1
|
Sermesant M, Delingette H, Cochet H, Jaïs P, Ayache N. Applications of artificial intelligence in cardiovascular imaging. Nat Rev Cardiol 2021; 18:600-609. [PMID: 33712806 DOI: 10.1038/s41569-021-00527-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
Research into artificial intelligence (AI) has made tremendous progress over the past decade. In particular, the AI-powered analysis of images and signals has reached human-level performance in many applications owing to the efficiency of modern machine learning methods, in particular deep learning using convolutional neural networks. Research into the application of AI to medical imaging is now very active, especially in the field of cardiovascular imaging because of the challenges associated with acquiring and analysing images of this dynamic organ. In this Review, we discuss the clinical questions in cardiovascular imaging that AI can be used to address and the principal methodological AI approaches that have been developed to solve the related image analysis problems. Some approaches are purely data-driven and rely mainly on statistical associations, whereas others integrate anatomical and physiological information through additional statistical, geometric and biophysical models of the human heart. In a structured manner, we provide representative examples of each of these approaches, with particular attention to the underlying computational imaging challenges. Finally, we discuss the remaining limitations of AI approaches in cardiovascular imaging (such as generalizability and explainability) and how they can be overcome.
Collapse
Affiliation(s)
| | | | - Hubert Cochet
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm 1045, Pessac, France
| | - Pierre Jaïs
- IHU Liryc, CHU Bordeaux, Université Bordeaux, Inserm 1045, Pessac, France
| | | |
Collapse
|
2
|
Pitoulis FG, Watson SA, Perbellini F, Terracciano CM. Myocardial slices come to age: an intermediate complexity in vitro cardiac model for translational research. Cardiovasc Res 2020; 116:1275-1287. [PMID: 31868875 PMCID: PMC7243278 DOI: 10.1093/cvr/cvz341] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/31/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022] Open
Abstract
Although past decades have witnessed significant reductions in mortality of heart failure together with advances in our understanding of its cellular, molecular, and whole-heart features, a lot of basic cardiac research still fails to translate into clinical practice. In this review we examine myocardial slices, a novel model in the translational arena. Myocardial slices are living ultra-thin sections of heart tissue. Slices maintain the myocardium's native function (contractility, electrophysiology) and structure (multicellularity, extracellular matrix) and can be prepared from animal and human tissue. The discussion begins with the history and current advances in the model, the different interlaboratory methods of preparation and their potential impact on results. We then contextualize slices' advantages and limitations by comparing it with other cardiac models. Recently, sophisticated methods have enabled slices to be cultured chronically in vitro while preserving the functional and structural phenotype. This is more timely now than ever where chronic physiologically relevant in vitro platforms for assessment of therapeutic strategies are urgently needed. We interrogate the technological developments that have permitted this, their limitations, and future directions. Finally, we look into the general obstacles faced by the translational field, and how implementation of research systems utilizing slices could help in resolving these.
Collapse
Affiliation(s)
- Fotios G Pitoulis
- Laboratory of Cell Electrophysiology, Department of Myocardial Function, Imperial College London, National Heart and Lung Institute, 4th Floor ICTEM Building Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Samuel A Watson
- Laboratory of Cell Electrophysiology, Department of Myocardial Function, Imperial College London, National Heart and Lung Institute, 4th Floor ICTEM Building Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| | - Filippo Perbellini
- Laboratory of Cell Electrophysiology, Department of Myocardial Function, Imperial College London, National Heart and Lung Institute, 4th Floor ICTEM Building Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | - Cesare M Terracciano
- Laboratory of Cell Electrophysiology, Department of Myocardial Function, Imperial College London, National Heart and Lung Institute, 4th Floor ICTEM Building Hammersmith Hospital, Du Cane Road, London W12 0NN, UK
| |
Collapse
|
3
|
Clinical Diagnostic Biomarkers from the Personalization of Computational Models of Cardiac Physiology. Ann Biomed Eng 2015; 44:46-57. [PMID: 26399986 DOI: 10.1007/s10439-015-1439-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
Computational modelling of the heart is rapidly advancing to the point of clinical utility. However, the difficulty of parameterizing and validating models from clinical data indicates that the routine application of truly predictive models remains a significant challenge. We argue there is significant value in an intermediate step towards prediction. This step is the use of biophysically based models to extract clinically useful information from existing patient data. Specifically in this paper we review methodologies for applying modelling frameworks for this goal in the areas of quantifying cardiac anatomy, estimating myocardial stiffness and optimizing measurements of coronary perfusion. Using these indicative examples of the general overarching approach, we finally discuss the value, ongoing challenges and future potential for applying biophysically based modelling in the clinical context.
Collapse
|
4
|
Burton RAB, Lee P, Casero R, Garny A, Siedlecka U, Schneider JE, Kohl P, Grau V. Three-dimensional histology: tools and application to quantitative assessment of cell-type distribution in rabbit heart. Europace 2015; 16 Suppl 4:iv86-iv95. [PMID: 25362175 PMCID: PMC4217519 DOI: 10.1093/europace/euu234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims Cardiac histo-anatomical organization is a major determinant of function. Changes in tissue structure are a relevant factor in normal and disease development, and form targets of therapeutic interventions. The purpose of this study was to test tools aimed to allow quantitative assessment of cell-type distribution from large histology and magnetic resonance imaging- (MRI) based datasets. Methods and results Rabbit heart fixation during cardioplegic arrest and MRI were followed by serial sectioning of the whole heart and light-microscopic imaging of trichrome-stained tissue. Segmentation techniques developed specifically for this project were applied to segment myocardial tissue in the MRI and histology datasets. In addition, histology slices were segmented into myocytes, connective tissue, and undefined. A bounding surface, containing the whole heart, was established for both MRI and histology. Volumes contained in the bounding surface (called ‘anatomical volume’), as well as that identified as containing any of the above tissue categories (called ‘morphological volume’), were calculated. The anatomical volume was 7.8 cm3 in MRI, and this reduced to 4.9 cm3 after histological processing, representing an ‘anatomical’ shrinkage by 37.2%. The morphological volume decreased by 48% between MRI and histology, highlighting the presence of additional tissue-level shrinkage (e.g. an increase in interstitial cleft space). The ratio of pixels classified as containing myocytes to pixels identified as non-myocytes was roughly 6:1 (61.6 vs. 9.8%; the remaining fraction of 28.6% was ‘undefined’). Conclusion Qualitative and quantitative differentiation between myocytes and connective tissue, using state-of-the-art high-resolution serial histology techniques, allows identification of cell-type distribution in whole-heart datasets. Comparison with MRI illustrates a pronounced reduction in anatomical and morphological volumes during histology processing.
Collapse
Affiliation(s)
- Rebecca A B Burton
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Peter Lee
- Department of Physics, University of Oxford, Oxford OX1 3RH, UK
| | - Ramón Casero
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| | - Alan Garny
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK
| | - Urszula Siedlecka
- The Heart Science Centre, National Heart and Lung Institute, Imperial College London, Harefield UB9 6JH, UK
| | - Jürgen E Schneider
- British Heart Foundation Experimental MR Unit, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Peter Kohl
- The Heart Science Centre, National Heart and Lung Institute, Imperial College London, Harefield UB9 6JH, UK
| | - Vicente Grau
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| |
Collapse
|
5
|
Living cardiac tissue slices: an organotypic pseudo two-dimensional model for cardiac biophysics research. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:314-27. [PMID: 25124067 DOI: 10.1016/j.pbiomolbio.2014.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 08/02/2014] [Indexed: 11/24/2022]
Abstract
Living cardiac tissue slices, a pseudo two-dimensional (2D) preparation, have received less attention than isolated single cells, cell cultures, or Langendorff-perfused hearts in cardiac biophysics research. This is, in part, due to difficulties associated with sectioning cardiac tissue to obtain live slices. With moderate complexity, native cell-types, and well-preserved cell-cell electrical and mechanical interconnections, cardiac tissue slices have several advantages for studying cardiac electrophysiology. The trans-membrane potential (Vm) has, thus far, mainly been explored using multi-electrode arrays. Here, we combine tissue slices with optical mapping to monitor Vm and intracellular Ca(2+) concentration ([Ca(2+)]i). This combination opens up the possibility of studying the effects of experimental interventions upon action potential (AP) and calcium transient (CaT) dynamics in 2D, and with relatively high spatio-temporal resolution. As an intervention, we conducted proof-of-principle application of stretch. Mechanical stimulation of cardiac preparations is well-established for membrane patches, single cells and whole heart preparations. For cardiac tissue slices, it is possible to apply stretch perpendicular or parallel to the dominant orientation of cells, while keeping the preparation in a constant focal plane for fluorescent imaging of in-slice functional dynamics. Slice-to-slice comparison furthermore allows one to assess transmural differences in ventricular tissue responses to mechanical challenges. We developed and tested application of axial stretch to cardiac tissue slices, using a manually-controlled stretching device, and recorded Vm and [Ca(2+)]i by optical mapping before, during, and after application of stretch. Living cardiac tissue slices, exposed to axial stretch, show an initial shortening in both AP and CaT duration upon stretch application, followed in most cases by a gradual prolongation of AP and CaT duration during stretch maintained for up to 50 min. After release of sustained stretch, AP duration (APD) and CaT duration reverted to shorter values. Living cardiac tissue slices are a promising experimental model for the study of cardiac mechano-electric interactions. The methodology described here can be refined to achieve more accurate control over stretch amplitude and timing (e.g. using a computer-controlled motorised stage, or by synchronising electrical and mechanical events) and through monitoring of regional tissue deformation (e.g. by adding motion tracking).
Collapse
|
6
|
Solovyova O, Katsnelson LB, Konovalov PV, Kursanov AG, Vikulova NA, Kohl P, Markhasin VS. The cardiac muscle duplex as a method to study myocardial heterogeneity. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:115-28. [PMID: 25106702 PMCID: PMC4210666 DOI: 10.1016/j.pbiomolbio.2014.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/25/2014] [Indexed: 12/14/2022]
Abstract
This paper reviews the development and application of paired muscle preparations, called duplex, for the investigation of mechanisms and consequences of intra-myocardial electro-mechanical heterogeneity. We illustrate the utility of the underlying combined experimental and computational approach for conceptual development and integration of basic science insight with clinically relevant settings, using previously published and new data. Directions for further study are identified.
Collapse
Affiliation(s)
- O Solovyova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia.
| | - L B Katsnelson
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P V Konovalov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - A G Kursanov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
| | - N A Vikulova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P Kohl
- National Heart and Lung Institute, Imperial College of London, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK; Department of Computer Sciences, University of Oxford, UK
| | - V S Markhasin
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
| |
Collapse
|
7
|
Konakanchi D, de Jongh Curry AL, Dokos S. Effects of macroscopic heterogeneity on propagation in a computationally inexpensive 2D model of the heart. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:4320-4323. [PMID: 25570948 DOI: 10.1109/embc.2014.6944580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We have developed a computationally inexpensive, two-dimensional, bidomain model of the heart to demonstrate the effect of tissue heterogeneity on propagation of cardiac impulses generated by the sino-atrial node (SAN). The geometry consists of a thin sheet of cardiac tissue with designated areas that represent the SAN and atria. The SAN auto-generates continuous impulses that result in waves of normal propagation throughout the tissue. On the introduction of heterogeneous patches with low tissue conductivities, the rhythm of the waveform becomes irregular. The study suggests that simplified and computationally inexpensive models can be insightful tools to better understand the mechanisms that cause atrial fibrillation (AF) and hence more effective treatment methods.
Collapse
|
8
|
|
9
|
A simplified 3D model of whole heart electrical activity and 12-lead ECG generation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:134208. [PMID: 23710247 PMCID: PMC3654639 DOI: 10.1155/2013/134208] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/15/2013] [Indexed: 11/18/2022]
Abstract
We present a computationally efficient three-dimensional bidomain model of torso-embedded whole heart electrical activity, with spontaneous initiation of activation in the sinoatrial node, incorporating a specialized conduction system with heterogeneous action potential morphologies throughout the heart. The simplified geometry incorporates the whole heart as a volume source, with heart cavities, lungs, and torso as passive volume conductors. We placed four surface electrodes at the limbs of the torso: VR, VL, VF and VGND and six electrodes on the chest to simulate the Einthoven, Goldberger-augmented and precordial leads of a standard 12-lead system. By placing additional seven electrodes at the appropriate torso positions, we were also able to calculate the vectorcardiogram of the Frank lead system. Themodel was able to simulate realistic electrocardiogram (ECG) morphologies for the 12 standard leads, orthogonal X, Y, and Z leads, as well as the vectorcardiogram under normal and pathological heart states. Thus, simplified and easy replicable 3D cardiac bidomain model offers a compromise between computational load and model complexity and can be used as an investigative tool to adjust cell, tissue, and whole heart properties, such as setting ischemic lesions or regions of myocardial infarction, to readily investigate their effects on whole ECG morphology.
Collapse
|
10
|
Quinn TA, Kohl P. Combining wet and dry research: experience with model development for cardiac mechano-electric structure-function studies. Cardiovasc Res 2013; 97:601-11. [PMID: 23334215 PMCID: PMC3583260 DOI: 10.1093/cvr/cvt003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/08/2013] [Accepted: 01/15/2013] [Indexed: 11/17/2022] Open
Abstract
Since the development of the first mathematical cardiac cell model 50 years ago, computational modelling has become an increasingly powerful tool for the analysis of data and for the integration of information related to complex cardiac behaviour. Current models build on decades of iteration between experiment and theory, representing a collective understanding of cardiac function. All models, whether computational, experimental, or conceptual, are simplified representations of reality and, like tools in a toolbox, suitable for specific applications. Their range of applicability can be explored (and expanded) by iterative combination of 'wet' and 'dry' investigation, where experimental or clinical data are used to first build and then validate computational models (allowing integration of previous findings, quantitative assessment of conceptual models, and projection across relevant spatial and temporal scales), while computational simulations are utilized for plausibility assessment, hypotheses-generation, and prediction (thereby defining further experimental research targets). When implemented effectively, this combined wet/dry research approach can support the development of a more complete and cohesive understanding of integrated biological function. This review illustrates the utility of such an approach, based on recent examples of multi-scale studies of cardiac structure and mechano-electric function.
Collapse
Affiliation(s)
- T Alexander Quinn
- National Heart and Lung Institute, Imperial College London, Heart Science Centre, Harefield UB9 6JH, UK.
| | | |
Collapse
|
11
|
Mirams GR, Davies MR, Cui Y, Kohl P, Noble D. Application of cardiac electrophysiology simulations to pro-arrhythmic safety testing. Br J Pharmacol 2012; 167:932-45. [PMID: 22568589 PMCID: PMC3492977 DOI: 10.1111/j.1476-5381.2012.02020.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/23/2012] [Accepted: 04/26/2012] [Indexed: 12/19/2022] Open
Abstract
Concerns over cardiac side effects are the largest single cause of compound attrition during pharmaceutical drug development. For a number of years, biophysically detailed mathematical models of cardiac electrical activity have been used to explore how a compound, interfering with specific ion-channel function, may explain effects at the cell-, tissue- and organ-scales. With the advent of high-throughput screening of multiple ion channels in the wet-lab, and improvements in computational modelling of their effects on cardiac cell activity, more reliable prediction of pro-arrhythmic risk is becoming possible at the earliest stages of drug development. In this paper, we review the current use of biophysically detailed mathematical models of cardiac myocyte electrical activity in drug safety testing, and suggest future directions to employ the full potential of this approach.
Collapse
Affiliation(s)
- Gary R Mirams
- Computational Biology, Department of Computer Science, University of OxfordOxford, UK
| | - Mark R Davies
- Computational Biology, Discovery SciencesAstraZeneca, Alderley Park, UK
| | - Yi Cui
- Safety Pharmacology, Safety Assessment, GlaxoSmithKline, R&D WareUK
| | - Peter Kohl
- Computational Biology, Department of Computer Science, University of OxfordOxford, UK
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Denis Noble
- Computational Biology, Department of Computer Science, University of OxfordOxford, UK
- Department of Physiology, Anatomy & Genetics, University of OxfordOxford, UK
| |
Collapse
|
12
|
Abstract
Systems biology, the approach that combines reduction and integration to explore dynamic structure-function interrelations across biomedically relevant spatio-temporal scales, is applied to heart research.
Collapse
Affiliation(s)
- T Alexander Quinn
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | | |
Collapse
|
13
|
Noble D. A theory of biological relativity: no privileged level of causation. Interface Focus 2012; 2:55-64. [PMID: 23386960 PMCID: PMC3262309 DOI: 10.1098/rsfs.2011.0067] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/17/2011] [Indexed: 12/29/2022] Open
Abstract
Must higher level biological processes always be derivable from lower level data and mechanisms, as assumed by the idea that an organism is completely defined by its genome? Or are higher level properties necessarily also causes of lower level behaviour, involving actions and interactions both ways? This article uses modelling of the heart, and its experimental basis, to show that downward causation is necessary and that this form of causation can be represented as the influences of initial and boundary conditions on the solutions of the differential equations used to represent the lower level processes. These insights are then generalized. A priori, there is no privileged level of causation. The relations between this form of 'biological relativity' and forms of relativity in physics are discussed. Biological relativity can be seen as an extension of the relativity principle by avoiding the assumption that there is a privileged scale at which biological functions are determined.
Collapse
Affiliation(s)
- Denis Noble
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford OX1 3PT, UK
| |
Collapse
|
14
|
Kanaan-Izquierdo S, Velazquez S, Benitez R. Identification of nonlinear cardiac cell dynamics using radial basis function regression. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:6833-6. [PMID: 22255908 DOI: 10.1109/iembs.2011.6091685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a novel method for the identification of the dynamics of physiological cardiac cell models. The main aim of the technique is to improve the computational efficiency of large-scale simulations of the electrical activity of the heart. The method identifies the dynamical attractor of a detailed physiological model using statistical learning techniques. In particular, a radial basis function regression method is used to capture the intrinsic dynamical features of the model, thus reducing the computational cost to quantitatively generate cardiac action potentials in a wide range of pacing conditions. The approach permits to recover key properties such as the action potential morphology and duration in a wide range of pacing frequencies.
Collapse
Affiliation(s)
- Samir Kanaan-Izquierdo
- Department of Software, Universitat Politecnica de Catalunya, Comte Urgell 187, 08036 Barcelona, Spain.
| | | | | |
Collapse
|
15
|
Camara O, Sermesant M, Lamata P, Wang L, Pop M, Relan J, De Craene M, Delingette H, Liu H, Niederer S, Pashaei A, Plank G, Romero D, Sebastian R, Wong KCL, Zhang H, Ayache N, Frangi AF, Shi P, Smith NP, Wright GA. Inter-model consistency and complementarity: learning from ex-vivo imaging and electrophysiological data towards an integrated understanding of cardiac physiology. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:122-33. [PMID: 21791225 DOI: 10.1016/j.pbiomolbio.2011.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 11/27/2022]
Abstract
Computational models of the heart at various scales and levels of complexity have been independently developed, parameterised and validated using a wide range of experimental data for over four decades. However, despite remarkable progress, the lack of coordinated efforts to compare and combine these computational models has limited their impact on the numerous open questions in cardiac physiology. To address this issue, a comprehensive dataset has previously been made available to the community that contains the cardiac anatomy and fibre orientations from magnetic resonance imaging as well as epicardial transmembrane potentials from optical mapping measured on a perfused ex-vivo porcine heart. This data was used to develop and customize four models of cardiac electrophysiology with different level of details, including a personalized fast conduction Purkinje system, a maximum a posteriori estimation of the 3D distribution of transmembrane potential, the personalization of a simplified reaction-diffusion model, and a detailed biophysical model with generic conduction parameters. This study proposes the integration of these four models into a single modelling and simulation pipeline, after analyzing their common features and discrepancies. The proposed integrated pipeline demonstrates an increase prediction power of depolarization isochrones in different pacing conditions.
Collapse
Affiliation(s)
- O Camara
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Universitat Pompeu Fabra, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Clayton RH, Nash MP, Bradley CP, Panfilov AV, Paterson DJ, Taggart P. Experiment-model interaction for analysis of epicardial activation during human ventricular fibrillation with global myocardial ischaemia. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2011; 107:101-11. [PMID: 21741985 DOI: 10.1016/j.pbiomolbio.2011.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 06/22/2011] [Indexed: 11/25/2022]
Abstract
We describe a combined experiment-modelling framework to investigate the effects of ischaemia on the organisation of ventricular fibrillation in the human heart. In a series of experimental studies epicardial activity was recorded from 10 patients undergoing routine cardiac surgery. Ventricular fibrillation was induced by burst pacing, and recording continued during 2.5 min of global cardiac ischaemia followed by 30 s of coronary reflow. Modelling used a 2D description of human ventricular tissue. Global cardiac ischaemia was simulated by (i) decreased intracellular ATP concentration and subsequent activation of an ATP sensitive K⁺ current, (ii) elevated extracellular K⁺ concentration, and (iii) acidosis resulting in reduced magnitude of the L-type Ca²⁺ current I(Ca,L). Simulated ischaemia acted to shorten action potential duration, reduce conduction velocity, increase effective refractory period, and flatten restitution. In the model, these effects resulted in slower re-entrant activity that was qualitatively consistent with our observations in the human heart. However, the flattening of restitution also resulted in the collapse of many re-entrant waves to several stable re-entrant waves, which was different to the overall trend we observed in the experimental data. These findings highlight a potential role for other factors, such as structural or functional heterogeneity in sustaining wavebreak during human ventricular fibrillation with global myocardial ischaemia.
Collapse
Affiliation(s)
- R H Clayton
- Department of Computer Science, University of Sheffield, Regent Court, 211 Portobello S14DP, UK.
| | | | | | | | | | | |
Collapse
|
17
|
Modeling and Registration for Electrophysiology Procedures Based on Three-Dimensional Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2011. [DOI: 10.1007/s12410-011-9067-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Relan J, Pop M, Delingette H, Wright GA, Ayache N, Sermesant M. Personalization of a cardiac electrophysiology model using optical mapping and MRI for prediction of changes with pacing. IEEE Trans Biomed Eng 2011; 58:3339-49. [PMID: 21257368 DOI: 10.1109/tbme.2011.2107513] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Computer models of cardiac electrophysiology (EP) can be a very efficient tool to better understand the mechanisms of arrhythmias. Quantitative adjustment of such models to experimental data (personalization) is needed in order to test their realism and predictive power, but it remains challenging at the organ scale. In this paper, we propose a framework for the personalization of a 3-D cardiac EP model, the Mitchell-Schaeffer (MS) model, and evaluate its volumetric predictive power under various pacing scenarios. The personalization was performed on ex vivo large porcine healthy hearts using diffusion tensor MRI (DT-MRI) and optical mapping data. The MS model was simulated on a 3-D mesh incorporating local fiber orientations, built from DT-MRI. The 3-D model parameters were optimized using features such as 2-D epicardial depolarization and repolarization maps, extracted from the optical mapping. We also evaluated the sensitivity of our personalization framework to different pacing locations and showed results on its robustness. Further, we evaluated volumetric model predictions for various epi- and endocardial pacing scenarios. We demonstrated promising results with a mean personalization error around 5 ms and a mean prediction error around 10 ms (5% of the total depolarization time). Finally, we discussed the potential translation of such work to clinical data and pathological hearts.
Collapse
Affiliation(s)
- Jatin Relan
- Inria, Asclepios team, Sophia-Antipolis, 06902 France.
| | | | | | | | | | | |
Collapse
|
19
|
Majumder D, Mukherjee A. A passage through systems biology to systems medicine: adoption of middle-out rational approaches towards the understanding of therapeutic outcomes in cancer. Analyst 2011; 136:663-78. [DOI: 10.1039/c0an00746c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
20
|
de Boer TP, Camelliti P, Ravens U, Kohl P. Myocardial tissue slices: organotypic pseudo-2D models for cardiac research & development. Future Cardiol 2010; 5:425-30. [PMID: 19715406 DOI: 10.2217/fca.09.32] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
21
|
|
22
|
The systems biology approach to drug development: application to toxicity assessment of cardiac drugs. Clin Pharmacol Ther 2010; 88:130-4. [PMID: 20520607 DOI: 10.1038/clpt.2010.95] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Side effects account for most of the instances of failure of candidate drugs at late stages of development. These development failures contribute to the exorbitant cost of bringing new compounds to market: a single withdrawal can represent a loss of more than $1 billion. Many unwanted actions of drugs affect the heart, resulting in potentially proarrhythmic alteration of ion channel function. Because these can be fatal, potential electrophysiological cardiotoxicity is among the most stringent exclusion criteria in the licensing process.
Collapse
|
23
|
Noble D. Biophysics and systems biology. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:1125-39. [PMID: 20123750 PMCID: PMC3263808 DOI: 10.1098/rsta.2009.0245] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Biophysics at the systems level, as distinct from molecular biophysics, acquired its most famous paradigm in the work of Hodgkin and Huxley, who integrated their equations for the nerve impulse in 1952. Their approach has since been extended to other organs of the body, notably including the heart. The modern field of computational biology has expanded rapidly during the first decade of the twenty-first century and, through its contribution to what is now called systems biology, it is set to revise many of the fundamental principles of biology, including the relations between genotypes and phenotypes. Evolutionary theory, in particular, will require re-assessment. To succeed in this, computational and systems biology will need to develop the theoretical framework required to deal with multilevel interactions. While computational power is necessary, and is forthcoming, it is not sufficient. We will also require mathematical insight, perhaps of a nature we have not yet identified. This article is therefore also a challenge to mathematicians to develop such insights.
Collapse
Affiliation(s)
- Denis Noble
- Department of Physiology, Anatomy and Genetics, University of Oxford, , Parks Road, Oxford OX1 3PT, UK.
| |
Collapse
|
24
|
|
25
|
Plank G, Burton RAB, Hales P, Bishop M, Mansoori T, Bernabeu MO, Garny A, Prassl AJ, Bollensdorff C, Mason F, Mahmood F, Rodriguez B, Grau V, Schneider JE, Gavaghan D, Kohl P. Generation of histo-anatomically representative models of the individual heart: tools and application. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2009; 367:2257-92. [PMID: 19414455 PMCID: PMC2881535 DOI: 10.1098/rsta.2009.0056] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper presents methods to build histo-anatomically detailed individualized cardiac models. The models are based on high-resolution three-dimensional anatomical and/or diffusion tensor magnetic resonance images, combined with serial histological sectioning data, and are used to investigate individualized cardiac function. The current state of the art is reviewed, and its limitations are discussed. We assess the challenges associated with the generation of histo-anatomically representative individualized in silico models of the heart. The entire processing pipeline including image acquisition, image processing, mesh generation, model set-up and execution of computer simulations, and the underlying methods are described. The multifaceted challenges associated with these goals are highlighted, suitable solutions are proposed, and an important application of developed high-resolution structure-function models in elucidating the effect of individual structural heterogeneity upon wavefront dynamics is demonstrated.
Collapse
Affiliation(s)
- Gernot Plank
- Computational Biology Group, University of Oxford, Oxford OX1 2JD, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Abstract
The heart automaticity is a fundamental physiological function in higher organisms. The spontaneous activity is initiated by specialized populations of cardiac cells generating periodical electrical oscillations. The exact cascade of steps initiating the pacemaker cycle in automatic cells has not yet been entirely elucidated. Nevertheless, ion channels and intracellular Ca(2+) signaling are necessary for the proper setting of the pacemaker mechanism. Here, we review the current knowledge on the cellular mechanisms underlying the generation and regulation of cardiac automaticity. We discuss evidence on the functional role of different families of ion channels in cardiac pacemaking and review recent results obtained on genetically engineered mouse strains displaying dysfunction in heart automaticity. Beside ion channels, intracellular Ca(2+) release has been indicated as an important mechanism for promoting automaticity at rest as well as for acceleration of the heart rate under sympathetic nerve input. The potential links between the activity of ion channels and Ca(2+) release will be discussed with the aim to propose an integrated framework of the mechanism of automaticity.
Collapse
Affiliation(s)
- Matteo E Mangoni
- Institute of Functional Genomics, Department of Physiology, Centre National de la Recherche Scientifique UMR5203, INSERM U661, University of Montpellier I and II, Montpellier, France.
| | | |
Collapse
|
28
|
Meir A, McNally DS, Fairbank JC, Jones D, Urban JP. The internal pressure and stress environment of the scoliotic intervertebral disc — a review. Proc Inst Mech Eng H 2008; 222:209-19. [DOI: 10.1243/09544119jeim303] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aetiology, in terms of both initiation and progression, of the deformity in idiopathic scoliosis is at present unclear. Even in neuromuscular cases, the mechanisms underlying progression are not fully elucidated. It is thought, however, that asymmetrical loading is involved in the progression of the disease, with evidence mainly from animal studies and modelling. There is, however, very little direct information as to the origin or mechanism of action of these forces in the scoliotic spine. This review describes the concept of intervertebral disc pressure or stress and examines possible measurement techniques. The biological and mechanical consequences of abnormalities in these parameters are described. Future possible studies and their clinical significance are also briefly discussed.Techniques of pressure measurement have culminated in the development of ‘pressure profilometry’, which provides stress profiles across the disc in mutually perpendicular axes. A hydrated intervertebral disc exhibits mainly hydrostatic behaviour. However, in pathological states such as degeneration and scoliosis, non-hydrostatic behaviour predominates and annular peaks of stress occur. Recent studies have shown that, in scoliosis, high hydrostatic pressures are seen with asymmetrical stresses from concave to convex sides. These abnormalities could influence both disc and endplate cellular activity directly, causing asymmetrical growth and matrix changes. In addition, disc cells could be influenced via nutritional changes consequent to end-plate calcification.Evidence suggests that the stress environment of the scoliotic disc is abnormal, probably generated by high and asymmetrical loading of non-muscular origin. If present in the scoliotic spine during daily activities, this could generate a positive feedback of cellular changes, resulting in curve progression. Future advances in understanding may rely on the development of computer models owing to the difficulties of in-vivo invasive measurements.
Collapse
Affiliation(s)
- A Meir
- Nuffield Department of Orthopaedic Surgery, Oxford, UK
| | - D S McNally
- Physiology Laboratory, Oxford University, Oxford, UK
| | - J C Fairbank
- Nuffield Department of Orthopaedic Surgery, Oxford, UK
| | - D Jones
- Nuffield Department of Orthopaedic Surgery, Oxford, UK
| | - J P Urban
- Institute of Biomechanics, University of Nottingham, Nottingham, UK
| |
Collapse
|
29
|
Kirschner DE, Chang ST, Riggs TW, Perry N, Linderman JJ. Toward a multiscale model of antigen presentation in immunity. Immunol Rev 2007; 216:93-118. [PMID: 17367337 DOI: 10.1111/j.1600-065x.2007.00490.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A functioning immune system and the process of antigen presentation in particular encompass events that occur at multiple length and time scales. Despite a wealth of information in the biological literature regarding each of these scales, no single representation synthesizing this information into a model of the overall immune response as it depends on antigen presentation is available. In this article, we outline an approach for integrating information over relevant biological and temporal scales to generate such a representation for major histocompatibility complex class II-mediated antigen presentation. In addition, we begin to address how such models can be used to answer questions about mechanisms of infection and new strategies for treatment and vaccines.
Collapse
Affiliation(s)
- Denise E Kirschner
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | | | | | | | | |
Collapse
|
30
|
Bauer S, Röder G, Bär M. Alternans and the influence of ionic channel modifications: Cardiac three-dimensional simulations and one-dimensional numerical bifurcation analysis. CHAOS (WOODBURY, N.Y.) 2007; 17:015104. [PMID: 17411261 DOI: 10.1063/1.2715668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Cardiac propagation is investigated by simulations using a realistic three-dimensional (3D) geometry including muscle fiber orientation of the ventricles of a rabbit heart and the modified Beeler-Reuter ionic model. Electrical excitation is introduced by a periodic pacing of the lower septum. Depending on the pacing frequency, qualitatively different dynamics are observed, namely, normal heart beat, T-wave alternans, and 2:1 conduction block at small, intermediate, and large pacing frequencies, respectively. In a second step, we performed a numerical stability and bifurcation analysis of a pulse propagating in a one-dimensional (1D) ring of cardiac tissue. The precise onset of the alternans instability is obtained from computer-assisted linear stability analysis of the pulse and computation of the associated spectrum. The critical frequency at the onset of alternans and the profiles of the membrane potential agree well with the ones obtained in the 3D simulations. Next, we computed changes in the wave profiles and in the onset of alternans for the Beeler-Reuter model with modifications of the sodium, calcium, and potassium channels, respectively. For this purpose, we employ the method of numerical bifurcation and stability analysis. While blocking of calcium channels has a stabilizing effect, blocked sodium or potassium channels lead to the occurrence of alternans at lower pacing frequencies. The findings regarding channel blocking are verified within three-dimensional simulations. Altogether, we have found T-wave alternans and conduction block in 3D simulations of a realistic rabbit heart geometry. The onset of alternans has been analyzed by numerical bifurcation and stability analysis of 1D wave trains. By comparing the results of the two approaches, we find that alternans is not strongly influenced by ingredients such as 3D geometry and propagation anisotropy, but depends mostly on the frequency of pacing (frequency of subsequent action potentials). In addition, we have introduced numerical bifurcation and stability analysis as a tool into heart modeling and demonstrated its efficiency in scanning a large set of parameters in the case of models with reduced conductivity. Bifurcation analysis also provides an accurate test for analytical theories of alternans as is demonstrated for the case of the restitution hypothesis.
Collapse
Affiliation(s)
- S Bauer
- Physikalisch-Technische Bundesanstalt Berlin, Abbestr. 2-12, 10587 Berlin, Germany
| | | | | |
Collapse
|
31
|
Dumotier BM, Georgieva AV. Preclinical cardio-safety assessment of torsadogenic risk and alternative methods to animal experimentation: The inseparable twins. Cell Biol Toxicol 2007; 23:293-302. [PMID: 17216548 DOI: 10.1007/s10565-006-0882-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/29/2006] [Indexed: 11/25/2022]
Abstract
The last decade has been marked by the withdrawal from the market of several medicines whose use in patients has been associated with the development of torsade de pointes (TdP), a potentially life-threatening polymorphic tachycardia. In a few cases, TdP can degenerate into ventricular fibrillation and lead to sudden death, thus constituting a real problem of public health. The recently finalized ICH S7B guideline defines the prolongation of the QT interval on the electrocardiogram as the best biomarker for predicting the torsadogenic risk of a given compound. However, a growing body of evidence suggests that drugs' torsadogenic potential may not necessarily be proportional to their ability to prolong the QT interval. It is a dynamic combination of multiple predisposing factors and components rather than a single particular event that can trigger this particular tachycardia. Following recommendations of the guideline, pharmaceutical companies have intensively implemented methodologies to assess the possible risk of QT prolongation and TdP in humans. The main problem in cardiac safety pharmacology is how best to combine the capabilities of different methodologies with their strengths and limitations in order to detect the potential of one molecular entity to induce a lethal arrhythmia of very low clinical incidence. This publication will review the current methodologies, focusing on the alternative methods to animal experimentation, including an overview of cardiac modeling.
Collapse
Affiliation(s)
- B M Dumotier
- Novartis Pharma AG, Development, Safety Profiling & Assessment, Safety Pharmacology, Basel, Switzerland.
| | | |
Collapse
|
32
|
Yoneyama M, Nakayama Y, Kawahara K. Coupling between contraction rhythm and calcium oscillation in a cultured cardiac myocyte: Fluctuation behaviour and its modelling. BIOL RHYTHM RES 2006. [DOI: 10.1080/09291010500288731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mitsuru Yoneyama
- a Research Institute for Electronic Science , Hokkaido University , Sapporo, 060-0812, Japan , Mitsubishi Chemical Group, Science and Technology Research Centre, Inc., Yokohama, 227-8502, Japan , CREST, JST, Japan
| | - Yukako Nakayama
- b Graduate School of Information Science and Technology , Hokkaido University , Sapporo, 060-0814, Japan
| | - Koichi Kawahara
- b Graduate School of Information Science and Technology , Hokkaido University , Sapporo, 060-0814, Japan
| |
Collapse
|
33
|
Gavaghan D, Garny A, Maini PK, Kohl P. Mathematical models in physiology. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2006; 364:1099-106. [PMID: 16608698 DOI: 10.1098/rsta.2006.1757] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Computational modelling of biological processes and systems has witnessed a remarkable development in recent years. The search-term (modelling OR modeling) yields over 58000 entries in PubMed, with more than 34000 since the year 2000: thus, almost two-thirds of papers appeared in the last 5-6 years, compared to only about one-third in the preceding 5-6 decades. The development is fuelled both by the continuously improving tools and techniques available for bio-mathematical modelling and by the increasing demand in quantitative assessment of element inter-relations in complex biological systems. This has given rise to a worldwide public domain effort to build a computational framework that provides a comprehensive theoretical representation of integrated biological function-the Physiome. The current and next issues of this journal are devoted to a small sub-set of this initiative and address biocomputation and modelling in physiology, illustrating the breadth and depth of experimental data-based model development in biological research from sub-cellular events to whole organ simulations.
Collapse
Affiliation(s)
- David Gavaghan
- Oxford University Computing Laboratory, Wolfson Building, Parks Road, Oxford OX1 3QD, UK.
| | | | | | | |
Collapse
|
34
|
Kohl P, Bollensdorff C, Garny A. Effects of mechanosensitive ion channels on ventricular electrophysiology: experimental and theoretical models. Exp Physiol 2006; 91:307-21. [PMID: 16407474 DOI: 10.1113/expphysiol.2005.031062] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The heart is an electrically driven mechanical pump, somewhat like an electric motor. Interestingly, like an electric motor in 'dynamo mode', the heart can also convert mechanical stimuli into electrical signals. This feedback from cardiac mechanics to electrical activity involves mechanosensitive ion channels, whose properties and pathophysiological relevance are reviewed in the context of experimental and theoretical modelling of ventricular beat-by-beat electromechanical function.
Collapse
Affiliation(s)
- Peter Kohl
- The Cardiac Mechano-Electric Feedback Group, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, UK.
| | | | | |
Collapse
|