Reduced left ventricular dynamics modeling based on a cylindrical assumption.

Biomechanical modeling and simulation is expected to play a significant role in the development of the next generation tools in many fields of medicine. However, full-order finite element models of complex organs such as the heart can be computationally very expensive, thus limiting their practical usability. Therefore, reduced models are much valuable to be used, for example, for pre-calibration of full-order models, fast predictions, real-time applications, and so forth. In this work, focused on the left ventricle, we develop a reduced model by defining reduced geometry & kinematics while keeping general motion and behavior laws, allowing to derive a reduced model where all variables & parameters have a strong physical meaning. More specifically, we propose a reduced ventricular model based on cylindrical geometry & kinematics, which allows to describe the myofiber orientation through the ventricular wall and to represent contraction patterns such as ventricular twist, two important features of ventricular mechanics. Our model is based on the original cylindrical model of Guccione, McCulloch, & Waldman (1991); Guccione, Waldman, & McCulloch (1993), albeit with multiple differences: we propose a fully dynamical formulation, integrated into an open-loop lumped circulation model, and based on a material behavior that incorporates a fine description of contraction mechanisms; moreover, the issue of the cylinder closure has been completely reformulated; our numerical approach is novel aswell, with consistent spatial (finite element) and time discretizations. Finally, we analyze the sensitivity of the model response to various numerical and physical parameters, and study its physiological response.

Using a population-based Kalman estimator to model the COVID-19 epidemic in France: estimating associations between disease transmission and non-pharmaceutical interventions.

In response to the COVID-19 pandemic caused by SARS-CoV-2, governments have adopted a wide range of non-pharmaceutical interventions (NPI). These include stringent measures such as strict lockdowns, closing schools, bars and restaurants, curfews, and barrier gestures such as mask-wearing and social distancing. Deciphering the effectiveness of each NPI is critical to responding to future waves and outbreaks. To this end, we first develop a dynamic model of the French COVID-19 epidemics over a one-year period. We rely on a global extended Susceptible-Infectious-Recovered (SIR) mechanistic model of infection that includes a dynamic transmission rate over time. Multilevel data across French regions are integrated using random effects on the parameters of the mechanistic model, boosting statistical power by multiplying integrated observation series. We estimate the parameters using a new population-based statistical approach based on a Kalman filter, used for the first time in analysing real-world data. We then fit the estimated time-varying transmission rate using a regression model that depends on the NPIs while accounting for vaccination coverage, the occurrence of variants of concern (VoC), and seasonal weather conditions. We show that all NPIs considered have an independent significant association with transmission rates. In addition, we show a strong association between weather conditions that reduces transmission in summer, and we also estimate increased transmissibility of VoC.

In-silico study of accuracy and precision of left-ventricular strain quantification from 3D tagged MRI.

Cardiac Magnetic Resonance Imaging (MRI) allows quantifying myocardial tissue deformation and strain based on the tagging principle. In this work, we investigate accuracy and precision of strain quantification from synthetic 3D tagged MRI using equilibrated warping. To this end, synthetic biomechanical left-ventricular tagged MRI data with varying tag distance, spatial resolution and signal-to-noise ratio (SNR) were generated and processed to quantify errors in radial, circumferential and longitudinal strains relative to ground truth. Results reveal that radial strain is more sensitive to image resolution and noise than the other strain components. The study also shows robustness of quantifying circumferential and longitudinal strain in the presence of geometrical inconsistencies of 3D tagged data. In conclusion, our study points to the need for higher-resolution 3D tagged MRI than currently available in practice in order to achieve sufficient accuracy of radial strain quantification.

Biomechanical Modeling to Inform Pulmonary Valve Replacement in Tetralogy of Fallot Patients After Complete Repair.

BACKGROUND: A biomechanical model of the heart can be used to incorporate multiple data sources (electrocardiography, imaging, invasive hemodynamics). The purpose of this study was to use this approach in a cohort of patients with tetralogy of Fallot after complete repair (rTOF) to assess comparative influences of residual right ventricular outflow tract obstruction (RVOTO) and pulmonary regurgitation on ventricular health. METHODS: Twenty patients with rTOF who underwent percutaneous pulmonary valve replacement (PVR) and cardiovascular magnetic resonance imaging were included in this retrospective study. Biomechanical models specific to individual patient and physiology (before and after PVR) were created and used to estimate the RV myocardial contractility. The ability of models to capture post-PVR changes of right ventricular (RV) end-diastolic volume (EDV) and effective flow in the pulmonary artery (Qeff) was also compared with expected values. RESULTS: RV contractility before PVR (mean 66 ± 16 kPa, mean ± standard deviation) was increased in patients with rTOF compared with normal RV (38-48 kPa) (P < 0.05). The contractility decreased significantly in all patients after PVR (P < 0.05). Patients with predominantly RVOTO demonstrated greater reduction in contractility (median decrease 35%) after PVR than those with predominant pulmonary regurgitation (median decrease 11%). The model simulated post-PVR decreased EDV for the majority and suggested an increase of Qeff-both in line with published data. CONCLUSIONS: This study used a biomechanical model to synthesize multiple clinical inputs and give an insight into RV health. Individualized modeling allows us to predict the RV response to PVR. Initial data suggest that residual RVOTO imposes greater ventricular work than isolated pulmonary regurgitation.

Combining data assimilation and machine learning to build data-driven models for unknown long time dynamics-Applications in cardiovascular modeling.

We propose a method to discover differential equations describing the long-term dynamics of phenomena featuring a multiscale behavior in time, starting from measurements taken at the fast-scale. Our methodology is based on a synergetic combination of data assimilation (DA), used to estimate the parameters associated with the known fast-scale dynamics, and machine learning (ML), used to infer the laws underlying the slow-scale dynamics. Specifically, by exploiting the scale separation between the fast and the slow dynamics, we propose a decoupling of time scales that allows to drastically lower the computational burden. Then, we propose a ML algorithm that learns a parametric mathematical model from a collection of time series coming from the phenomenon to be modeled. Moreover, we study the interpretability of the data-driven models obtained within the black-box learning framework proposed in this paper. In particular, we show that every model can be rewritten in infinitely many different equivalent ways, thus making intrinsically ill-posed the problem of learning a parametric differential equation starting from time series. Hence, we propose a strategy that allows to select a unique representative model in each equivalence class, thus enhancing the interpretability of the results. We demonstrate the effectiveness and noise-robustness of the proposed methods through several test cases, in which we reconstruct several differential models starting from time series generated through the models themselves. Finally, we show the results obtained for a test case in the cardiovascular modeling context, which sheds light on a promising field of application of the proposed methods.

A flexible framework for sequential estimation of model parameters in computational hemodynamics.

A major challenge in constructing three dimensional patient specific hemodynamic models is the calibration of model parameters to match patient data on flow, pressure, wall motion, etc. acquired in the clinic. Current workflows are manual and time-consuming. This work presents a flexible computational framework for model parameter estimation in cardiovascular flows that relies on the following fundamental contributions. (i) A Reduced-Order Unscented Kalman Filter (ROUKF) model for data assimilation for wall material and simple lumped parameter network (LPN) boundary condition model parameters. (ii) A constrained least squares augmentation (ROUKF-CLS) for more complex LPNs. (iii) A "Netlist" implementation, supporting easy filtering of parameters in such complex LPNs. The ROUKF algorithm is demonstrated using non-invasive patient-specific data on anatomy, flow and pressure from a healthy volunteer. The ROUKF-CLS algorithm is demonstrated using synthetic data on a coronary LPN. The methods described in this paper have been implemented as part of the CRIMSON hemodynamics software package.

Dobutamine stress testing in patients with Fontan circulation augmented by biomechanical modeling.

Understanding (patho)physiological phenomena and mechanisms of failure in patients with Fontan circulation-a surgically established circulation for patients born with a functionally single ventricle-remains challenging due to the complex hemodynamics and high inter-patient variations in anatomy and function. In this work, we present a biomechanical model of the heart and circulation to augment the diagnostic evaluation of Fontan patients with early-stage heart failure. The proposed framework employs a reduced-order model of heart coupled with a simplified circulation including venous return, creating a closed-loop system. We deploy this framework to augment the information from data obtained during combined cardiac catheterization and magnetic resonance exams (XMR), performed at rest and during dobutamine stress in 9 children with Fontan circulation and 2 biventricular controls. We demonstrate that our modeling framework enables patient-specific investigation of myocardial stiffness, contractility at rest, contractile reserve during stress and changes in vascular resistance. Hereby, the model allows to identify key factors underlying the pathophysiological response to stress in these patients. In addition, the rapid personalization of the model to patient data and fast simulation of cardiac cycles make our framework directly applicable in a clinical workflow. We conclude that the proposed modeling framework is a valuable addition to the current clinical diagnostic XMR exam that helps to explain patient-specific stress hemodynamics and can identify potential mechanisms of failure in patients with Fontan circulation.

Stochastic modeling of chemical-mechanical coupling in striated muscles.

We propose a chemical-mechanical model of myosin heads in sarcomeres, within the classical description of rigid sliding filaments. In our case, myosin heads have two mechanical degrees-of-freedom (dofs)-one of which associated with the so-called power stroke-and two possible chemical states, i.e., bound to an actin site or not. Our major motivations are twofold: (1) to derive a multiscale coupled chemical-mechanical model and (2) to thus account-at the macroscopic scale-for mechanical phenomena that are out of reach for classical muscle models. This model is first written in the form of Langevin stochastic equations, and we are then able to obtain the corresponding Fokker-Planck partial differential equations governing the probability density functions associated with the mechanical dofs and chemical states. This second form is important, as it allows to monitor muscle energetics and also to compare our model with classical ones, such as the Huxley'57 model to which our equations are shown to reduce under two different types of simplifying assumptions. This provides insight and gives a Langevin form for Huxley'57. We then show how we can calibrate our model based on experimental data-taken here for skeletal muscles-and numerical simulations demonstrate the adequacy of the model to represent complex physiological phenomena, in particular the fast isometric transients in which the power stroke is known to have a crucial role, thus circumventing a limitation of many classical models.

The mechanism of monomer transfer between two structurally distinct PrP oligomers.

In mammals, Prion pathology refers to a class of infectious neuropathologies whose mechanism is based on the self-perpetuation of structural information stored in the pathological conformer. The characterisation of the PrP folding landscape has revealed the existence of a plethora of pathways conducing to the formation of structurally different assemblies with different biological properties. However, the biochemical interconnection between these diverse assemblies remains unclear. The PrP oligomerisation process leads to the formation of neurotoxic and soluble assemblies called O1 oligomers with a high size heterodispersity. By combining the measurements in time of size distribution and average size with kinetic models and data assimilation, we revealed the existence of at least two structurally distinct sets of assemblies, termed Oa and Ob, forming O1 assemblies. We propose a kinetic model representing the main processes in prion aggregation pathway: polymerisation, depolymerisation, and disintegration. The two groups interact by exchanging monomers through a disintegration process that increases the size of Oa. Our observations suggest that PrP oligomers constitute a highly dynamic population.

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.

Estimation from moments measurements for amyloid depolymerisation.

Estimating reaction rates and size distributions of protein polymers is an important step for understanding the mechanisms of protein misfolding and aggregation, a key feature for amyloid diseases. This study aims at setting this framework problem when the experimental measurements consist in the time-dynamics of a moment of the population (i.e. for instance the total polymerised mass, as in Thioflavin T measurements, or the second moment measured by Static Light Scattering). We propose a general methodology, and we solve the problem theoretically and numerically in the case of a depolymerising system. We then apply our method to experimental data of depolymerising oligomers, and conclude that smaller aggregates of ovPrP protein should be more stable than larger ones. This has an important biological implication, since it is commonly admitted that small oligomers constitute the most cytotoxic species during prion misfolding process.

Identification of artery wall stiffness: in vitro validation and in vivo results of a data assimilation procedure applied to a 3D fluid-structure interaction model.

We consider the problem of estimating the stiffness of an artery wall using a data assimilation method applied to a 3D fluid-structure interaction (FSI) model. Recalling previous works, we briefly present the FSI model, the data assimilation procedure and the segmentation algorithm. We present then two examples of the procedure using real data. First, we estimate the stiffness distribution of a silicon rubber tube from image data. Second, we present the estimation of aortic wall stiffness from real clinical data.

Sequential parameter estimation for fluid-structure problems: application to hemodynamics.

We present a robust and computationally efficient parameter estimation strategy for fluid-structure interaction problems. The method is based on a filtering algorithm restricted to the parameter space, known as the reduced-order unscented Kalman filter. It does not require any adjoint or tangent problems. In addition, it can easily be run in parallel, which is of great interest in fluid-structure problems where the computational cost of the forward simulation is already a challenge in itself. We illustrate our methodology with the estimation of the artery wall stiffness from the wall displacement measurements - as they could be extracted from medical imaging - in a three-dimensional idealized abdominal aortic aneurysm. We also show preliminary results about the estimation of the proximal Windkessel resistance, which is an important parameter for setting appropriate fluid boundary conditions.

Myocardial transversely isotropic material parameter estimation from in-silico measurements based on a reduced-order unscented Kalman filter.

Parameter estimation from non-invasive measurements is a crucial step in patient-specific cardiac modeling. It also has the potential to provide significant assistance in the clinical diagnosis of cardiac diseases through the quantification of myocardial material heterogeneity. In this paper, we formulate a novel Reduced-order Unscented Kalman Filter (rUKF) applied to the left ventricular (LV) nonlinear mechanical model based on cubic-Hermite finite elements. Material parameters in the widely-employed transversely isotropic Guccione's constitutive law are successfully identified for both homogeneous and heterogeneous cases. We conclude that the four parameters in Guccione's law can be uniquely and correctly determined in-silico from noisy displacement measurements of material points located on the myocardial surfaces. The future application of this novel and effective approach to real clinical measurements is thus promising.