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Jaffery OA, Melki L, Slabaugh G, Good WW, Roney CH. A Review of Personalised Cardiac Computational Modelling Using Electroanatomical Mapping Data. Arrhythm Electrophysiol Rev 2024; 13:e08. [PMID: 38807744 PMCID: PMC11131150 DOI: 10.15420/aer.2023.25] [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: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 05/30/2024] Open
Abstract
Computational models of cardiac electrophysiology have gradually matured during the past few decades and are now being personalised to provide patient-specific therapy guidance for improving suboptimal treatment outcomes. The predictive features of these personalised electrophysiology models hold the promise of providing optimal treatment planning, which is currently limited in the clinic owing to reliance on a population-based or average patient approach. The generation of a personalised electrophysiology model entails a sequence of steps for which a range of activation mapping, calibration methods and therapy simulation pipelines have been suggested. However, the optimal methods that can potentially constitute a clinically relevant in silico treatment are still being investigated and face limitations, such as uncertainty of electroanatomical data recordings, generation and calibration of models within clinical timelines and requirements to validate or benchmark the recovered tissue parameters. This paper is aimed at reporting techniques on the personalisation of cardiac computational models, with a focus on calibrating cardiac tissue conductivity based on electroanatomical mapping data.
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Affiliation(s)
- Ovais A Jaffery
- School of Engineering and Materials Science, Queen Mary University of London London, UK
| | - Lea Melki
- R&D Algorithms, Acutus Medical Carlsbad, CA, US
| | - Gregory Slabaugh
- Digital Environment Research Institute, Queen Mary University of London London, UK
| | | | - Caroline H Roney
- School of Engineering and Materials Science, Queen Mary University of London London, UK
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Torre M, Morganti S, Pasqualini FS, Reali A. Current progress toward isogeometric modeling of the heart biophysics. BIOPHYSICS REVIEWS 2023; 4:041301. [PMID: 38510845 PMCID: PMC10903424 DOI: 10.1063/5.0152690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/24/2023] [Indexed: 03/22/2024]
Abstract
In this paper, we review a powerful methodology to solve complex numerical simulations, known as isogeometric analysis, with a focus on applications to the biophysical modeling of the heart. We focus on the hemodynamics, modeling of the valves, cardiac tissue mechanics, and on the simulation of medical devices and treatments. For every topic, we provide an overview of the methods employed to solve the specific numerical issue entailed by the simulation. We try to cover the complete process, starting from the creation of the geometrical model up to the analysis and post-processing, highlighting the advantages and disadvantages of the methodology.
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Affiliation(s)
- Michele Torre
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy
| | - Francesco S. Pasqualini
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
| | - Alessandro Reali
- Department of Civil Engineering and Architecture, University of Pavia, Via Ferrata 3, 27100 Pavia, Italy
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3
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Dokuchaev A, Chumarnaya T, Bazhutina A, Khamzin S, Lebedeva V, Lyubimtseva T, Zubarev S, Lebedev D, Solovyova O. Combination of personalized computational modeling and machine learning for optimization of left ventricular pacing site in cardiac resynchronization therapy. Front Physiol 2023; 14:1162520. [PMID: 37497440 PMCID: PMC10367108 DOI: 10.3389/fphys.2023.1162520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction: The 30-50% non-response rate to cardiac resynchronization therapy (CRT) calls for improved patient selection and optimized pacing lead placement. The study aimed to develop a novel technique using patient-specific cardiac models and machine learning (ML) to predict an optimal left ventricular (LV) pacing site (ML-PS) that maximizes the likelihood of LV ejection fraction (LVEF) improvement in a given CRT candidate. To validate the approach, we evaluated whether the distance DPS between the clinical LV pacing site (ref-PS) and ML-PS is associated with improved response rate and magnitude. Materials and methods: We reviewed retrospective data for 57 CRT recipients. A positive response was defined as a more than 10% LVEF improvement. Personalized models of ventricular activation and ECG were created from MRI and CT images. The characteristics of ventricular activation during intrinsic rhythm and biventricular (BiV) pacing with ref-PS were derived from the models and used in combination with clinical data to train supervised ML classifiers. The best logistic regression model classified CRT responders with a high accuracy of 0.77 (ROC AUC = 0.84). The LR classifier, model simulations and Bayesian optimization with Gaussian process regression were combined to identify an optimal ML-PS that maximizes the ML-score of CRT response over the LV surface in each patient. Results: The optimal ML-PS improved the ML-score by 17 ± 14% over the ref-PS. Twenty percent of the non-responders were reclassified as positive at ML-PS. Selection of positive patients with a max ML-score >0.5 demonstrated an improved clinical response rate. The distance DPS was shorter in the responders. The max ML-score and DPS were found to be strong predictors of CRT response (ROC AUC = 0.85). In the group with max ML-score > 0.5 and DPS< 30 mm, the response rate was 83% compared to 14% in the rest of the cohort. LVEF improvement in this group was higher than in the other patients (16 ± 8% vs. 7 ± 8%). Conclusion: A new technique combining clinical data, personalized heart modelling and supervised ML demonstrates the potential for use in clinical practice to assist in optimizing patient selection and predicting optimal LV pacing lead position in HF candidates for CRT.
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Affiliation(s)
- Arsenii Dokuchaev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | - Tatiana Chumarnaya
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Laboratory of Mathematical Modeling in Physiology and Medicine Based on Supercomputers, Ural Federal University, Ekaterinburg, Russia
| | - Anastasia Bazhutina
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Laboratory of Mathematical Modeling in Physiology and Medicine Based on Supercomputers, Ural Federal University, Ekaterinburg, Russia
| | - Svyatoslav Khamzin
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
| | | | - Tamara Lyubimtseva
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Stepan Zubarev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Dmitry Lebedev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Olga Solovyova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russia
- Laboratory of Mathematical Modeling in Physiology and Medicine Based on Supercomputers, Ural Federal University, Ekaterinburg, Russia
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4
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Gibbs CE, Marchianó S, Zhang K, Yang X, Murry CE, Boyle PM. Graft-host coupling changes can lead to engraftment arrhythmia: a computational study. J Physiol 2023; 601:2733-2749. [PMID: 37014103 PMCID: PMC10901678 DOI: 10.1113/jp284244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
After myocardial infarction (MI), a significant portion of heart muscle is replaced with scar tissue, progressively leading to heart failure. Human pluripotent stem cell-derived cardiomyocytes (hPSC-CM) offer a promising option for improving cardiac function after MI. However, hPSC-CM transplantation can lead to engraftment arrhythmia (EA). EA is a transient phenomenon arising shortly after transplantation then spontaneously resolving after a few weeks. The underlying mechanism of EA is unknown. We hypothesize that EA may be explained partially by time-varying, spatially heterogeneous, graft-host electrical coupling. Here, we created computational slice models derived from histological images that reflect different configuration of grafts in the infarcted ventricle. We ran simulations with varying degrees of connection imposed upon the graft-host perimeter to assess how heterogeneous electrical coupling affected EA with non-conductive scar, slow-conducting scar and scar replaced by host myocardium. We also quantified the effect of variation in intrinsic graft conductivity. Susceptibility to EA initially increased and subsequently decreased with increasing graft-host coupling, suggesting the waxing and waning of EA is regulated by progressive increases in graft-host coupling. Different spatial distributions of graft, host and scar yielded markedly different susceptibility curves. Computationally replacing non-conductive scar with host myocardium or slow-conducting scar, and increasing intrinsic graft conductivity both demonstrated potential means to blunt EA vulnerability. These data show how graft location, especially relative to scar, along with its dynamic electrical coupling to host, can influence EA burden; moreover, they offer a rational base for further studies aimed to define the optimal delivery of hPSC-CM injection. KEY POINTS: Human pluripotent stem cell-derived cardiomyocytes (hPSC-CM) hold great cardiac regenerative potential but can also cause engraftment arrhythmias (EA). Spatiotemporal evolution in the pattern of electrical coupling between injected hPSC-CMs and surrounding host myocardium may explain the dynamics of EA observed in large animal models. We conducted simulations in histology-derived 2D slice computational models to assess the effects of heterogeneous graft-host electrical coupling on EA propensity, with or without scar tissue. Our findings suggest spatiotemporally heterogeneous graft-host coupling can create an electrophysiological milieu that favours graft-initiated host excitation, a surrogate metric of EA susceptibility. Removing scar from our models reduced but did not abolish the propensity for this phenomenon. Conversely, reduced intra-graft electrical connectedness increased the incidence of graft-initiated host excitation. The computational framework created for this study can be used to generate new hypotheses, targeted delivery of hPSC-CMs.
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Affiliation(s)
- Chelsea E Gibbs
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Silvia Marchianó
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Kelly Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Xiulan Yang
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Charles E Murry
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Patrick M Boyle
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
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Duport O, Le Rolle V, Galli E, Danan D, Darrigrand E, Donal E, Hernández A. Model-based analysis of myocardial contraction patterns in ischemic heart disease. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liang C, Li Q, Wang K, Du Y, Wang W, Zhang H. Mechanisms of ventricular arrhythmias elicited by coexistence of multiple electrophysiological remodeling in ischemia: A simulation study. PLoS Comput Biol 2022; 18:e1009388. [PMID: 35476614 PMCID: PMC9045648 DOI: 10.1371/journal.pcbi.1009388] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
Myocardial ischemia, injury and infarction (MI) are the three stages of acute coronary syndrome (ACS). In the past two decades, a great number of studies focused on myocardial ischemia and MI individually, and showed that the occurrence of reentrant arrhythmias is often associated with myocardial ischemia or MI. However, arrhythmogenic mechanisms in the tissue with various degrees of remodeling in the ischemic heart have not been fully understood. In this study, biophysical detailed single-cell models of ischemia 1a, 1b, and MI were developed to mimic the electrophysiological remodeling at different stages of ACS. 2D tissue models with different distributions of ischemia and MI areas were constructed to investigate the mechanisms of the initiation of reentrant waves during the progression of ischemia. Simulation results in 2D tissues showed that the vulnerable windows (VWs) in simultaneous presence of multiple ischemic conditions were associated with the dynamics of wave propagation in the tissues with each single pathological condition. In the tissue with multiple pathological conditions, reentrant waves were mainly induced by two different mechanisms: one is the heterogeneity along the excitation wavefront, especially the abrupt variation in conduction velocity (CV) across the border of ischemia 1b and MI, and the other is the decreased safe factor (SF) for conduction at the edge of the tissue in MI region which is attributed to the increased excitation threshold of MI region. Finally, the reentrant wave was observed in a 3D model with a scar reconstructed from MRI images of a MI patient. These comprehensive findings provide novel insights for understanding the arrhythmic risk during the progression of myocardial ischemia and highlight the importance of the multiple pathological stages in designing medical therapies for arrhythmias in ischemia.
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Affiliation(s)
- Cuiping Liang
- School of Computer Science and Technology, Harbin Institute of Technology (HIT), Harbin, China
| | - Qince Li
- School of Computer Science and Technology, Harbin Institute of Technology (HIT), Harbin, China
- Peng Cheng Laboratory, Shenzhen, China
- * E-mail:
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology (HIT), Harbin, China
| | - Yimei Du
- Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wang
- School of Computer Science and Technology, Harbin Institute of Technology (HIT), Harbin, China
| | - Henggui Zhang
- Peng Cheng Laboratory, Shenzhen, China
- School of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
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Gionti V, Scacchi S, Colli Franzone P, Pavarino LF, Dore R, Storti C. Role of Scar and Border Zone Geometry on the Genesis and Maintenance of Re-Entrant Ventricular Tachycardia in Patients With Previous Myocardial Infarction. Front Physiol 2022; 13:834747. [PMID: 35399271 PMCID: PMC8989182 DOI: 10.3389/fphys.2022.834747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
In patients with healed myocardial infarction, the left ventricular ejection fraction is characterized by low sensitivity and specificity in the prediction of future malignant arrhythmias. Thus, there is the need for new parameters in daily practice to perform arrhythmic risk stratification. The aim of this study is to identify some features of proarrhythmic geometric configurations of scars and border zones (BZ), by means of numerical simulations based on left ventricular models derived from post myocardial infarction patients. Two patients with similar clinical characteristics were included in this study. Both patients exhibited left ventricular scars characterized by subendo- and subepicardial BZ and a transmural BZ isthmus. The scar of patient #1 was significantly larger than that of patient #2, whereas the transmural BZ isthmus and the subdendo- and subepicardial BZs of patient #2 were thicker than those of patient #1. Patient #1 was positive at electrophysiologic testing, whereas patient #2 was negative. Based on the cardiac magnetic resonance (CMR) data, we developed a geometric model of the left ventricles of the two patients, taking into account the position, extent, and topological features of scars and BZ. The numerical simulations were based on the anisotropic monodomain model of electrocardiology. In the model of patient #1, sustained ventricular tachycardia (VT) was inducible by an S2 stimulus delivered at any of the six stimulation sites considered, while in the model of patient #2 we were not able to induce sustained VT. In the model of patient #1, making the subendo- and subepicardial BZs as thick as those of patient #2 did not affect the inducibility and maintenance of VT. On the other hand, in the model of patient #2, making the subendo- and subepicardial BZs as thin as those of patient #1 yielded sustained VT. In conclusion, the results show that the numerical simulations have an effective predictive capability in discriminating patients at high arrhythmic risk. The extent of the infarct scar and the presence of transmural BZ isthmuses and thin subendo- and subepicardial BZs promote sustained VT.
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Affiliation(s)
- Vincenzo Gionti
- Divisione di Cardiologia, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Simone Scacchi
- Dipartimento di Matematica, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Simone Scacchi
| | | | - Luca F. Pavarino
- Dipartimento di Matematica, Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Dore
- Divisione di Cardiologia, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Cesare Storti
- Divisione di Cardiologia, Istituto di Cura Città di Pavia, Pavia, Italy
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8
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Qian S, Connolly A, Mendonca-Costa C, Campos F, Williams SE, Whitaker J, Rinaldi CA, Bishop MJ. An in-silico assessment of efficacy of two novel intra-cardiac electrode configurations versus traditional anti-tachycardia pacing therapy for terminating sustained ventricular tachycardia. Comput Biol Med 2021; 139:104987. [PMID: 34741904 PMCID: PMC8669079 DOI: 10.1016/j.compbiomed.2021.104987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/24/2021] [Accepted: 10/24/2021] [Indexed: 11/06/2022]
Abstract
The implanted cardioverter defibrillator (ICD) is an effective direct therapy for the treatment of cardiac arrhythmias, including ventricular tachycardia (VT). Anti-tachycardia pacing (ATP) is often applied by the ICD as the first mode of therapy, but is often found to be ineffective, particularly for fast VTs. In such cases, strong, painful and damaging backup defibrillation shocks are applied by the device. Here, we propose two novel electrode configurations: "bipolar" and "transmural" which both combine the concept of targeted shock delivery with the advantage of reduced energy required for VT termination. We perform an in silico study to evaluate the efficacy of VT termination by applying one single (low-energy) monophasic shock from each novel configuration, comparing with conventional ATP therapy. Both bipolar and transmural configurations are able to achieve a higher efficacy (93% and 85%) than ATP (45%), with energy delivered similar to and two orders of magnitudes smaller than conventional ICD defibrillation shocks, respectively. Specifically, the transmural configuration (which applies the shock vector directly across the scar substrate sustaining the VT) is most efficient, requiring typically less than 1 J shock energy to achieve a high efficacy. The efficacy of both bipolar and transmural configurations are higher when applied to slow VTs (100% and 97%) compared to fast VTs (57% and 29%). Both novel electrode configurations introduced are able to improve electrotherapy efficacy while reducing the overall number of required therapies and need for strong backup shocks.
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Affiliation(s)
- Shuang Qian
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Adam Connolly
- Invicro, Burlington Danes Building, Du Cane Rd, London, W12 0N, United Kingdom
| | - Caroline Mendonca-Costa
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Fernando Campos
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guy's and St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, King's College London, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
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Quinn TA, Kohl P. Cardiac Mechano-Electric Coupling: Acute Effects of Mechanical Stimulation on Heart Rate and Rhythm. Physiol Rev 2020; 101:37-92. [PMID: 32380895 DOI: 10.1152/physrev.00036.2019] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The heart is vital for biological function in almost all chordates, including humans. It beats continually throughout our life, supplying the body with oxygen and nutrients while removing waste products. If it stops, so does life. The heartbeat involves precise coordination of the activity of billions of individual cells, as well as their swift and well-coordinated adaption to changes in physiological demand. Much of the vital control of cardiac function occurs at the level of individual cardiac muscle cells, including acute beat-by-beat feedback from the local mechanical environment to electrical activity (as opposed to longer term changes in gene expression and functional or structural remodeling). This process is known as mechano-electric coupling (MEC). In the current review, we present evidence for, and implications of, MEC in health and disease in human; summarize our understanding of MEC effects gained from whole animal, organ, tissue, and cell studies; identify potential molecular mediators of MEC responses; and demonstrate the power of computational modeling in developing a more comprehensive understanding of ‟what makes the heart tick.ˮ.
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Affiliation(s)
- T Alexander Quinn
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Peter Kohl
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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10
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Liang C, Wang K, Li Q, Bai J, Zhang H. Influence of the distribution of fibrosis within an area of myocardial infarction on wave propagation in ventricular tissue. Sci Rep 2019; 9:14151. [PMID: 31578428 PMCID: PMC6775234 DOI: 10.1038/s41598-019-50478-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
The presence of fibrosis in heart tissue is strongly correlated with an incidence of arrhythmia, which is a leading cause of sudden cardiac death (SCD). However, it remains incompletely understood how different distributions, sizes and positions of fibrotic tissues contribute to arrhythmogenesis. In this study, we designed 4 different ventricular models mimicking wave propagation in cardiac tissues under normal, myocardial infarction (MI), MI with random fibrosis and MI with gradient fibrosis conditions. Simulation results of ideal square tissues indicate that vulnerable windows (VWs) of random and gradient fibrosis distributions are similar with low levels of fibrosis. However, with a high level of fibrosis, the VWs significantly increase in random fibrosis tissue but not in gradient fibrosis tissue. In addition, we systematically analyzed the effects of the size and position of fibrosis tissues on VWs. Simulation results show that it is more likely for a reentry wave to appear when the length of the infarcted area is greater than 25% of the perimeter of the ventricle, when the width is approximately half that of the ventricular wall, or when the infarcted area is attached to the inside or outside of the ventricular wall.
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Affiliation(s)
- Cuiping Liang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China.
| | - Qince Li
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China.
| | - Jieyun Bai
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China
| | - Henggui Zhang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, Heilongjiang, China.,School of Physics and Astronomy, The University of Manchester, Manchester, UK.,Space Institute of Southern China, Shenzhen, China.,Key Laboratory of Medical Electrophysiology, Ministry of Education, Collaborative Innovation Center for Prevention and Treatment of Cardiovascular Disease/Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
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11
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Pashakhanloo F, Herzka DA, Halperin H, McVeigh ER, Trayanova NA. Role of 3-Dimensional Architecture of Scar and Surviving Tissue in Ventricular Tachycardia: Insights From High-Resolution Ex Vivo Porcine Models. Circ Arrhythm Electrophysiol 2019; 11:e006131. [PMID: 29880529 DOI: 10.1161/circep.117.006131] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND An improved knowledge of the spatial organization of infarct structure and its contribution to ventricular tachycardia (VT) is important for designing optimal treatments. This study explores the relationship between the 3-dimensional structure of the healed infarct and the VT reentrant pathways in high-resolution models of infarcted porcine hearts. METHODS Structurally detailed models of infarcted ventricles were reconstructed from ex vivo late gadolinium enhancement and diffusion tensor magnetic resonance imaging data of 8 chronically infarcted porcine hearts at submillimeter resolution (0.25×0.25×0.5 mm3). To characterize the 3-dimensional structure of surviving tissue in the zone of infarct, a novel scar-mapped thickness metric was introduced. Further, using the ventricular models, electrophysiological simulations were conducted to determine and analyze the 3-dimensional VT pathways that were established in each of the complex infarct morphologies. RESULTS The scar-mapped thickness metric revealed the heterogeneous organization of infarct and enabled us to systematically characterize the distribution of surviving tissue thickness in 8 hearts. Simulation results demonstrated the involvement of a subendocardial tissue layer of varying thickness in the majority of VT pathways. Importantly, they revealed that VT pathways are most frequently established within thin surviving tissue structures of thickness ≤2.2 mm (90th percentile) surrounding the scar. CONCLUSIONS The combination of high-resolution imaging data and ventricular simulations revealed the 3-dimensional distribution of surviving tissue surrounding the scar and demonstrated its involvement in VT pathways. The new knowledge obtained in this study contributes toward a better understanding of infarct-related VT.
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Affiliation(s)
| | - Daniel A Herzka
- Department of Biomedical Engineering (F.P., D.A.H., E.R.M., N.A.T.)
| | | | - Elliot R McVeigh
- Department of Biomedical Engineering (F.P., D.A.H., E.R.M., N.A.T.).,Johns Hopkins University, Baltimore, MD. Departments of Bioengineering, Medicine, and Radiology, University of California, San Diego, La Jolla (E.R.M.)
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Lopez-Perez A, Sebastian R, Izquierdo M, Ruiz R, Bishop M, Ferrero JM. Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia. Front Physiol 2019; 10:580. [PMID: 31156460 PMCID: PMC6531915 DOI: 10.3389/fphys.2019.00580] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/25/2019] [Indexed: 12/20/2022] Open
Abstract
In the chronic stage of myocardial infarction, a significant number of patients develop life-threatening ventricular tachycardias (VT) due to the arrhythmogenic nature of the remodeled myocardium. Radiofrequency ablation (RFA) is a common procedure to isolate reentry pathways across the infarct scar that are responsible for VT. Unfortunately, this strategy show relatively low success rates; up to 50% of patients experience recurrent VT after the procedure. In the last decade, intensive research in the field of computational cardiac electrophysiology (EP) has demonstrated the ability of three-dimensional (3D) cardiac computational models to perform in-silico EP studies. However, the personalization and modeling of certain key components remain challenging, particularly in the case of the infarct border zone (BZ). In this study, we used a clinical dataset from a patient with a history of infarct-related VT to build an image-based 3D ventricular model aimed at computational simulation of cardiac EP, including detailed patient-specific cardiac anatomy and infarct scar geometry. We modeled the BZ in eight different ways by combining the presence or absence of electrical remodeling with four different levels of image-based patchy fibrosis (0, 10, 20, and 30%). A 3D torso model was also constructed to compute the ECG. Patient-specific sinus activation patterns were simulated and validated against the patient's ECG. Subsequently, the pacing protocol used to induce reentrant VTs in the EP laboratory was reproduced in-silico. The clinical VT was induced with different versions of the model and from different pacing points, thus identifying the slow conducting channel responsible for such VT. Finally, the real patient's ECG recorded during VT episodes was used to validate our simulation results and to assess different strategies to model the BZ. Our study showed that reduced conduction velocities and heterogeneity in action potential duration in the BZ are the main factors in promoting reentrant activity. Either electrical remodeling or fibrosis in a degree of at least 30% in the BZ were required to initiate VT. Moreover, this proof-of-concept study confirms the feasibility of developing 3D computational models for cardiac EP able to reproduce cardiac activation in sinus rhythm and during VT, using exclusively non-invasive clinical data.
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Affiliation(s)
- Alejandro Lopez-Perez
- Center for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Universitat de València, Valencia, Spain
| | - M Izquierdo
- INCLIVA Health Research Institute, Valencia, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ricardo Ruiz
- INCLIVA Health Research Institute, Valencia, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Martin Bishop
- Division of Imaging Sciences & Biomedical Engineering, Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Jose M Ferrero
- Center for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
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Alqahtani A, Abed AA, Anderson EE, Lovell NH, Dokos S. A Multi-Domain Continuum Model of Electrical Stimulation of Healthy and Degenerate Retina. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:6117-6120. [PMID: 30441730 DOI: 10.1109/embc.2018.8513665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A continuum multi-domain model of electrical stimulation of the retina is presented and validated against retinal ganglion cell (RGC) excitation thresholds reported in a recently published in vitro experimental study. We applied our model to investigate the response of the RGC layer to electrical stimulation during mid-to-late stage retinal degeneration for both epiretinal and suprachoroidal configurations. Interestingly, our model predicted that suprachoroidal stimulation of the degenerate retina required increased current thresholds, mainly because of the presence of the glial scar layer. In contrast, epiretinal stimulation thresholds were almost similar for both healthy and degenerate models. The latter finding implies that there is no influence of the glial scar layer on epiretinal stimulation current thresholds.
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Mendonca Costa C, Plank G, Rinaldi CA, Niederer SA, Bishop MJ. Modeling the Electrophysiological Properties of the Infarct Border Zone. Front Physiol 2018; 9:356. [PMID: 29686626 PMCID: PMC5900020 DOI: 10.3389/fphys.2018.00356] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/22/2018] [Indexed: 12/28/2022] Open
Abstract
Ventricular arrhythmias (VA) in patients with myocardial infarction (MI) are thought to be associated with structural and electrophysiological remodeling within the infarct border zone (BZ). Personalized computational models have been used to investigate the potential role of the infarct BZ in arrhythmogenesis, which still remains incompletely understood. Most recent models have relied on experimental data to assign BZ properties. However, experimental measurements vary significantly resulting in different computational representations of this region. Here, we review experimental data available in the literature to determine the most prominent properties of the infarct BZ. Computational models are then used to investigate the effect of different representations of the BZ on activation and repolarization properties, which may be associated with VA. Experimental data obtained from several animal species and patients with infarct show that BZ properties vary significantly depending on disease's stage, with the early disease stage dominated by ionic remodeling and the chronic stage by structural remodeling. In addition, our simulations show that ionic remodeling in the BZ leads to large repolarization gradients in the vicinity of the scar, which may have a significant impact on arrhythmia simulations, while structural remodeling plays a secondary role. We conclude that it is imperative to faithfully represent the properties of regions of infarction within computational models specific to the disease stage under investigation in order to conduct in silico mechanistic investigations.
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Affiliation(s)
- Caroline Mendonca Costa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Gernot Plank
- Department of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Abstract
This Special Collection will gather all studies highlighting recent advances in theoretical and experimental studies of arrhythmia, with a specific focus on research seeking to elucidate links between calcium homeostasis in cardiac cells and organ-scale disruption of heart rhythm.
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Affiliation(s)
- Makarand Deo
- Department of Engineering, Norfolk State University, Norfolk, VA, USA
| | - Seth H Weinberg
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Patrick M Boyle
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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Kaese S, Larbig R, Rohrbeck M, Frommeyer G, Dechering D, Olligs J, Schönhofer-Merl S, Wessely R, Klingel K, Seebohm G, Eckardt L. Electrophysiological alterations in a murine model of chronic coxsackievirus B3 myocarditis. PLoS One 2017. [PMID: 28644868 PMCID: PMC5482483 DOI: 10.1371/journal.pone.0180029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Coxsackievirus B3 (CVB3) is known to induce acute and chronic myocarditis. Most infections are clinically unapparent but some patients suffer from ventricular arrhythmias (VA) and sudden cardiac death (SCD). Studies showed that acute CVB3 infection may cause impaired function of cardiac ion channels, creating a proarrhythmic substrate. However, it is unknown whether low level CVB3+ expression in myocytes may cause altered cardiac electrophysiology leading to VA. METHODS Cellular electrophysiology was used to analyze cellular action potentials (APs) and occurrence of afterdepolarizations from isolated cardiomyocytes of wildtype (WT) and transgenic CVB3ΔVP0 (CVB3+) mice. Further, we studied surface ECGs, monophasic APs, ventricular effective refractory period (VERP) and inducibility of VAs in Langendorff-perfused whole hearts. All used cardiomyocytes and whole hearts originated from male mice. RESULTS Cellular action potential duration (APD) in WT and CVB3+ myocytes was unchanged. No difference in mean occurrence or amplitude of afterdepolarizations in WT and CVB3+ myocytes was found. Interestingly, resting membrane potential in CVB3+ myocytes was significantly hyperpolarized (WT: -90.0±2.2 mV, n = 7; CVB3+: -114.1±3.0 mV, n = 14; p<0.005). Consistently, in Langendorff-perfused hearts, APDs were also not different between WT and CVB3+ whole hearts. Within both groups, we found a heart rate dependent shortening of ADP90 with increasing heart rate in Langendorff-perfused hearts. VERP was significantly prolonged in CVB3+ hearts compared to WT (WT: 36.0±2.7 ms, n = 5; CVB3+: 47.0±2.0 ms, n = 7; p = 0.018). Resting heart rate (HR) in Langendorff-perfused hearts was not significantly different between both genotypes. Electrical pacing protocols induced no VA in WT and CVB3+ hearts. CONCLUSION In CVB3+ mice, prolonged ventricular refractoriness and hyperpolarized resting membrane potentials in presence of unchanged APD were observed, suggesting that low level CVB3 expression does not promote VA by altered cardiac electrophysiology in this type of chronic myocarditis. These findings may suggest that other mechanisms such as chronic myocardial inflammation or fibrosis may account for arrhythmias observed in patients with chronic enteroviral myocarditis.
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Affiliation(s)
- Sven Kaese
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
- * E-mail:
| | - Robert Larbig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Matthias Rohrbeck
- The IfGH-Myocellular Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
- Interdisciplinary Centre for Clinical Research (IZKF), Faculty of Medicine, University of Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Dirk Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Jan Olligs
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - Sabine Schönhofer-Merl
- Deutsches Herzzentrum and Medizinische Klinik, Klinikum rechts der Isar, University of Technology, Munich, Germany
| | - Rainer Wessely
- Deutsches Herzzentrum and Medizinische Klinik, Klinikum rechts der Isar, University of Technology, Munich, Germany
- Zentrum für Herz- und Gefäßmedizin, Im Mediapark 2, Köln, Germany
| | - Karin Klingel
- Department of Molecular Pathology, University of Tübingen, Tübingen, Germany
| | - Guiscard Seebohm
- The IfGH-Myocellular Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
- Interdisciplinary Centre for Clinical Research (IZKF), Faculty of Medicine, University of Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany
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