Radomir Chabiniok

Trials on tissue contractility estimation from cardiac cine MRI using a biomechanical heart model

In this paper we apply specific data assimilation methods in order to estimate regional contractility parameters in a biomechanical heart model, using as measurements real Cine MR images obtained in an animal experiment. We assess the effectiveness of this estimation based on independent knowledge of the controlled infarcted condition, and on late enhancement images. Moreover, we show that the estimated contractility values can improve the model behavior in itself, and that they can serve as an indicator of the local heart function, namely, to assist medical diagnosis for the post-infarct detection of hypokinetic or akinetic regions in the myocardial tissue.

Patient-specific electromechanical models of the heart for the prediction of pacing acute effects in CRT: a preliminary clinical validation.

Cardiac resynchronisation therapy (CRT) is an effective treatment for patients with congestive heart failure and a wide QRS complex. However, up to 30% of patients are non-responders to therapy in terms of exercise capacity or left ventricular reverse remodelling. A number of controversies still remain surrounding patient selection, targeted lead implantation and optimisation of this important treatment. The development of biophysical models to predict the response to CRT represents a potential strategy to address these issues. In this article, we present how the personalisation of an electromechanical model of the myocardium can predict the acute haemodynamic changes associated with CRT. In order to introduce such an approach as a clinical application, we needed to design models that can be individualised from images and electrophysiological mapping of the left ventricle. In this paper the personalisation of the anatomy, the electrophysiology, the kinematics and the mechanics are described. The acute effects of pacing on pressure development were predicted with the in silico model for several pacing conditions on two patients, achieving good agreement with invasive haemodynamic measurements: the mean error on dP/dt(max) is 47.5±35mmHgs(-1), less than 5% error. These promising results demonstrate the potential of physiological models personalised from images and electrophysiology signals to improve patient selection and plan CRT.

Estimation of tissue contractility from cardiac cine-MRI using a biomechanical heart model

The objective of this paper is to propose and assess an estimation procedure—based on data assimilation principles—well suited to obtain some regional values of key biophysical parameters in a beating heart model, using actual Cine-MR images. The motivation is twofold: (1) to provide an automatic tool for personalizing the characteristics of a cardiac model in order to achieve predictivity in patient-specific modeling and (2) to obtain some useful information for diagnosis purposes in the estimated quantities themselves. In order to assess the global methodology, we specifically devised an animal experiment in which a controlled infarct was produced and data acquired before and after infarction, with an estimation of regional tissue contractility—a key parameter directly affected by the pathology—performed for every measured stage. After performing a preliminary assessment of our proposed methodology using synthetic data, we then demonstrate a full-scale application by first estimating contractility values associated with 6 regions based on the AHA subdivision, before running a more detailed estimation using the actual AHA segments. The estimation results are assessed by comparison with the medical knowledge of the specific infarct, and with late enhancement MR images. We discuss their accuracy at the various subdivision levels, in the light of the inherent modeling limitations and of the intrinsic information contents featured in the data.

Multiphysics and multiscale modelling, data-model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics.

With heart and cardiovascular diseases continually challenging healthcare systems worldwide, translating basic research on cardiac (patho)physiology into clinical care is essential. Exacerbating this already extensive challenge is the complexity of the heart, relying on its hierarchical structure and function to maintain cardiovascular flow. Computational modelling has been proposed and actively pursued as a tool for accelerating research and translation. Allowing exploration of the relationships between physics, multiscale mechanisms and function, computational modelling provides a platform for improving our understanding of the heart. Further integration of experimental and clinical data through data assimilation and parameter estimation techniques is bringing computational models closer to use in routine clinical practice. This article reviews developments in computational cardiac modelling and how their integration with medical imaging data is providing new pathways for translational cardiac modelling.

A novel porous mechanical framework for modelling the interaction between coronary perfusion and myocardial mechanics

The strong coupling between the flow in coronary vessels and the mechanical deformation of the myocardial tissue is a central feature of cardiac physiology and must therefore be accounted for by models of coronary perfusion. Currently available geometrically explicit vascular models fail to capture this interaction satisfactorily, are numerically intractable for whole organ simulations, and are difficult to parameterise in human contexts. To address these issues, in this study, a finite element formulation of an incompressible, poroelastic model of myocardial perfusion is presented. Using high-resolution ex vivo imaging data of the coronary tree, the permeability tensors of the porous medium were mapped onto a mesh of the corresponding left ventricular geometry. The resultant tensor field characterises not only the distinct perfusion regions that are observed in experimental data, but also the wide range of vascular length scales present in the coronary tree, through a multi-compartment porous model. Finite deformation mechanics are solved using a macroscopic constitutive law that defines the coupling between the fluid and solid phases of the porous medium. Results are presented for the perfusion of the left ventricle under passive inflation that show wall-stiffening associated with perfusion, and that show the significance of a non-hierarchical multi-compartment model within a particular perfusion territory.

Personalised Electromechanical Model of the Heart for the Prediction of the Acute Effects of Cardiac Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) has been shown to be an effective adjunctive treatment for patients with dyssynchronous ventricular contraction and symptoms of the heart failure. However, clinical trials have also demonstrated that up to 30% of patients may be classified as non-responders. In this article, we present how the personalisation of an electromechanical model of the myocardium could help the therapy planning for CRT. We describe the four main components of our myocardial model, namely the anatomy, the electrophysiology, the kinematics and the mechanics. For each of these components we combine prior knowledge and observable parameters in order to personalise these models to patient data. Then the acute effects of a pacemaker on the cardiac function are predicted with the in silico model on a clinical case. This is a proof of concept of the potential of virtual physiological models to better select and plan the therapy.

Estimation of passive and active properties in the human heart using 3D tagged MRI.

Advances in medical imaging and image processing are paving the way for personalised cardiac biomechanical modelling. Models provide the capacity to relate kinematics to dynamics and—through patient-specific modelling—derived material parameters to underlying cardiac muscle pathologies. However, for clinical utility to be achieved, model-based analyses mandate robust model selection and parameterisation. In this paper, we introduce a patient-specific biomechanical model for the left ventricle aiming to balance model fidelity with parameter identifiability. Using non-invasive data and common clinical surrogates, we illustrate unique identifiability of passive and active parameters over the full cardiac cycle. Identifiability and accuracy of the estimates in the presence of controlled noise are verified with a number of in silico datasets. Unique parametrisation is then obtained for three datasets acquired in vivo. The model predictions show good agreement with the data extracted from the images providing a pipeline for personalised biomechanical analysis.

Constitutive parameter estimation methodology using tagged-MRI data

We propose a methodology for performing the estimation of a key constitutive parameter in a biomechanical heart model - namely, the tissue contractility - using tagged-MRI data. We adopt a sequential data assimilation strategy, and the image data is assumed to be processed in the form of deforming tag planes, which we employ to obtain a discrepancy between the model and the data by computing distances to these surfaces. We assess our procedure using synthetic measurements produced with a model representing an infarcted heart as observed in an animal experiment, and the estimation results are found to be of superior accuracy compared to assimilation based on segmented endo- and epicardium surfaces.

Dimensional reductions of a cardiac model for effective validation and calibration.

Complex 3D beating heart models are now available, but their complexity makes calibration and validation very difficult tasks. We thus propose a systematic approach of deriving simplified reduced-dimensional models, in “0D”—typically, to represent a cardiac cavity, or several coupled cavities—and in “1D”—to model elongated structures such as muscle samples or myocytes. We apply this approach with an earlier-proposed 3D cardiac model designed to capture length-dependence effects in contraction, which we here complement by an additional modeling component devised to represent length-dependent relaxation. We then present experimental data produced with rat papillary muscle samples when varying preload and afterload conditions, and we achieve some detailed validations of the 1D model with these data, including for the length-dependence effects that are accurately captured. Finally, when running simulations of the 0D model pre-calibrated with the 1D model parameters, we obtain pressure–volume indicators of the left ventricle in good agreement with some important features of cardiac physiology, including the so-called Frank–Starling mechanism, the End-Systolic Pressure–Volume Relationship, as well as varying elastance properties. This integrated multi-dimensional modeling approach thus sheds new light on the relations between the phenomena observed at different scales and at the local versus organ levels.

Analysis of passive cardiac constitutive laws for parameter estimation using 3D tagged MRI

An unresolved issue in patient-specific models of cardiac mechanics is the choice of an appropriate constitutive law, able to accurately capture the passive behavior of the myocardium, while still having uniquely identifiable parameters tunable from available clinical data. In this paper, we aim to facilitate this choice by examining the practical identifiability and model fidelity of constitutive laws often used in cardiac mechanics. Our analysis focuses on the use of novel 3D tagged MRI, providing detailed displacement information in three dimensions. The practical identifiability of each law is examined by generating synthetic 3D tags from in silico simulations, allowing mapping of the objective function landscape over parameter space and comparison of minimizing parameter values with original ground truth values. Model fidelity was tested by comparing these laws with the more complex transversely isotropic Guccione law, by characterizing their passive end-diastolic pressure–volume relation behavior, as well as by considering the in vivo case of a healthy volunteer. These results show that a reduced form of the Holzapfel–Ogden law provides the best balance between identifiability and model fidelity across the tests considered.