized approach to the management of cardiovascular diseases, contrary to the standardized blanket approach.
Collapse
Affiliation(s)
- Yashendra Sethi
- PearResearch, Dehradun 248001, India
- Department of Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun 248001, India
| | - Neil Patel
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Nirja Kaka
- PearResearch, Dehradun 248001, India
- Department of Medicine, GMERS Medical College, Himmatnagar 383001, India
| | - Oroshay Kaiwan
- PearResearch, Dehradun 248001, India
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Jill Kar
- PearResearch, Dehradun 248001, India
- Department of Medicine, Lady Hardinge Medical College, New Delhi 110001, India
| | - Arsalan Moinuddin
- Vascular Health Researcher, School of Sports and Exercise, University of Gloucestershire, Cheltenham GL50 4AZ, UK
| | - Ashish Goel
- Department of Medicine, Government Doon Medical College, HNB Uttarakhand Medical Education University, Dehradun 248001, India
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
| |
Collapse
|
6
|
Liu Z, Wang L, Xing Q, Liu X, Hu Y, Li W, Yan Q, Liu R, Huang N. Identification of GLS as a cuproptosis-related diagnosis gene in acute myocardial infarction. Front Cardiovasc Med 2022; 9:1016081. [PMID: 36440046 PMCID: PMC9691691 DOI: 10.3389/fcvm.2022.1016081] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Acute myocardial infarction (AMI) has the characteristics of sudden onset, rapid progression, poor prognosis, and so on. Therefore, it is urgent to identify diagnostic and prognostic biomarkers for it. Cuproptosis is a new form of mitochondrial respiratory-dependent cell death. However, studies are limited on the clinical significance of cuproptosis-related genes (CRGs) in AMI. In this study, we systematically assessed the genetic alterations of CRGs in AMI by bioinformatics approach. The results showed that six CRGs (LIAS, LIPT1, DLAT, PDHB, MTF1, and GLS) were markedly differentially expressed between stable coronary heart disease (stable_CAD) and AMI. Correlation analysis indicated that CRGs were closely correlated with N6-methyladenosine (m6A)-related genes through R language “corrplot” package, especially GLS was positively correlated with FMR1 and MTF1 was negatively correlated with HNRNPA2B1. Immune landscape analysis results revealed that CRGs were closely related to various immune cells, especially GLS was positively correlated with T cells CD4 memory resting and negatively correlated with monocytes. Kaplan–Meier analysis demonstrated that the group with high DLAT expression had a better prognosis. The area under curve (AUC) certified that GLS had good diagnostic value, in the training set (AUC = 0.87) and verification set (ACU = 0.99). Gene set enrichment analysis (GSEA) suggested that GLS was associated with immune- and hypoxia-related pathways. In addition, Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, competing endogenous RNA (ceRNA) analysis, transcription factor (TF), and compound prediction were performed to reveal the regulatory mechanism of CRGs in AMI. Overall, our study can provide additional information for understanding the role of CRGs in AMI, which may provide new insights into the identification of therapeutic targets for AMI.
Collapse
Affiliation(s)
- Zheng Liu
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Lei Wang
- Department of Cardiovascular Medicine, Xiangtan Center Hospital, Xiangtan, China
| | - Qichang Xing
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Xiang Liu
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Yixiang Hu
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Wencan Li
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Qingzi Yan
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Renzhu Liu
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- Zhou Honghao Research Institute Xiangtan, Xiangtan, China
| | - Nan Huang
- Clinical Pharmacy, Xiangtan Center Hospital, Xiangtan, China
- *Correspondence: Nan Huang,
| |
Collapse
|
7
|
Personalized Medicine for the Critically Ill Patient: A Narrative Review. Processes (Basel) 2022. [DOI: 10.3390/pr10061200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Personalized Medicine (PM) is rapidly advancing in everyday medical practice. Technological advances allow researchers to reach patients more than ever with their discoveries. The critically ill patient is probably the most complex of all, and personalized medicine must make serious efforts to fulfill the desire to “treat the individual, not the disease”. The complexity of critically ill pathologies arises from the severe state these patients and from the deranged pathways of their diseases. PM constitutes the integration of basic research into clinical practice; however, to make this possible complex and voluminous data require processing through even more complex mathematical models. The result of processing biodata is a digitized individual, from which fragments of information can be extracted for specific purposes. With this review, we aim to describe the current state of PM technologies and methods and explore its application in critically ill patients, as well as some of the challenges associated with PM in intensive care from the perspective of economic, approval, and ethical issues. This review can help in understanding the complexity of, P.M.; the complex processes needed for its application in critically ill patients, the benefits that make the effort of implementation worthwhile, and the current challenges of PM.
Collapse
|
8
|
Guan D, Gao H, Cai L, Luo X. A new active contraction model for the myocardium using a modified hill model. Comput Biol Med 2022; 145:105417. [DOI: 10.1016/j.compbiomed.2022.105417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
|
9
|
Borowska A, Gao H, Lazarus A, Husmeier D. Bayesian optimisation for efficient parameter inference in a cardiac mechanics model of the left ventricle. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3593. [PMID: 35302293 PMCID: PMC9285944 DOI: 10.1002/cnm.3593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
We consider parameter inference in cardio-mechanic models of the left ventricle, in particular the one based on the Holtzapfel-Ogden (HO) constitutive law, using clinical in vivo data. The equations underlying these models do not admit closed form solutions and hence need to be solved numerically. These numerical procedures are computationally expensive making computational run times associated with numerical optimisation or sampling excessive for the uptake of the models in the clinical practice. To address this issue, we adopt the framework of Bayesian optimisation (BO), which is an efficient statistical technique of global optimisation. BO seeks the optimum of an unknown black-box function by sequentially training a statistical surrogate-model and using it to select the next query point by leveraging the associated exploration-exploitation trade-off. To guarantee that the estimates based on the in vivo data are realistic also for high-pressures, unobservable in vivo, we include a penalty term based on a previously published empirical law developed using ex vivo data. Two case studies based on real data demonstrate that the proposed BO procedure outperforms the state-of-the-art inference algorithm for the HO constitutive law.
Collapse
Affiliation(s)
| | - Hao Gao
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| | - Alan Lazarus
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| | - Dirk Husmeier
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| |
Collapse
|
10
|
Cai L, Jiao J, Ma P, Xie W, Wang Y. Estimation of left ventricular parameters based on deep learning method. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:6638-6658. [PMID: 35730275 DOI: 10.3934/mbe.2022312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Estimating material properties of personalized human left ventricular (LV) modelling is a central problem in biomechanical studies. In this work we use deep learning (DL) method to evaluating the passive myocardial mechanical properties inversely. In the first part of the paper, we establish a standardized geometric model of the LV. The geometric model parameters are optimized based on 27 different healthy volunteers. In the second part, we use statistical methods and Latin hypercube sampling (LHS) to obtain the geometric parameters data. The LV myocardium is described using a structure-based orthotropic Holzapfel-Ogden constitutive law. The LV diastolic pressure-volume (PV) curves are calculated by numerical simulation. Tn the third part, we establish the multiple neural networks to pblackict PV curve parameters. Then, instead of using constrained optimization problems to solve constitutive parameters, DL was used to establish the nonlinear mapping relationship of geometric parameters, PV curve parameters and constitutive parameters. The results show that the deep learning method can greatly improve the computational efficiency of numerical simulation and increase the possibility of its application in rapid feedback of clinical data.
Collapse
Affiliation(s)
- Li Cai
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
| | - Jie Jiao
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
| | - Pengfei Ma
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
| | - Wenxian Xie
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
| | - Yongheng Wang
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
| |
Collapse
|
11
|
Lazarus A, Gao H, Luo X, Husmeier D. Improving cardio‐mechanic inference by combining in vivo strain data with ex vivo volume–pressure data. J R Stat Soc Ser C Appl Stat 2022. [DOI: 10.1111/rssc.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hao Gao
- University of Glasgow GlasgowUK
| | | | | |
Collapse
|
12
|
Maarman GJ. Reviewing the suitability of mitochondrial transplantation as therapeutic approach for pulmonary hypertension in the era of personalised medicine. Am J Physiol Lung Cell Mol Physiol 2022; 322:L641-L646. [PMID: 35318860 DOI: 10.1152/ajplung.00484.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a fatal disease, defined as a mean pulmonary artery pressure ≥ 25 mm Hg. It is caused, in part, by mitochondrial dysfunction. Among the various biological therapies proposed to rescue mitochondrial dysfunction, evidence going back as far as 2009, suggests that mitochondrial transplantation is an alternative. Although scant, recent PH findings and other literature supports a role for mitochondrial transplantation as a therapeutic approach in the context of PH. In experimental models of PH, it confers beneficial effects that include reduced pulmonary vasoconstriction, reduced pulmonary vascular remodelling, and improved right ventricular function. It also reduces the proliferation of pulmonary artery smooth muscle cells. However, first, we must understand that more research is needed before mitochondrial transplantation can be considered an effective therapy in the clinical setting, as many of the mechanisms or potential long-term risks are still unknown. Second, the current challenges of mitochondrial transplantation are surmountable and should not deter researchers from further investigating its effectiveness and trying to overcome these challenges in creative ways.
Collapse
Affiliation(s)
- Gerald J Maarman
- CARMA: Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Department of Biomedical Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
13
|
Taking It Personally: 3D Bioprinting a Patient-Specific Cardiac Patch for the Treatment of Heart Failure. Bioengineering (Basel) 2022; 9:bioengineering9030093. [PMID: 35324782 PMCID: PMC8945185 DOI: 10.3390/bioengineering9030093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Despite a massive global preventative effort, heart failure remains the major cause of death globally. The number of patients requiring a heart transplant, the eventual last treatment option, far outnumbers the available donor hearts, leaving many to deteriorate or die on the transplant waiting list. Treating heart failure by transplanting a 3D bioprinted patient-specific cardiac patch to the infarcted region on the myocardium has been investigated as a potential future treatment. To date, several studies have created cardiac patches using 3D bioprinting; however, testing the concept is still at a pre-clinical stage. A handful of clinical studies have been conducted. However, moving from animal studies to human trials will require an increase in research in this area. This review covers key elements to the design of a patient-specific cardiac patch, divided into general areas of biological design and 3D modelling. It will make recommendations on incorporating anatomical considerations and high-definition motion data into the process of 3D-bioprinting a patient-specific cardiac patch.
Collapse
|
14
|
Yang L, Wang T, Zhang X, Zhang H, Yan N, Zhang G, Yan R, Li Y, Yu J, He J, Jia S, Wang H. Exosomes derived from human placental mesenchymal stem cells ameliorate myocardial infarction via anti-inflammation and restoring gut dysbiosis. BMC Cardiovasc Disord 2022; 22:61. [PMID: 35172728 PMCID: PMC8851843 DOI: 10.1186/s12872-022-02508-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/09/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) represents a severe cardiovascular disease with limited therapeutic agents. This study was aimed to elucidate the role of the exosomes derived from human placental mesenchymal stem cells (PMSCs-Exos) in MI. METHODS PMSCs were isolated and cultured in vitro, with identification by both transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). To further investigate the effects of PMSC-Exos on MI, C57BL/6 mice were randomly divided into Sham group, MI group, and PMSC-Exos group. After 4 weeks of the intervention, cardiac function was assessed by cardiac echocardiography, electrocardiogram and masson trichrome staining; lipid indicators were determined by automatic biochemical instrument; inflammatory cytokines were measured by cytometric bead array (CBA); gut microbiota, microbial metabolites short chain fatty acids (SCFAs) as well as lipopolysaccharide (LPS) were separately investigated by 16S rRNA high throughput sequencing, gas chromatography mass spectrometry (GC-MS) and tachypleus amebocyte lysate kit; transcriptome analysis was used to test the transcriptional components (mRNA\miRNA\cirRNA\lncRNA) of PMSC-Exos. RESULTS We found that human PMSC-Exos were obtained and identified with high purity and uniformity. MI model was successfully established. Compared to MI group, PMSC-Exos treatment ameliorated myocardial fibrosis and left ventricular (LV) remodeling (P < 0.05). Moreover, PMSC-Exos treatment obviously decreased MI molecular markers (AST/BNP/MYO/Tn-I/TC), pro-inflammatory indicators (IL-1β, IL-6, TNF-α, MCP-1), as well as increased HDL in comparison with MI group (all P < 0.05). Intriguingly, PMSC-Exos intervention notably modulated gut microbial community via increasing the relative abundances of Bacteroidetes, Proteobacteria, Verrucomicrobia, Actinobacteria, Akkermansia, Bacteroides, Bifidobacterium, Thauera and Ruminiclostridium, as well as decreasing Firmicutes (all P < 0.05), compared with MI group. Furthermore, PMSC-Exos supplementation increased gut microbiota metabolites SCFAs (butyric acid, isobutyric acid and valeric acid) and decreased LPS in comparison with MI group (all P < 0.05). Correlation analysis indicated close correlations among gut microbiota, microbial SCFAs and inflammation in MI. CONCLUSIONS Our study highlighted that PMSC-Exos intervention alleviated MI via modulating gut microbiota and suppressing inflammation.
Collapse
Affiliation(s)
- Libo Yang
- Clinical Medical College, Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004 China
| | - Ting Wang
- Department of Pathogenic Biology and Medical Immunology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Xiaoxia Zhang
- College of Traditional Chinese Medicine, Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Hua Zhang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Ning Yan
- Clinical Medical College, Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004 China
| | - Guoshan Zhang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Ru Yan
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004 China
| | - Yiwei Li
- Department of Pathogenic Biology and Medical Immunology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004 Ningxia China
| | - Jingjing Yu
- Clinical Medical College, Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Department of Beijing National Biochip Research Center Sub-Center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jun He
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004 China
| | - Shaobin Jia
- Clinical Medical College, Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004 Ningxia China
- Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004 China
| | - Hao Wang
- Department of Pathogenic Biology and Medical Immunology, School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, 750004 Ningxia China
| |
Collapse
|
15
|
Guan D, Wang Y, Xu L, Cai L, Luo X, Gao H. Effects of dispersed fibres in myocardial mechanics, Part II: active response. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:4101-4119. [PMID: 35341289 DOI: 10.3934/mbe.2022189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This work accompanies the first part of our study "effects of dispersed fibres in myocardial mechanics: Part I passive response" with a focus on myocardial active contraction. Existing studies have suggested that myofibre architecture plays an important role in myocardial active contraction. Following the first part of our study, we firstly study how the general fibre architecture affects ventricular pump function by varying the mean myofibre rotation angles, and then the impact of fibre dispersion along the myofibre direction on myocardial contraction in a left ventricle model. Dispersed active stress is described by a generalised structure tensor method for its computational efficiency. Our results show that both the myofibre rotation angle and its dispersion can significantly affect cardiac pump function by redistributing active tension circumferentially and longitudinally. For example, larger myofibre rotation angle and higher active tension along the sheet-normal direction can lead to much reduced end-systolic volume and higher longitudinal shortening, and thus a larger ejection fraction. In summary, these two studies together have demonstrated that it is necessary and essential to include realistic fibre structures (both fibre rotation angle and fibre dispersion) in personalised cardiac modelling for accurate myocardial dynamics prediction.
Collapse
Affiliation(s)
- Debao Guan
- School of Mathematics and Statistics, University of Glasgow, UK
| | - Yingjie Wang
- School of Mathematics and Statistics, University of Glasgow, UK
| | - Lijian Xu
- Centre for Perceptual and Interactive Intelligence, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an, China
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, UK
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, UK
| |
Collapse
|
16
|
Guan D, Mei Y, Xu L, Cai L, Luo X, Gao H. Effects of dispersed fibres in myocardial mechanics, Part I: passive response. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:3972-3993. [PMID: 35341283 DOI: 10.3934/mbe.2022183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It is widely acknowledged that an imbalanced biomechanical environment can have significant effects on myocardial pathology, leading to adverse remodelling of cardiac function if it persists. Accurate stress prediction essentially depends on the strain energy function which should have competent descriptive and predictive capabilities. Previous studies have focused on myofibre dispersion, but not on fibres along other directions. In this study, we will investigate how fibre dispersion affects myocardial biomechanical behaviours by taking into account both the myofibre dispersion and the sheet fibre dispersion, with a focus on the sheet fibre dispersion. Fibre dispersion is incorporated into a widely-used myocardial strain energy function using the discrete fibre bundle approach. We first study how different dispersion affects the descriptive capability of the strain energy function when fitting to ex vivo experimental data, and then the predictive capability in a human left ventricle during diastole. Our results show that the chosen strain energy function can achieve the best goodness-of-fit to the experimental data by including both fibre dispersion. Furthermore, noticeable differences in stress can be found in the LV model. Our results may suggest that it is necessary to include both dispersion for myofibres and the sheet fibres for the improved descriptive capability to the ex vivo experimental data and potentially more accurate stress prediction in cardiac mechanics.
Collapse
Affiliation(s)
- Debao Guan
- School of Mathematics and Statistics, University of Glasgow, UK
| | - Yuqian Mei
- School of Medical Imaging, North Sichuan Medical College, Sichuan, China
| | - Lijian Xu
- Centre for Perceptual and Interactive Intelligence, The Chinese University of Hong Kong, Hong Kong, China
| | - Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an, China
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, UK
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, UK
| |
Collapse
|
17
|
Romaszko L, Borowska A, Lazarus A, Dalton D, Berry C, Luo X, Husmeier D, Gao H. Neural network-based left ventricle geometry prediction from CMR images with application in biomechanics. Artif Intell Med 2021; 119:102140. [PMID: 34531009 DOI: 10.1016/j.artmed.2021.102140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Combining biomechanical modelling of left ventricular (LV) function and dysfunction with cardiac magnetic resonance (CMR) imaging has the potential to improve the prognosis of patient-specific cardiovascular disease risks. Biomechanical studies of LV function in three dimensions usually rely on a computerized representation of the LV geometry based on finite element discretization, which is essential for numerically simulating in vivo cardiac dynamics. Detailed knowledge of the LV geometry is also relevant for various other clinical applications, such as assessing the LV cavity volume and wall thickness. Accurately and automatically reconstructing personalized LV geometries from conventional CMR images with minimal manual intervention is still a challenging task, which is a pre-requisite for any subsequent automated biomechanical analysis. We propose a deep learning-based automatic pipeline for predicting the three-dimensional LV geometry directly from routinely-available CMR cine images, without the need to manually annotate the ventricular wall. Our framework takes advantage of a low-dimensional representation of the high-dimensional LV geometry based on principal component analysis. We analyze how the inference of myocardial passive stiffness is affected by using our automatically generated LV geometries instead of manually generated ones. These insights will inform the development of statistical emulators of LV dynamics to avoid computationally expensive biomechanical simulations. Our proposed framework enables accurate LV geometry reconstruction, outperforming previous approaches by delivering a reconstruction error 50% lower than reported in the literature. We further demonstrate that for a nonlinear cardiac mechanics model, using our reconstructed LV geometries instead of manually extracted ones only moderately affects the inference of passive myocardial stiffness described by an anisotropic hyperelastic constitutive law. The developed methodological framework has the potential to make an important step towards personalized medicine by eliminating the need for time consuming and costly manual operations. In addition, our method automatically maps the CMR scan into a low-dimensional representation of the LV geometry, which constitutes an important stepping stone towards the development of an LV geometry-heterogeneous emulator.
Collapse
Affiliation(s)
- Lukasz Romaszko
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - Agnieszka Borowska
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - Alan Lazarus
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - David Dalton
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Xiaoyu Luo
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - Dirk Husmeier
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK
| | - Hao Gao
- School of Mathematics and Statistics, Univeristy of Glasgow, Glasgow, UK.
| |
Collapse
|
18
|
Khodaei S, Henstock A, Sadeghi R, Sellers S, Blanke P, Leipsic J, Emadi A, Keshavarz-Motamed Z. Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework. Sci Rep 2021; 11:10888. [PMID: 34035325 PMCID: PMC8149684 DOI: 10.1038/s41598-021-85500-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/12/2021] [Indexed: 02/04/2023] Open
Abstract
One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.
Collapse
Affiliation(s)
- Seyedvahid Khodaei
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Alison Henstock
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Reza Sadeghi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada
| | - Stephanie Sellers
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Philipp Blanke
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Jonathon Leipsic
- grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Ali Emadi
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON Canada
| | - Zahra Keshavarz-Motamed
- grid.25073.330000 0004 1936 8227Department of Mechanical Engineering, McMaster University, Hamilton, ON L8S 4L7 Canada ,grid.25073.330000 0004 1936 8227School of Biomedical Engineering, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227School of Computational Science and Engineering, McMaster University, Hamilton, ON Canada
| |
Collapse
|
19
|
Richardson SIH, Gao H, Cox J, Janiczek R, Griffith BE, Berry C, Luo X. A poroelastic immersed finite element framework for modelling cardiac perfusion and fluid-structure interaction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3446. [PMID: 33559359 PMCID: PMC8274593 DOI: 10.1002/cnm.3446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/22/2020] [Accepted: 01/20/2021] [Indexed: 05/11/2023]
Abstract
Modern approaches to modelling cardiac perfusion now commonly describe the myocardium using the framework of poroelasticity. Cardiac tissue can be described as a saturated porous medium composed of the pore fluid (blood) and the skeleton (myocytes and collagen scaffold). In previous studies fluid-structure interaction in the heart has been treated in a variety of ways, but in most cases, the myocardium is assumed to be a hyperelastic fibre-reinforced material. Conversely, models that treat the myocardium as a poroelastic material typically neglect interactions between the myocardium and intracardiac blood flow. This work presents a poroelastic immersed finite element framework to model left ventricular dynamics in a three-phase poroelastic system composed of the pore blood fluid, the skeleton, and the chamber fluid. We benchmark our approach by examining a pair of prototypical poroelastic formations using a simple cubic geometry considered in the prior work by Chapelle et al (2010). This cubic model also enables us to compare the differences between system behaviour when using isotropic and anisotropic material models for the skeleton. With this framework, we also simulate the poroelastic dynamics of a three-dimensional left ventricle, in which the myocardium is described by the Holzapfel-Ogden law. Results obtained using the poroelastic model are compared to those of a corresponding hyperelastic model studied previously. We find that the poroelastic LV behaves differently from the hyperelastic LV model. For example, accounting for perfusion results in a smaller diastolic chamber volume, agreeing well with the well-known wall-stiffening effect under perfusion reported previously. Meanwhile differences in systolic function, such as fibre strain in the basal and middle ventricle, are found to be comparatively minor.
Collapse
Affiliation(s)
| | - Hao Gao
- School of Mathematics and Statistics, University of
Glasgow, Glasgow, UK
| | | | | | - Boyce E. Griffith
- Departments of Mathematics, Applied Physical Sciences, and
Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina,
USA
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research
Centre, University of Glasgow, Glasgow, UK
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of
Glasgow, Glasgow, UK
| |
Collapse
|
20
|
Tu C, Wan B, Zeng Y. Ginsenoside Rg3 alleviates inflammation in a rat model of myocardial infarction via the SIRT1/NF-κB pathway. Exp Ther Med 2020; 20:238. [PMID: 33193843 PMCID: PMC7646702 DOI: 10.3892/etm.2020.9368] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 06/05/2020] [Indexed: 12/31/2022] Open
Abstract
Inflammation serves an important role in myocardial infarction (MI). Ginsenoside Rg3 (Rg3), an activator of sirtuin 1 (SIRT1), has been identified to elicit anti-inflammatory effects via the NF-κB pathway. However, the function of Rg3 in MI remains unknown. In the present study, a MI rat model was established by coronary artery ligation and treated with Rg3 to explore whether Rg3 could inhibit inflammation in MI rats by inhibiting the SIRT1/NF-κB pathway. At 28 days post-MI, it was identified that Rg3 not only decreased the ST-segment ECG values in MI rats, but also significantly decreased serum LDH, CK-MB and cTnI levels in MI rats. In addition, Rg3 also significantly decreased serum tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-6 levels and increased serum IL-10 levels in MI rats. In the heart tissues of the MI rats, Rg3 attenuated myocardial pathological changes and cell apoptosis caused by MI, decreased the gene expression levels of TNF-α, IL-1β and IL-6, but increased the gene expression level of IL-10. In addition, the expression levels of the SIRT1 and transcription factor RelB proteins were significantly increased following Rg3 treatment, and the expression level of p-p65/p65 protein was significantly decreased in the heart tissues of MI rats with Rg3 treatment compared with that in heart tissues of MI rats without Rg3 treatment. In conclusion, Rg3 alleviates inflammation in a rat model of MI via the SIRT1/NF-κB pathway.
Collapse
Affiliation(s)
- Chenchen Tu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Baoyan Wan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| |
Collapse
|
21
|
Xu W, Li XP, Li EZ, Liu YF, Zhao J, Wei LN, Ma L. Protective Effects of Allicin on ISO-Induced Rat Model of Myocardial Infarction via JNK Signaling Pathway. Pharmacology 2020; 105:505-513. [PMID: 32784309 DOI: 10.1159/000503755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This research was aimed to explore protective effects of allicin on rat model of myocardial infarction via JNK signaling pathway. METHODS Rat myocardial ischemia model was established with subcutaneous injection of isoproterenol (ISO). Seventy-five rats were randomly divided into 5 groups (n = 15): sham group, ISO group, low-dose group (1.2 mg/kg/days for 7 days), medium-dose group (1.8 mg/kg/days for 7 days), and high-dose group (3.6 mg/kg/days for 7 days). Routine HE staining and Masson staining were performed to observe myocardial histopathology. The expression of oxidative stress-related indicators, heart tissue apoptosis-related proteins, and JNK and p-JNK proteins were measured for different groups. RESULTS Compared with the sham group, the T wave value of the ISO group was significantly increased (p < 0.01). When allicin was administered, the T wave values at different time points in all groups were all decreased. Compared with the sham group, the ratio of eNOS, Bcl-2/Bax was significantly decreased, and p-eNOS, iNOS, caspase-3, caspase-9, and Cyt-c were significantly elevated in the ISO group (p < 0.05). After allicin was administered, significant changes in these proteins were observed in the medium- and high-dose groups. There was no significant change in the expression of JNK protein in the ISO group compared with the sham group; however, the expression of eNOS and p-JNK protein were significantly upregulated (p < 0.01) and the expression of p-eNOS and iNOS were significantly downregulated (p < 0.01). When allicin was administered, expression of p-JNK protein was significantly downregulated. CONCLUSION Allicin can reduce oxidative stress damage and cardiomyocyte apoptosis in rat model of myocardial infarction and can significantly regulate JNK signaling pathway.
Collapse
Affiliation(s)
- Wen Xu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiang-Peng Li
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - En-Ze Li
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yue-Fen Liu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jun Zhao
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Na Wei
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lin Ma
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, China,
| |
Collapse
|
22
|
Abstract
Non-linear electrical waves propagate through the heart and control cardiac contraction. Abnormal wave propagation causes various forms of the heart disease and can be lethal. One of the main causes of abnormality is a condition of cardiac fibrosis, which, from mathematical point of view, is the presence of multiple non-conducting obstacles for wave propagation. The fibrosis can have different texture which varies from diffuse (e.g., small randomly distributed obstacles), patchy (e.g., elongated interstitional stria), and focal (e.g., post-infarct scars) forms. Recently, Nezlobinsky et al. (2020) used 2D biophysical models to quantify the effects of elongation of obstacles (fibrosis texture) and showed that longitudinal and transversal propagation differently depends on the obstacle length resulting in anisotropy for wave propagation. In this paper, we extend these studies to 3D tissue models. We show that 3D consideration brings essential new effects; for the same obstacle length in 3D systems, anisotropy is about two times smaller compared to 2D, however, wave propagation is more stable with percolation threshold of about 60% (compared to 35% in 2D). The percolation threshold increases with the obstacle length for the longitudinal propagation, while it decreases for the transversal propagation. Further, in 3D, the dependency of velocity on the obstacle length for the transversal propagation disappears.
Collapse
|
23
|
Guan D, Yao J, Luo X, Gao H. Effect of myofibre architecture on ventricular pump function by using a neonatal porcine heart model: from DT-MRI to rule-based methods. ROYAL SOCIETY OPEN SCIENCE 2020; 7:191655. [PMID: 32431869 PMCID: PMC7211874 DOI: 10.1098/rsos.191655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/26/2020] [Indexed: 05/17/2023]
Abstract
Myofibre architecture is one of the essential components when constructing personalized cardiac models. In this study, we develop a neonatal porcine bi-ventricle model with three different myofibre architectures for the left ventricle (LV). The most realistic one is derived from ex vivo diffusion tensor magnetic resonance imaging, and other two simplifications are based on rule-based methods (RBM): one is regionally dependent by dividing the LV into 17 segments, each with different myofibre angles, and the other is more simplified by assigning a set of myofibre angles across the whole ventricle. Results from different myofibre architectures are compared in terms of cardiac pump function. We show that the model with the most realistic myofibre architecture can produce larger cardiac output, higher ejection fraction and larger apical twist compared with those of the rule-based models under the same pre/after-loads. Our results also reveal that when the cross-fibre contraction is included, the active stress seems to play a dual role: its sheet-normal component enhances the ventricular contraction while its sheet component does the opposite. We further show that by including non-symmetric fibre dispersion using a general structural tensor, even the most simplified rule-based myofibre model can achieve similar pump function as the most realistic one, and cross-fibre contraction components can be determined from this non-symmetric dispersion approach. Thus, our study highlights the importance of including myofibre dispersion in cardiac modelling if RBM are used, especially in personalized models.
Collapse
Affiliation(s)
- Debao Guan
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Jiang Yao
- Dassault Systemes, Johnston, RI, USA
| | - Xiaoyu Luo
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Hao Gao
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
- Author for correspondence: Hao Gao e-mail:
| |
Collapse
|
24
|
Kim S, Chon SB, Oh WS, Cho S. Determination of the theoretical personalized optimum chest compression point using anteroposterior chest radiography. Clin Exp Emerg Med 2019; 6:303-313. [PMID: 31910501 PMCID: PMC6952631 DOI: 10.15441/ceem.19.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 11/23/2022] Open
Abstract
Objective There is a traditional assumption that to maximize stroke volume, the point beneath which the left ventricle (LV) is at its maximum diameter (P_max.LV) should be compressed. Thus, we aimed to derive and validate rules to estimate P_max.LV using anteroposterior chest radiography (chest_AP), which is performed for critically ill patients urgently needing determination of their personalized P_max.LV. Methods A retrospective, cross-sectional study was performed with non-cardiac arrest adults who underwent chest_AP within 1 hour of computed tomography (derivation:validation=3:2). On chest_AP, we defined cardiac diameter (CD), distance from right cardiac border to midline (RB), and cardiac height (CH) from the carina to the uppermost point of left hemi-diaphragm. Setting point zero (0, 0) at the midpoint of the xiphisternal joint and designating leftward and upward directions as positive on x- and y-axes, we located P_max.LV (x_max.LV, y_max.LV). The coefficients of the following mathematically inferred rules were sought: x_max.LV=α0*CD-RB; y_max.LV=β0*CH+γ0 (α0: mean of [x_max.LV+RB]/CD; β0, γ0: representative coefficient and constant of linear regression model, respectively). Results Among 360 cases (52.0±18.3 years, 102 females), we derived: x_max.LV=0.643*CD-RB and y_max.LV=55-0.390*CH. This estimated P_max.LV (19±11 mm) was as close as the averaged P_max.LV (19±11 mm, P=0.13) and closer than the three equidistant points representing the current guidelines (67±13, 56±10, and 77±17 mm; all P<0.001) to the reference identified on computed tomography. Thus, our findings were validated. Conclusion Personalized P_max.LV can be estimated using chest_AP. Further studies with actual cardiac arrest victims are needed to verify the safety and effectiveness of the rule.
Collapse
Affiliation(s)
- Shinwoo Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sung-Bin Chon
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sunho Cho
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
25
|
Doborjeh M, Kasabov N, Doborjeh Z, Enayatollahi R, Tu E, Gandomi AH. Personalised modelling with spiking neural networks integrating temporal and static information. Neural Netw 2019; 119:162-177. [PMID: 31446235 DOI: 10.1016/j.neunet.2019.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
This paper proposes a new personalised prognostic/diagnostic system that supports classification, prediction and pattern recognition when both static and dynamic/spatiotemporal features are presented in a dataset. The system is based on a proposed clustering method (named d2WKNN) for optimal selection of neighbouring samples to an individual with respect to the integration of both static (vector-based) and temporal individual data. The most relevant samples to an individual are selected to train a Personalised Spiking Neural Network (PSNN) that learns from sets of streaming data to capture the space and time association patterns. The generated time-dependant patterns resulted in a higher accuracy of classification/prediction (80% to 93%) when compared with global modelling and conventional methods. In addition, the PSNN models can support interpretability by creating personalised profiling of an individual. This contributes to a better understanding of the interactions between features. Therefore, an end-user can comprehend what interactions in the model have led to a certain decision (outcome). The proposed PSNN model is an analytical tool, applicable to several real-life health applications, where different data domains describe a person's health condition. The system was applied to two case studies: (1) classification of spatiotemporal neuroimaging data for the investigation of individual response to treatment and (2) prediction of risk of stroke with respect to temporal environmental data. For both datasets, besides the temporal data, static health data were also available. The hyper-parameters of the proposed system, including the PSNN models and the d2WKNN clustering parameters, are optimised for each individual.
Collapse
Affiliation(s)
- Maryam Doborjeh
- Knowledge Engineering and Discovery Research Institute, Auckland University of Technology, Auckland, New Zealand; Computer Science Department, Auckland University of Technology, New Zealand.
| | - Nikola Kasabov
- Knowledge Engineering and Discovery Research Institute, Auckland University of Technology, Auckland, New Zealand; Computer Science Department, Auckland University of Technology, New Zealand
| | - Zohreh Doborjeh
- Knowledge Engineering and Discovery Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Reza Enayatollahi
- BioDesign Lab, School of Engineering, Computer & Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Enmei Tu
- School of Electronics, Information & Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Amir H Gandomi
- Faculty of Engineering & Information Technology, University of Technology, Sydney, Ultimo, NSW 2007, Australia; School of Business, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| |
Collapse
|
26
|
Guan D, Ahmad F, Theobald P, Soe S, Luo X, Gao H. On the AIC-based model reduction for the general Holzapfel-Ogden myocardial constitutive law. Biomech Model Mechanobiol 2019; 18:1213-1232. [PMID: 30945052 PMCID: PMC6647490 DOI: 10.1007/s10237-019-01140-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
Constitutive laws that describe the mechanical responses of cardiac tissue under loading hold the key to accurately model the biomechanical behaviour of the heart. There have been ample choices of phenomenological constitutive laws derived from experiments, some of which are quite sophisticated and include effects of microscopic fibre structures of the myocardium. A typical example is the strain-invariant-based Holzapfel-Ogden 2009 model that is excellently fitted to simple shear tests. It has been widely used and regarded as the state-of-the-art constitutive law for myocardium. However, there has been no analysis to show if it has both adequate descriptive and predictive capabilities for other tissue tests of myocardium. Indeed, such an analysis is important for any constitutive laws for clinically useful computational simulations. In this work, we perform such an analysis using combinations of tissue tests, uniaxial tension, biaxial tension and simple shear from three different sets of myocardial tissue studies. Starting from the general 14-parameter myocardial constitutive law developed by Holzapfel and Ogden, denoted as the general HO model, we show that this model has good descriptive and predictive capabilities for all the experimental tests. However, to reliably determine all 14 parameters of the model from experiments remains a great challenge. Our aim is to reduce the constitutive law using Akaike information criterion, to maintain its mechanical integrity whilst achieving minimal computational cost. A competent constitutive law should have descriptive and predictive capabilities for different tissue tests. By competent, we mean the model has least terms but is still able to describe and predict experimental data. We also investigate the optimal combinations of tissue tests for a given constitutive model. For example, our results show that using one of the reduced HO models, one may need just one shear response (along normal-fibre direction) and one biaxial stretch (ratio of 1 mean fibre : 1 cross-fibre) to satisfactorily describe Sommer et al. human myocardial mechanical properties. Our study suggests that single-state tests (i.e. simple shear or stretching only) are insufficient to determine the myocardium responses. We also found it is important to consider transmural fibre rotations within each myocardial sample of tests during the fitting process. This is done by excluding un-stretched fibres using an "effective fibre ratio", which depends on the sample size, shape, local myofibre architecture and loading conditions. We conclude that a competent myocardium material model can be obtained from the general HO model using AIC analysis and a suitable combination of tissue tests.
Collapse
Affiliation(s)
- Debao Guan
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Faizan Ahmad
- School of Engineering, Cardiff University, Cardiff, UK
| | | | - Shwe Soe
- School of Engineering, Cardiff University, Cardiff, UK
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| |
Collapse
|
27
|
Read MN, Alden K, Timmis J, Andrews PS. Strategies for calibrating models of biology. Brief Bioinform 2018; 21:24-35. [PMID: 30239570 DOI: 10.1093/bib/bby092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 11/14/2022] Open
Abstract
Computational and mathematical modelling has become a valuable tool for investigating biological systems. Modelling enables prediction of how biological components interact to deliver system-level properties and extrapolation of biological system performance to contexts and experimental conditions where this is unknown. A model's value hinges on knowing that it faithfully represents the biology under the contexts of use, or clearly ascertaining otherwise and thus motivating further model refinement. These qualities are evaluated through calibration, typically formulated as identifying model parameter values that align model and biological behaviours as measured through a metric applied to both. Calibration is critical to modelling but is often underappreciated. A failure to appropriately calibrate risks unrepresentative models that generate erroneous insights. Here, we review a suite of strategies to more rigorously challenge a model's representation of a biological system. All are motivated by features of biological systems, and illustrative examples are drawn from the modelling literature. We examine the calibration of a model against distributions of biological behaviours or outcomes, not only average values. We argue for calibration even where model parameter values are experimentally ascertained. We explore how single metrics can be non-distinguishing for complex systems, with multiple-component dynamic and interaction configurations giving rise to the same metric output. Under these conditions, calibration is insufficiently constraining and the model non-identifiable: multiple solutions to the calibration problem exist. We draw an analogy to curve fitting and argue that calibrating a biological model against a single experiment or context is akin to curve fitting against a single data point. Though useful for communicating model results, we explore how metrics that quantify heavily emergent properties may not be suitable for use in calibration. Lastly, we consider the role of sensitivity and uncertainty analysis in calibration and the interpretation of model results. Our goal in this manuscript is to encourage a deeper consideration of calibration, and how to increase its capacity to either deliver faithful models or demonstrate them otherwise.
Collapse
Affiliation(s)
| | | | | | - Paul S Andrews
- SimOmics Ltd, Suite 10 IT Centre, Innovation Way, York, UK
| |
Collapse
|
28
|
Currie G, Delles C. Precision Medicine and Personalized Medicine in Cardiovascular Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:589-605. [PMID: 30051409 DOI: 10.1007/978-3-319-77932-4_36] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Precision medicine aims to offer "the right treatment to the right patient at the right time." In cardiovascular medicine the potential of precision medicine applies to all stages of the disease development and includes risk prediction, preventative measures, and targeted therapeutic approaches. Precision medicine will benefit from new developments in the area of genomics and other omics but equally heavily depends on established biomarkers, functional tests, and imaging. Cardiovascular medicine often relies on noninvasive diagnostic procedures and symptom-based disease management. In contrast, other clinical disciplines including oncology and immunology have already moved to molecular diagnostics that lend themselves to precision medicine approaches. There are opportunities to implement precision medicine approaches by focusing on common diseases such as hypertension, conditions with diagnostic and prognostic uncertainty such as angina, and conditions that are associated with high mortality and involve costly and potentially harmful interventions such as dilated cardiomyopathy and cardiac resynchronization therapy. Sex and gender issues have not yet been fully explored in precision medicine although the opportunity to use molecular data to more accurately manage men and women with cardiovascular disease has been acknowledged. A mindshift is required in order to fully exploit the potential of precision medicine to tackle the global burden of cardiovascular diseases.
Collapse
Affiliation(s)
- Gemma Currie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK
| | - Christian Delles
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland, UK.
| |
Collapse
|