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Fumagalli I, Pagani S, Vergara C, Dede’ L, Adebo DA, Del Greco M, Frontera A, Luciani GB, Pontone G, Scrofani R, Quarteroni A. The role of computational methods in cardiovascular medicine: a narrative review. Transl Pediatr 2024; 13:146-163. [PMID: 38323181 PMCID: PMC10839285 DOI: 10.21037/tp-23-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
Background and Objective Computational models of the cardiovascular system allow for a detailed and quantitative investigation of both physiological and pathological conditions, thanks to their ability to combine clinical-possibly patient-specific-data with physical knowledge of the processes underlying the heart function. These models have been increasingly employed in clinical practice to understand pathological mechanisms and their progression, design medical devices, support clinicians in improving therapies. Hinging upon a long-year experience in cardiovascular modeling, we have recently constructed a computational multi-physics and multi-scale integrated model of the heart for the investigation of its physiological function, the analysis of pathological conditions, and to support clinicians in both diagnosis and treatment planning. This narrative review aims to systematically discuss the role that such model had in addressing specific clinical questions, and how further impact of computational models on clinical practice are envisaged. Methods We developed computational models of the physical processes encompassed by the heart function (electrophysiology, electrical activation, force generation, mechanics, blood flow dynamics, valve dynamics, myocardial perfusion) and of their inherently strong coupling. To solve the equations of such models, we devised advanced numerical methods, implemented in a flexible and highly efficient software library. We also developed computational procedures for clinical data post-processing-like the reconstruction of the heart geometry and motion from diagnostic images-and for their integration into computational models. Key Content and Findings Our integrated computational model of the heart function provides non-invasive measures of indicators characterizing the heart function and dysfunctions, and sheds light on its underlying processes and their coupling. Moreover, thanks to the close collaboration with several clinical partners, we addressed specific clinical questions on pathological conditions, such as arrhythmias, ventricular dyssynchrony, hypertrophic cardiomyopathy, degeneration of prosthetic valves, and the way coronavirus disease 2019 (COVID-19) infection may affect the cardiac function. In multiple cases, we were also able to provide quantitative indications for treatment. Conclusions Computational models provide a quantitative and detailed tool to support clinicians in patient care, which can enhance the assessment of cardiac diseases, the prediction of the development of pathological conditions, and the planning of treatments and follow-up tests.
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Affiliation(s)
- Ivan Fumagalli
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Stefano Pagani
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Christian Vergara
- Laboratory of Biological Structures Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Luca Dede’
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Dilachew A. Adebo
- Children’s Heart Institute, Hermann Children’s Hospital, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Maurizio Del Greco
- Department of Cardiology, S. Maria del Carmine Hospital, Rovereto, Italy
| | - Antonio Frontera
- Electrophysiology Department, De Gasperis Cardio Center, ASST Great Metropolitan Hospital Niguarda, Milan, Italy
| | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCSS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Roberto Scrofani
- Cardiovascular Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfio Quarteroni
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Switzerland
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Bucelli M, Zingaro A, Africa PC, Fumagalli I, Dede' L, Quarteroni A. A mathematical model that integrates cardiac electrophysiology, mechanics, and fluid dynamics: Application to the human left heart. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3678. [PMID: 36579792 DOI: 10.1002/cnm.3678] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
We propose a mathematical and numerical model for the simulation of the heart function that couples cardiac electrophysiology, active and passive mechanics and hemodynamics, and includes reduced models for cardiac valves and the circulatory system. Our model accounts for the major feedback effects among the different processes that characterize the heart function, including electro-mechanical and mechano-electrical feedback as well as force-strain and force-velocity relationships. Moreover, it provides a three-dimensional representation of both the cardiac muscle and the hemodynamics, coupled in a fluid-structure interaction (FSI) model. By leveraging the multiphysics nature of the problem, we discretize it in time with a segregated electrophysiology-force generation-FSI approach, allowing for efficiency and flexibility in the numerical solution. We employ a monolithic approach for the numerical discretization of the FSI problem. We use finite elements for the spatial discretization of partial differential equations. We carry out a numerical simulation on a realistic human left heart model, obtaining results that are qualitatively and quantitatively in agreement with physiological ranges and medical images.
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Affiliation(s)
- Michele Bucelli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alberto Zingaro
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Luca Dede'
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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