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Fumagalli I, Pagani S, Vergara C, Dede’ L, Adebo DA, Del Greco M, Frontera A, Luciani GB, Pontone G, Scrofani R, Quarteroni A. The role of computational methods in cardiovascular medicine: a narrative review. Transl Pediatr 2024; 13:146-163. [PMID: 38323181 PMCID: PMC10839285 DOI: 10.21037/tp-23-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
Background and Objective Computational models of the cardiovascular system allow for a detailed and quantitative investigation of both physiological and pathological conditions, thanks to their ability to combine clinical-possibly patient-specific-data with physical knowledge of the processes underlying the heart function. These models have been increasingly employed in clinical practice to understand pathological mechanisms and their progression, design medical devices, support clinicians in improving therapies. Hinging upon a long-year experience in cardiovascular modeling, we have recently constructed a computational multi-physics and multi-scale integrated model of the heart for the investigation of its physiological function, the analysis of pathological conditions, and to support clinicians in both diagnosis and treatment planning. This narrative review aims to systematically discuss the role that such model had in addressing specific clinical questions, and how further impact of computational models on clinical practice are envisaged. Methods We developed computational models of the physical processes encompassed by the heart function (electrophysiology, electrical activation, force generation, mechanics, blood flow dynamics, valve dynamics, myocardial perfusion) and of their inherently strong coupling. To solve the equations of such models, we devised advanced numerical methods, implemented in a flexible and highly efficient software library. We also developed computational procedures for clinical data post-processing-like the reconstruction of the heart geometry and motion from diagnostic images-and for their integration into computational models. Key Content and Findings Our integrated computational model of the heart function provides non-invasive measures of indicators characterizing the heart function and dysfunctions, and sheds light on its underlying processes and their coupling. Moreover, thanks to the close collaboration with several clinical partners, we addressed specific clinical questions on pathological conditions, such as arrhythmias, ventricular dyssynchrony, hypertrophic cardiomyopathy, degeneration of prosthetic valves, and the way coronavirus disease 2019 (COVID-19) infection may affect the cardiac function. In multiple cases, we were also able to provide quantitative indications for treatment. Conclusions Computational models provide a quantitative and detailed tool to support clinicians in patient care, which can enhance the assessment of cardiac diseases, the prediction of the development of pathological conditions, and the planning of treatments and follow-up tests.
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Affiliation(s)
- Ivan Fumagalli
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Stefano Pagani
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Christian Vergara
- Laboratory of Biological Structures Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Luca Dede’
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Dilachew A. Adebo
- Children’s Heart Institute, Hermann Children’s Hospital, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - Maurizio Del Greco
- Department of Cardiology, S. Maria del Carmine Hospital, Rovereto, Italy
| | - Antonio Frontera
- Electrophysiology Department, De Gasperis Cardio Center, ASST Great Metropolitan Hospital Niguarda, Milan, Italy
| | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCSS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Roberto Scrofani
- Cardiovascular Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfio Quarteroni
- MOX Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Switzerland
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Zingaro A, Bucelli M, Fumagalli I, Dede' L, Quarteroni A. Modeling isovolumetric phases in cardiac flows by an Augmented Resistive Immersed Implicit Surface method. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3767. [PMID: 37615375 DOI: 10.1002/cnm.3767] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 06/05/2023] [Accepted: 07/30/2023] [Indexed: 08/25/2023]
Abstract
A major challenge in the computational fluid dynamics modeling of the heart function is the simulation of isovolumetric phases when the hemodynamics problem is driven by a prescribed boundary displacement. During such phases, both atrioventricular and semilunar valves are closed: consequently, the ventricular pressure may not be uniquely defined, and spurious oscillations may arise in numerical simulations. These oscillations can strongly affect valve dynamics models driven by the blood flow, making unlikely to recovering physiological dynamics. Hence, prescribed opening and closing times are usually employed, or the isovolumetric phases are neglected altogether. In this article, we propose a suitable modification of the Resistive Immersed Implicit Surface (RIIS) method (Fedele et al., Biomech Model Mechanobiol 2017, 16, 1779-1803) by introducing a reaction term to correctly capture the pressure transients during isovolumetric phases. The method, that we call Augmented RIIS (ARIIS) method, extends the previously proposed ARIS method (This et al., Int J Numer Methods Biomed Eng 2020, 36, e3223) to the case of a mesh which is not body-fitted to the valves. We test the proposed method on two different benchmark problems, including a new simplified problem that retains all the characteristics of a heart cycle. We apply the ARIIS method to a fluid dynamics simulation of a realistic left heart geometry, and we show that ARIIS allows to correctly simulate isovolumetric phases, differently from standard RIIS method. Finally, we demonstrate that by the new method the cardiac valves can open and close without prescribing any opening/closing times.
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Affiliation(s)
- Alberto Zingaro
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- ELEM Biotech S.L., Barcelona, Spain
| | - Michele Bucelli
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Ivan Fumagalli
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Luca Dede'
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Laboratory of Modeling and Scientific Computing, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Bucelli M, Zingaro A, Africa PC, Fumagalli I, Dede' L, Quarteroni A. A mathematical model that integrates cardiac electrophysiology, mechanics, and fluid dynamics: Application to the human left heart. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3678. [PMID: 36579792 DOI: 10.1002/cnm.3678] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
We propose a mathematical and numerical model for the simulation of the heart function that couples cardiac electrophysiology, active and passive mechanics and hemodynamics, and includes reduced models for cardiac valves and the circulatory system. Our model accounts for the major feedback effects among the different processes that characterize the heart function, including electro-mechanical and mechano-electrical feedback as well as force-strain and force-velocity relationships. Moreover, it provides a three-dimensional representation of both the cardiac muscle and the hemodynamics, coupled in a fluid-structure interaction (FSI) model. By leveraging the multiphysics nature of the problem, we discretize it in time with a segregated electrophysiology-force generation-FSI approach, allowing for efficiency and flexibility in the numerical solution. We employ a monolithic approach for the numerical discretization of the FSI problem. We use finite elements for the spatial discretization of partial differential equations. We carry out a numerical simulation on a realistic human left heart model, obtaining results that are qualitatively and quantitatively in agreement with physiological ranges and medical images.
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Affiliation(s)
- Michele Bucelli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alberto Zingaro
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Luca Dede'
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Karabelas E, Longobardi S, Fuchsberger J, Razeghi O, Rodero C, Strocchi M, Rajani R, Haase G, Plank G, Niederer S. Global Sensitivity Analysis of Four Chamber Heart Hemodynamics Using Surrogate Models. IEEE Trans Biomed Eng 2022; 69:3216-3223. [PMID: 35353691 PMCID: PMC9491017 DOI: 10.1109/tbme.2022.3163428] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/19/2022] [Indexed: 11/15/2022]
Abstract
Computational Fluid Dynamics (CFD) is used to assist in designing artificial valves and planning procedures, focusing on local flow features. However, assessing the impact on overall cardiovascular function or predicting longer-term outcomes may requires more comprehensive whole heart CFD models. Fitting such models to patient data requires numerous computationally expensive simulations, and depends on specific clinical measurements to constrain model parameters, hampering clinical adoption. Surrogate models can help to accelerate the fitting process while accounting for the added uncertainty. We create a validated patient-specific four-chamber heart CFD model based on the Navier-Stokes-Brinkman (NSB) equations and test Gaussian Process Emulators (GPEs) as a surrogate model for performing a variance-based global sensitivity analysis (GSA). GSA identified preload as the dominant driver of flow in both the right and left side of the heart, respectively. Left-right differences were seen in terms of vascular outflow resistances, with pulmonary artery resistance having a much larger impact on flow than aortic resistance. Our results suggest that GPEs can be used to identify parameters in personalized whole heart CFD models, and highlight the importance of accurate preload measurements.
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Affiliation(s)
- Elias Karabelas
- Institute of Mathematics and Scientific ComputingUniversity of GrazAustria
| | - Stefano Longobardi
- Cardiac Electromechanics Research Group, School of Biomedical Engineering and Imaging SciencesKing’s College LondonU.K.
| | - Jana Fuchsberger
- Institute of Mathematics and Scientific ComputingUniversity of GrazAustria
| | - Orod Razeghi
- Research IT Services DepartmentUniversity College LondonU.K.
| | - Cristobal Rodero
- Cardiac Electromechanics Research Group, School of Biomedical Engineering and Imaging SciencesKing’s College LondonU.K.
| | - Marina Strocchi
- Cardiac Electromechanics Research Group, School of Biomedical Engineering and Imaging SciencesKing’s College LondonU.K.
| | - Ronak Rajani
- Department of Adult EchocardiographyGuy’s and St Thomas’ Hospitals NHS Foundation TrustU.K.
| | - Gundolf Haase
- Institute of Mathematics and Scientific ComputingUniversity of GrazAustria
| | - Gernot Plank
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Division BiophysicsMedical University of GrazAustria
| | - Steven Niederer
- Cardiac Electromechanics Research Group, School of Biomedical Engineering and Imaging SciencesKing’s College LondonSE1 7EHLondonU.K.
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