1
|
Xiao W, Yang H, Hao Z, Li M, Zhao M, Zhang S, Zhang G, Mao H, Wang C. Relationship between Fear-Avoidance Beliefs and Reaction Time Changes Prior to and following Exercise-Induced Muscle Fatigue in Chronic Low Back Pain. Pain Res Manag 2024; 2024:9982411. [PMID: 38312327 PMCID: PMC10838204 DOI: 10.1155/2024/9982411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
Background Reaction time is a reliable indicator of the velocity and efficiency of neuromuscular control and may be associated with fear-avoidance beliefs. However, the effect of exercise-induced muscle fatigue on reaction time in chronic low back pain (cLBP) and its relationship with fear-avoidance beliefs remains poorly understood. Objectives This study aimed to reveal the relationship between fear-avoidance beliefs and reaction time changes before and after exercise-induced muscle fatigue in cLBP. Methods Twenty-five patients with cLBP were tested by the Biering-Sorensen test (BST) to induce exhaustive muscle fatigue. Total reaction time (TRT), premotor time (PMT), and electromechanical delay (EMD) of dominated deltoid muscle were recorded by surface electromyography during the arm-raising task with visual cues before and after muscle fatigue. The mean difference (MD) of TRT (MDTRT), PMT (MDPMT), and EMD (MDEMD) was calculated from the changes before and after muscle fatigue. Fear-avoidance beliefs questionnaire (FABQ) was applied to evaluate fear-avoidance beliefs before muscle fatigue. In addition, the duration time of BST was recorded for each subject. Results TRT and PMT of dominated deltoid muscle were prolonged after exercise-induced muscle fatigue (Z = 3.511, p < 0.001; t = 3.431, p = 0.001), while there was no statistical difference in EMD (Z = 1.029, p = 0.304). Correlation analysis showed that both the MDTRT and MDPMT were positively correlated with FABQ (r = 0.418, p = 0.042; r = 0.422, p = 0.040). Conclusions These findings suggested that we should pay attention to both muscle fatigue-induced reaction time delay in cLBP management and the possible psychological mechanism involved in it. Furthermore, this study implied that FABQ-based psychotherapy might serve as a potential approach for cLBP treatment by improving reaction time delay. This trial is registered with ChiCTR2300074348.
Collapse
Affiliation(s)
- Wenwu Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Huaichun Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Menglin Li
- Department of Rehabilitation, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510180, China
| | - Mengchu Zhao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR 999077, China
| | - Siyun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Guifang Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Haian Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| |
Collapse
|
2
|
Liu W, Han JL, Tomek J, Bub G, Entcheva E. Simultaneous Widefield Voltage and Dye-Free Optical Mapping Quantifies Electromechanical Waves in Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes. ACS PHOTONICS 2023; 10:1070-1083. [PMID: 37096210 PMCID: PMC10119986 DOI: 10.1021/acsphotonics.2c01644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 05/03/2023]
Abstract
Coupled electromechanical waves define a heart's function in health and diseases. Optical mapping of electrical waves using fluorescent labels offers mechanistic insights into cardiac conduction abnormalities. Dye-free/label-free mapping of mechanical waves presents an attractive non-invasive alternative. In this study, we developed a simultaneous widefield voltage and interferometric dye-free optical imaging methodology that was used as follows: (1) to validate dye-free optical mapping for quantification of cardiac wave properties in human iPSC-cardiomyocytes (CMs); (2) to demonstrate low-cost optical mapping of electromechanical waves in hiPSC-CMs using recent near-infrared (NIR) voltage sensors and orders of magnitude cheaper miniature industrial CMOS cameras; (3) to uncover previously underexplored frequency- and space-varying parameters of cardiac electromechanical waves in hiPSC-CMs. We find similarity in the frequency-dependent responses of electrical (NIR fluorescence-imaged) and mechanical (dye-free-imaged) waves, with the latter being more sensitive to faster rates and showing steeper restitution and earlier appearance of wavefront tortuosity. During regular pacing, the dye-free-imaged conduction velocity and electrical wave velocity are correlated; both modalities are sensitive to pharmacological uncoupling and dependent on gap-junctional protein (connexins) determinants of wave propagation. We uncover the strong frequency dependence of the electromechanical delay (EMD) locally and globally in hiPSC-CMs on a rigid substrate. The presented framework and results offer new means to track the functional responses of hiPSC-CMs inexpensively and non-invasively for counteracting heart disease and aiding cardiotoxicity testing and drug development.
Collapse
Affiliation(s)
- Wei Liu
- Department
of Biomedical Engineering, George Washington
University, Washington, D.C. 20052, United States
| | - Julie L. Han
- Department
of Biomedical Engineering, George Washington
University, Washington, D.C. 20052, United States
| | - Jakub Tomek
- Department
of Pharmacology, University of California−Davis, Davis, California 95616, United States
| | - Gil Bub
- Department
of Physiology, McGill University, Montréal, Québec H3G 1Y6, Canada
| | - Emilia Entcheva
- Department
of Biomedical Engineering, George Washington
University, Washington, D.C. 20052, United States
| |
Collapse
|
3
|
Pargaei M, Kumar BVR, Pavarino LF, Scacchi S. Cardiac electro-mechanical activity in a deforming human cardiac tissue: modeling, existence-uniqueness, finite element computation and application to multiple ischemic disease. J Math Biol 2022; 84:17. [PMID: 35142929 DOI: 10.1007/s00285-022-01717-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/11/2021] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
Abstract
In this study, the cardiac electro-mechanical model in a deforming domain is taken with the addition of mechanical feedback and stretch-activated channel current coupled with the ten Tusscher human ventricular cell level model that results in a coupled PDE-ODE system. The existence and uniqueness of such a coupled system in a deforming domain is proved. At first, the existence of a solution is proved in the deformed domain. The local existence of the solution is proved using the regularization and the Faedo-Galerkin technique. Then, the global existence is proved using the energy estimates in appropriate Banach spaces, Gronwall lemma, and the compactness procedure. The existence of the solution in an undeformed domain is proved using the lower semi-continuity of the norms. Uniqueness is proved using Young's inequality, Gronwall lemma, and the Cauchy-Schwartz inequality. For the application purpose, this model is applied to understand the electro-mechanical activity in ischemic cardiac tissue. It also takes care of the development of active tension, conductive, convective, and ionic feedback. The Second Piola-Kirchoff stress tensor arising in Lagrangian mapping between reference and moving frames is taken as a combination of active, passive, and volumetric components. We investigated the effect of varying strength of hyperkalemia and hypoxia, in the ischemic subregions of human cardiac tissue with local multiple ischemic subregions, on the electro-mechanical activity of healthy and ischemic zones. This system is solved numerically using the [Formula: see text] finite element method in space and the implicit-explicit Euler method in time. Discontinuities arising with the modeled multiple ischemic regions are treated to the desired order of accuracy by a simple regularization technique using the interpolating polynomials. We examined the cardiac electro-mechanical activity for several cases in multiple hyperkalemic and hypoxic human cardiac tissue. We concluded that local multiple ischemic subregions severely affect the cardiac electro-mechanical activity more, in terms of action potential (v) and mechanical parameters, intracellular calcium ion concentration [Formula: see text], active tension ([Formula: see text]), stretch ([Formula: see text]) and stretch rate ([Formula: see text]), of a healthy cell in its vicinity, compared to a single Hyperkalemic or Hypoxic subregion. The four moderate hypoxically generated ischemic subregions affect the waveform of the stretch along the fiber and the stretch rate more than a single severe ischemic subregion.
Collapse
Affiliation(s)
- Meena Pargaei
- Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, India.,Govt. Post Graduate College, Champawat, Uttarakhand, India
| | - B V Rathish Kumar
- Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, India
| | - Luca F Pavarino
- Department of Mathematics, University of Pavia, Pavia, Italy
| | - Simone Scacchi
- Department of Mathematics, University of Milan, Milan, Italy
| |
Collapse
|
4
|
Qauli AI, Marcellinus A, Lim KM. Sensitivity Analysis of Ion Channel Conductance on Myocardial Electromechanical Delay: Computational Study. Front Physiol 2021; 12:697693. [PMID: 34512377 PMCID: PMC8430256 DOI: 10.3389/fphys.2021.697693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023] Open
Abstract
It is well known that cardiac electromechanical delay (EMD) can cause dyssynchronous heart failure (DHF), a prominent cardiovascular disease (CVD). This work computationally assesses the conductance variation of every ion channel on the cardiac cell to give rise to EMD prolongation. The electrical and mechanical models of human ventricular tissue were simulated, using a population approach with four conductance reductions for each ion channel. Then, EMD was calculated by determining the difference between the onset of action potential and the start of cell shortening. Finally, EMD data were put into the optimized conductance dimensional stacking to show which ion channel has the most influence in elongating the EMD. We found that major ion channels, such as L-type calcium (CaL), slow-delayed rectifier potassium (Ks), rapid-delayed rectifier potassium (Kr), and inward rectifier potassium (K1), can significantly extend the action potential duration (APD) up to 580 ms. Additionally, the maximum intracellular calcium (Cai) concentration is greatly affected by the reduction in channel CaL, Ks, background calcium, and Kr. However, among the aforementioned major ion channels, only the CaL channel can play a superior role in prolonging the EMD up to 83 ms. Furthermore, ventricular cells with long EMD have been shown to inherit insignificant mechanical response (in terms of how strong the tension can grow and how far length shortening can go) compared with that in normal cells. In conclusion, despite all variations in every ion channel conductance, only the CaL channel can play a significant role in extending EMD. In addition, cardiac cells with long EMD tend to have inferior mechanical responses due to a lack of Cai compared with normal conditions, which are highly likely to result in a compromised pump function of the heart.
Collapse
Affiliation(s)
- Ali Ikhsanul Qauli
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Aroli Marcellinus
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| |
Collapse
|
5
|
Comparison of Electromechanical Delay during Ventricular Tachycardia and Fibrillation under Different Conductivity Conditions Using Computational Modeling. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:9501985. [PMID: 32300375 PMCID: PMC7146094 DOI: 10.1155/2020/9501985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/25/2020] [Indexed: 01/27/2023]
Abstract
Electromechanical delay (EMD) is the time interval between local myocyte depolarization and the onset of myofiber shortening. Previously, researchers measured EMD during sinus rhythm and ectopic pacing in normal and heart failure conditions. However, to our knowledge, there are no reports regarding EMD during another type of rhythms or arrhythmia. The goal of this study was to quantify EMD during sinus rhythm, tachycardia, and ventricular fibrillation conditions. We hypothesized that EMD under sinus rhythm is longer due to isovolumetric contraction which is imprecise during arrhythmia. We used a realistic model of 3D electromechanical ventricles. During sinus rhythm, EMD was measured in the last cycle of cardiac systole under steady conditions. EMD under tachycardia and fibrillation conditions was measured during the entire simulation, resulting in multiple EMD values. We assessed EMD for the following 3 conduction velocities (CVs): 31 cm/s, 51 cm/s, and 69 cm/s. The average EMD during fibrillation condition was the shortest corresponding to 53.45 ms, 55.07 ms, and 50.77 ms, for the CVs of 31 cm/s, 51 cm/s, and 69 cm/s, respectively. The average EMD during tachycardia was 58.61 ms, 58.33 ms, and 52.50 ms for the three CVs. Under sinus rhythm with action potential duration restitution (APDR) slope 0.7, the average EMD was 66.35 ms, 66.41 ms, and 66.60 ms in line with the three CVs. This result supports our hypothesis that EMD under sinus rhythm is longer than that under tachyarrhythmia conditions. In conclusion, this study observed and quantified EMD under tachycardia and ventricular fibrillation conditions. This simulation study has widened our understanding of EMD in 3D ventricles under chaotic conditions.
Collapse
|
6
|
Grondin J, Wang D, Grubb CS, Trayanova N, Konofagou EE. 4D cardiac electromechanical activation imaging. Comput Biol Med 2019; 113:103382. [PMID: 31476587 DOI: 10.1016/j.compbiomed.2019.103382] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 12/15/2022]
Abstract
Cardiac abnormalities, a major cause of morbidity and mortality, affect millions of people worldwide. Despite the urgent clinical need for early diagnosis, there is currently no noninvasive technique that can infer to the electrical function of the whole heart in 3D and thereby localize abnormalities at the point of care. Here we present a new method for noninvasive 4D mapping of the cardiac electromechanical activity in a single heartbeat for heart disease characterization such as arrhythmia and infarction. Our novel technique captures the 3D activation wave of the heart in vivo using high volume-rate (500 volumes per second) ultrasound with a 32 × 32 matrix array. Electromechanical activation maps are first presented in a normal and infarcted cardiac model in silico and in canine heart during pacing and re-entrant ventricular tachycardia in vivo. Noninvasive 4D electromechanical activation mapping in a healthy volunteer and a heart failure patient are also determined. The technique described herein allows for direct, simultaneous and noninvasive visualization of electromechanical activation in 3D, which provides complementary information on myocardial viability and/or abnormality to clinical imaging.
Collapse
Affiliation(s)
- Julien Grondin
- Department of Radiology, Columbia University, 630 W 168th, Street, New York, NY, 10032, USA.
| | - Dafang Wang
- Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Christopher S Grubb
- Department of Medicine, Columbia University, 630 W 168th, Street, New York, NY, 10032, USA
| | - Natalia Trayanova
- Institute of Computational Medicine, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Elisa E Konofagou
- Department of Radiology, Columbia University, 630 W 168th, Street, New York, NY, 10032, USA; Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Avenue, New York, NY, 10027, USA.
| |
Collapse
|
7
|
Computational Prediction of the Combined Effect of CRT and LVAD on Cardiac Electromechanical Delay in LBBB and RBBB. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:4253928. [PMID: 30538769 PMCID: PMC6261249 DOI: 10.1155/2018/4253928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/03/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022]
Abstract
Two case reports showed that the combination of CRT and LVAD benefits the end-stage heart failure patients with prolonged QRS interval significantly. In one of the reports, the patient had the LVAD removed due to the recovery of the heart function. However, the quantification of the combined devices has yet to be conducted. This study aimed at computationally predicting the effects of CRT-only or combined with LVAD on electromechanical behaviour in the failing ventricle with left bundle branch blocked (LBBB) and right bundle branch blocked (RBBB) conditions. The subjects are normal sinus rhythm, LBBB, RBBB, LBBB with CRT-only, RBBB with CRT-only, LBBB with CRT + LVAD, and RBBB with CRT + LVAD. The results showed that the CRT-only shortened the total electrical activation time (EAT) in the LBBB and RBBB conditions by 20.2% and 17.1%, respectively. The CRT-only reduced the total mechanical activation time (MAT) and electromechanical delay (EMD) of the ventricle under LBBB by 21.3% and 10.1%, respectively. Furthermore, the CRT-only reduced the contractile adenosine triphosphate (ATP) consumption by 5%, increased left ventricular (LV) pressure by 6%, and enhanced cardiac output (CO) by 0.2 L/min under LBBB condition. However, CRT-only barely affects the ventricle under RBBB condition. Under the LBBB condition, CRT + LVAD increased LV pressure and CO by 10.5% and by 0.9 L/min, respectively. CRT + LVAD reduced ATP consumption by 15%, shortened the MAT by 23.4%, and shortened the EMD by 15.2%. In conclusion, we computationally predicted and quantified that the CRT + LVAD implementation is superior to CRT-only implementation particularly in HF with LBBB condition.
Collapse
|
8
|
Jeong DU, Lim KM. The effect of myocardial action potential duration on cardiac pumping efficacy: a computational study. Biomed Eng Online 2018; 17:79. [PMID: 29907152 PMCID: PMC6003003 DOI: 10.1186/s12938-018-0508-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Although studies on the relation between arrhythmias and the action potential duration (APD) have been carried out, most of them are based only on electrophysiological factors of the heart and lack experiments that consider cardiac mechanical and electromechanical characteristics. Therefore, we conducted this study to clarify the relevance of the shortening of APD of a cell in relation to the mechanical contraction activity of the heart and the associated risk of arrhythmia. METHODS The human ventricular model used in this study has two dynamic characteristics: electrophysiological conduction and mechanical contraction. The model simulating electrophysiological characteristics was consisted of lumped parameter circuit that can mimic the phenomenon of ion exchange through the cell membrane of myocyte and consisted of 214,319 tetrahedral finite elements. In contrast, the model simulating mechanical contraction characteristics was constructed to mimic cardiac contraction by means of the crossbridge of a myofilament and consisted of 14,720 hermite-based finite elements to represent a natural 3D curve of the cardiac surface. First, we performed a single cell simulation and the electrophysiological simulation according to the change of the APD by changing the electrical conductivity of the I Ks channel. Thus, we confirmed the correlation between APD and intracellular Ca2+ concentration. Then, we compared mechanical response through mechanical simulation using Ca2+ data from electrical simulation. RESULTS The APD and the sum of the intracellular Ca2+ concentrations showed a positive correlation. The shortened APD reduced the conduction wavelength of ventricular cells by shortening the plateau and early repolarization in myocardial cells. The decrease in APD reduced ventricular pumping efficiency by more than 60% as compared with the normal group (normal conditions). This change is caused by the decline of ventricular output owing to reduced ATP consumption during the crossbridge of myofilaments and decreased tension. CONCLUSION The shortening of APD owing to increased electrical conductivity of a protein channel on myocardial cells likely decreases the wavelength and the pumping efficiency of the ventricles. Additionally, it may increase tissue sensitivity to ventricular fibrillation, including reentry, and cause symptoms such as dyspnea and dizziness.
Collapse
Affiliation(s)
- Da Un Jeong
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk 39177 Republic of Korea
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk 39177 Republic of Korea
| |
Collapse
|
9
|
How should we follow-up patients undergoing CRT? Hellenic J Cardiol 2018; 59:232-233. [PMID: 29860094 DOI: 10.1016/j.hjc.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 11/21/2022] Open
|
10
|
Influence of LVAD function on mechanical unloading and electromechanical delay: a simulation study. Med Biol Eng Comput 2017; 56:911-921. [PMID: 29098548 PMCID: PMC5906510 DOI: 10.1007/s11517-017-1730-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 10/04/2017] [Indexed: 12/16/2022]
Abstract
This study hypothesized that a left ventricular assist device (LVAD) shortens the electromechanical delay (EMD) by mechanical unloading. The goal of this study is to examine, by computational modeling, the influence of LVAD on EMD for four heart failure (HF) cases ranging from mild HF to severe HF. We constructed an integrated model of an LVAD-implanted cardiovascular system, then we altered the Ca2+ transient magnitude, with scaling factors 1, 0.9, 0.8, and 0.7 representing HF1, HF2, HF3, and HF4, respectively, in order of increasing HF severity. The four HF conditions are classified into two groups. Group one is the four HF conditions without LVAD, and group two is the conditions treated with continuous LVAD pump. The single-cell mechanical responses showed that EMD was prolonged with the higher load. The findings indicated that in group one, the HF-induced Ca2 + transient remodeling prolonged the mechanical activation time (MAT) and decreased the contractile tension, which reduced the left ventricle (LV) pressure, and increased the end-diastolic strain. In group two, LVAD shortened MAT of the ventricles. Furthermore, LVAD reduced the contractile tension, and end-diastolic strain, but increased the aortic pressure. The computational study demonstrated that LVAD shortens EMD by mechanical unloading of the ventricle.
Collapse
|
11
|
Kim YS, Yuniarti AR, Song KS, Trayanova NA, Shim EB, Lim KM. Computational analysis of the effect of mitral and aortic regurgitation on the function of ventricular assist devices using 3D cardiac electromechanical model. Med Biol Eng Comput 2017; 56:889-898. [PMID: 29080191 PMCID: PMC5906511 DOI: 10.1007/s11517-017-1727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Abstract
Valvular insufficiency affects cardiac responses and the pumping efficacy of left ventricular assist devices (LVADs) when patients undergo LVAD therapy. Knowledge of the effect of valvular regurgitation on the function of LVADs is important when treating heart failure patients. The goal of this study was to examine the effect of valvular regurgitation on the ventricular mechanics of a heart under LVAD treatment and the pumping efficacy of an LVAD using a computational model of the cardiovascular system. For this purpose, a 3D electromechanical model of failing ventricles in a human heart was coupled with a lumped-parameter model of valvular regurgitation and an LVAD-implanted vascular system. We used the computational model to predict cardiac responses with respect to the severity of valvular regurgitation in the presence of LVAD treatment. An LVAD could reduce left ventricle (LV) pressure (up to 34%) and end-diastolic ventricular volume (up to 80%) and maintain cardiac output at the estimated flow rate from the LVAD under the condition of mitral regurgitation (MR); however, the opposite would occur under the condition of aortic regurgitation (AR). Considering these physiological responses, we conclude that AR, and not MR, diminishes the pumping function of LVADs.
Collapse
Affiliation(s)
- Yoo Seok Kim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of South Korea
| | - Ana R Yuniarti
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of South Korea
| | - Kwang-Soup Song
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of South Korea
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Eun Bo Shim
- Department of Mechanical & Biomedical Engineering, Kangwon National University, Chuncheon, Republic of South Korea
| | - Ki Moo Lim
- Department of IT Convergence Engineering, Kumoh National Institute of Technology, 61 Daehak-ro, Gumi, Gyeongbuk, 39253, Republic of South Korea.
| |
Collapse
|
12
|
Colli Franzone P, Pavarino LF, Scacchi S. Effects of mechanical feedback on the stability of cardiac scroll waves: A bidomain electro-mechanical simulation study. CHAOS (WOODBURY, N.Y.) 2017; 27:093905. [PMID: 28964121 DOI: 10.1063/1.4999465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this work, we investigate the influence of cardiac tissue deformation on re-entrant wave dynamics. We have developed a 3D strongly coupled electro-mechanical Bidomain model posed on an ideal monoventricular geometry, including fiber direction anisotropy and stretch-activated currents (SACs). The cardiac mechanical deformation influences the bioelectrical activity with two main mechanical feedback: (a) the geometric feedback (GEF) due to the presence of the deformation gradient in the diffusion coefficients and in a convective term depending on the deformation rate and (b) the mechano-electric feedback (MEF) due to SACs. Here, we investigate the relative contribution of these two factors with respect to scroll wave stability. We extend the previous works [Keldermann et al., Am. J. Physiol. Heart Circ. Physiol. 299, H134-H143 (2010) and Hu et al., PLoS One 8(4), e60287 (2013)] that were based on the Monodomain model and a simple non-selective linear SAC, while here we consider the full Bidomain model and both selective and non-selective components of SACs. Our simulation results show that the stability of cardiac scroll waves is influenced by MEF, which in case of low reversal potential of non-selective SACs might be responsible for the onset of ventricular fibrillation; GEF increases the scroll wave meandering but does not determine the scroll wave stability.
Collapse
Affiliation(s)
- P Colli Franzone
- Dipartimento di Matematica, Università di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - L F Pavarino
- Dipartimento di Matematica, Università di Pavia, Via Ferrata 1, 27100 Pavia, Italy
| | - S Scacchi
- Dipartimento di Matematica, Università di Milano, Via Saldini 50, 20133 Milano, Italy
| |
Collapse
|
13
|
Bai X, Wang K, Yuan Y, Li Q, Dobrzynski H, Boyett MR, Hancox JC, Zhang H. Mechanism underlying impaired cardiac pacemaking rhythm during ischemia: A simulation study. CHAOS (WOODBURY, N.Y.) 2017; 27:093934. [PMID: 28964153 DOI: 10.1063/1.5002664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ischemia in the heart impairs function of the cardiac pacemaker, the sinoatrial node (SAN). However, the ionic mechanisms underlying the ischemia-induced dysfunction of the SAN remain elusive. In order to investigate the ionic mechanisms by which ischemia causes SAN dysfunction, action potential models of rabbit SAN and atrial cells were modified to incorporate extant experimental data of ischemia-induced changes to membrane ion channels and intracellular ion homeostasis. The cell models were incorporated into an anatomically detailed 2D model of the intact SAN-atrium. Using the multi-scale models, the functional impact of ischemia-induced electrical alterations on cardiac pacemaking action potentials (APs) and their conduction was investigated. The effects of vagal tone activity on the regulation of cardiac pacemaker activity in control and ischemic conditions were also investigated. The simulation results showed that at the cellular level ischemia slowed the SAN pacemaking rate, which was mainly attributable to the altered Na+-Ca2+ exchange current and the ATP-sensitive potassium current. In the 2D SAN-atrium tissue model, ischemia slowed down both the pacemaking rate and the conduction velocity of APs into the surrounding atrial tissue. Simulated vagal nerve activity, including the actions of acetylcholine in the model, amplified the effects of ischemia, leading to possible SAN arrest and/or conduction exit block, which are major features of the sick sinus syndrome. In conclusion, this study provides novel insights into understanding the mechanisms by which ischemia alters SAN function, identifying specific conductances as contributors to bradycardia and conduction block.
Collapse
Affiliation(s)
- Xiangyun Bai
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Yongfeng Yuan
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Qince Li
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Halina Dobrzynski
- Institute of Cardiovascular Sciences, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Mark R Boyett
- Institute of Cardiovascular Sciences, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Jules C Hancox
- Biological Physics Group, School of Physics and Astronomy, The University of Manchester, M13 9PL Manchester, United Kingdom
| | - Henggui Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| |
Collapse
|
14
|
Garcia-Canadilla P, Rodriguez JF, Palazzi MJ, Gonzalez-Tendero A, Schönleitner P, Balicevic V, Loncaric S, Luiken JJFP, Ceresa M, Camara O, Antoons G, Crispi F, Gratacos E, Bijnens B. A two dimensional electromechanical model of a cardiomyocyte to assess intra-cellular regional mechanical heterogeneities. PLoS One 2017; 12:e0182915. [PMID: 28837585 PMCID: PMC5570434 DOI: 10.1371/journal.pone.0182915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023] Open
Abstract
Experimental studies on isolated cardiomyocytes from different animal species and human hearts have demonstrated that there are regional differences in the Ca2+ release, Ca2+ decay and sarcomere deformation. Local deformation heterogeneities can occur due to a combination of factors: regional/local differences in Ca2+ release and/or re-uptake, intra-cellular material properties, sarcomere proteins and distribution of the intracellular organelles. To investigate the possible causes of these heterogeneities, we developed a two-dimensional finite-element electromechanical model of a cardiomyocyte that takes into account the experimentally measured local deformation and cytosolic [Ca2+] to locally define the different variables of the constitutive equations describing the electro/mechanical behaviour of the cell. Then, the model was individualised to three different rat cardiac cells. The local [Ca2+] transients were used to define the [Ca2+]-dependent activation functions. The cell-specific local Young's moduli were estimated by solving an inverse problem, minimizing the error between the measured and simulated local deformations along the longitudinal axis of the cell. We found that heterogeneities in the deformation during contraction were determined mainly by the local elasticity rather than the local amount of Ca2+, while in the relaxation phase deformation was mainly influenced by Ca2+ re-uptake. Our electromechanical model was able to successfully estimate the local elasticity along the longitudinal direction in three different cells. In conclusion, our proposed model seems to be a good approximation to assess the heterogeneous intracellular mechanical properties to help in the understanding of the underlying mechanisms of cardiomyocyte dysfunction.
Collapse
Affiliation(s)
| | - Jose F. Rodriguez
- LaBS, Chemistry, materials and chemical engineering department “Giulio Natta”, Politecnico di Milano, Milano, Italy
| | - Maria J. Palazzi
- Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Gonzalez-Tendero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Vedrana Balicevic
- Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Sven Loncaric
- Molecular Genetics, Maastricht University, Maastricht, The Netherlands
| | | | - Mario Ceresa
- Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gudrun Antoons
- Dept. of Physiology, Maastricht University, Maastricht, The Netherlands
| | - Fatima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Bart Bijnens
- Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| |
Collapse
|
15
|
Choi YJ, Constantino J, Vedula V, Trayanova N, Mittal R. A New MRI-Based Model of Heart Function with Coupled Hemodynamics and Application to Normal and Diseased Canine Left Ventricles. Front Bioeng Biotechnol 2015; 3:140. [PMID: 26442254 PMCID: PMC4585083 DOI: 10.3389/fbioe.2015.00140] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 11/22/2022] Open
Abstract
A methodology for the simulation of heart function that combines an MRI-based model of cardiac electromechanics (CE) with a Navier–Stokes-based hemodynamics model is presented. The CE model consists of two coupled components that simulate the electrical and the mechanical functions of the heart. Accurate representations of ventricular geometry and fiber orientations are constructed from the structural magnetic resonance and the diffusion tensor MR images, respectively. The deformation of the ventricle obtained from the electromechanical model serves as input to the hemodynamics model in this one-way coupled approach via imposed kinematic wall velocity boundary conditions and at the same time, governs the blood flow into and out of the ventricular volume. The time-dependent endocardial surfaces are registered using a diffeomorphic mapping algorithm, while the intraventricular blood flow patterns are simulated using a sharp-interface immersed boundary method-based flow solver. The utility of the combined heart-function model is demonstrated by comparing the hemodynamic characteristics of a normal canine heart beating in sinus rhythm against that of the dyssynchronously beating failing heart. We also discuss the potential of coupled CE and hemodynamics models for various clinical applications.
Collapse
Affiliation(s)
- Young Joon Choi
- Department of Mechanical Engineering, Johns Hopkins University , Baltimore, MD , USA ; Institute for Computational Medicine, Johns Hopkins University , Baltimore, MD , USA
| | - Jason Constantino
- Institute for Computational Medicine, Johns Hopkins University , Baltimore, MD , USA ; Department of Biomedical Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Natalia Trayanova
- Institute for Computational Medicine, Johns Hopkins University , Baltimore, MD , USA ; Department of Biomedical Engineering, Johns Hopkins University , Baltimore, MD , USA
| | - Rajat Mittal
- Department of Mechanical Engineering, Johns Hopkins University , Baltimore, MD , USA ; Institute for Computational Medicine, Johns Hopkins University , Baltimore, MD , USA
| |
Collapse
|
16
|
Walmsley J, Arts T, Derval N, Bordachar P, Cochet H, Ploux S, Prinzen FW, Delhaas T, Lumens J. Fast Simulation of Mechanical Heterogeneity in the Electrically Asynchronous Heart Using the MultiPatch Module. PLoS Comput Biol 2015. [PMID: 26204520 PMCID: PMC4512705 DOI: 10.1371/journal.pcbi.1004284] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cardiac electrical asynchrony occurs as a result of cardiac pacing or conduction disorders such as left bundle-branch block (LBBB). Electrically asynchronous activation causes myocardial contraction heterogeneity that can be detrimental for cardiac function. Computational models provide a tool for understanding pathological consequences of dyssynchronous contraction. Simulations of mechanical dyssynchrony within the heart are typically performed using the finite element method, whose computational intensity may present an obstacle to clinical deployment of patient-specific models. We present an alternative based on the CircAdapt lumped-parameter model of the heart and circulatory system, called the MultiPatch module. Cardiac walls are subdivided into an arbitrary number of patches of homogeneous tissue. Tissue properties and activation time can differ between patches. All patches within a wall share a common wall tension and curvature. Consequently, spatial location within the wall is not required to calculate deformation in a patch. We test the hypothesis that activation time is more important than tissue location for determining mechanical deformation in asynchronous hearts. We perform simulations representing an experimental study of myocardial deformation induced by ventricular pacing, and a patient with LBBB and heart failure using endocardial recordings of electrical activation, wall volumes, and end-diastolic volumes. Direct comparison between simulated and experimental strain patterns shows both qualitative and quantitative agreement between model fibre strain and experimental circumferential strain in terms of shortening and rebound stretch during ejection. Local myofibre strain in the patient simulation shows qualitative agreement with circumferential strain patterns observed in the patient using tagged MRI. We conclude that the MultiPatch module produces realistic regional deformation patterns in the asynchronous heart and that activation time is more important than tissue location within a wall for determining myocardial deformation. The CircAdapt model is therefore capable of fast and realistic simulations of dyssynchronous myocardial deformation embedded within the closed-loop cardiovascular system. Under normal conditions, the electrical activation of the heart is almost synchronous, leading to uniform contraction. Due to either pathology or electrical pacing, the heart can be activated asynchronously. The result is discoordinated contraction and a reduction in the ability to pump blood. There is considerable interest in using computer simulations to understand how asynchronous electrical activation affects cardiac deformation, and how pathologies of the cardiac conduction system can be treated by pacing the heart. We present the MultiPatch module for simulating the effects of asynchronous electrical activation on cardiac contraction in the relatively simple CircAdapt model of the heart and circulation. We quantitatively compare model simulations to deformation patterns recorded during an experimental study of pacing-induced electrical asynchrony. We then demonstrate a ‘patient-specific’ simulation of deformation in a patient with a conduction disorder called left bundle-branch block. We use timings from endocardial mapping of electrical activation in a patient as an input for the model, and compare the resulting simulated deformation patterns to tagged magnetic resonance imaging recordings from the same patient. The model qualitatively reproduces deformation as observed in the patient. We conclude that the MultiPatch module makes CircAdapt appropriate for simulation of dyssynchronous heart failure in patients.
Collapse
Affiliation(s)
- John Walmsley
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Theo Arts
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, IHU-LIRYC, CHU de Bordeaux, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, IHU-LIRYC, CHU de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, IHU-LIRYC, CHU de Bordeaux, Bordeaux, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, IHU-LIRYC, CHU de Bordeaux, Bordeaux, France
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Hôpital Cardiologique du Haut-Lévêque, IHU-LIRYC, CHU de Bordeaux, Bordeaux, France
| |
Collapse
|
17
|
Lim KM, Hong SB, Lee BK, Shim EB, Trayanova N. Computational analysis of the effect of valvular regurgitation on ventricular mechanics using a 3D electromechanics model. J Physiol Sci 2015; 65:159-64. [PMID: 25644379 PMCID: PMC4816651 DOI: 10.1007/s12576-014-0353-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 12/14/2014] [Indexed: 01/29/2023]
Abstract
Using a three-dimensional electromechanical model of the canine ventricles with dyssynchronous heart failure, we investigated the relationship between severity of valve regurgitation and ventricular mechanical responses. The results demonstrated that end-systolic tension in the septum and left ventricular free wall was significantly lower under the condition of mitral regurgitation (MR) than under aortic regurgitation (AR). Stroke work in AR was higher than that in MR. On the other hand, the difference in stroke volume between the two conditions was not significant, indicating that AR may cause worse pumping efficiency than MR in terms of consumed energy and performed work.
Collapse
Affiliation(s)
- Ki Moo Lim
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Seung-Bae Hong
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-Si, Gangwon-do 200-701 Republic of Korea
| | - Byong Kwon Lee
- Department of Cardiology, Yonsei University Hospital, Seoul, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, 1 Kangwondaehak-gil, Chuncheon-Si, Gangwon-do 200-701 Republic of Korea
| | - Natalia Trayanova
- Institute for Computational Medicine and the Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218 USA
| |
Collapse
|