In vitrodifferentiation of human cardiac fibroblasts into myofibroblasts: characterization using electrical impedance.

Cardiac arrhythmias represent about 50% of the cardiovascular diseases which are the first cause of mortality in the world. Implantable medical devices play a major role for treating these arrhythmias. Nevertheless the leads induce an unwanted biological phenomenon called fibrosis. This phenomenon begins at a cellular level and is effective at a macroscopic scale causing tissue remodelling with a local modification of the active cardiac tissue. Fibrosis mechanism is complex but at the cellular level, it mainly consists in cardiac fibroblasts activation and differentiation into myofibroblasts. We developed a simplifiedin vitromodel of cardiac fibrosis, with human cardiac fibroblasts whom differentiation into myofibroblasts was promoted with TGF-ß1. Our study addresses an unreported impedance-based method for real-time monitoring ofin vitrocardiac fibrosis. The objective was to study whether the differentiation of cardiac fibroblasts in myofibroblasts had a specific signature on the cell index, an impedance-based feature measured by the xCELLigence system. Primary human cardiac fibroblasts were cultured along 6 days, with or without laminin coating, to study the role of this adhesion protein in cultures long-term maintenance. The cultures were characterized in the presence or absence of TGF-ß1 and we obtained a significant cell index signature specific to the human cardiac fibroblasts differentiation.

A 3D high resolution MRI method for the visualization of cardiac fibro-fatty infiltrations.

Modifications of the myocardial architecture can cause abnormal electrical activity of the heart. Fibro-fatty infiltrations have been implicated in various cardiac pathologies associated with arrhythmias and sudden cardiac death, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Here, we report the development of an MRI protocol to observe these modifications at 9.4 T. Two fixed ex vivo human hearts, one healthy and one ARVC, were imaged with an Iterative decomposition with echo asymmetry and least-square estimations (IDEAL) and a magnetization transfer (MT) 3D sequences. The resulting fat fraction and MT ratio (MTR) were analyzed and compared to histological analysis of the three regions ("ARVC triangle") primarily involved in ARVC structural remodeling. In the ARVC heart, high fat content was observed in the "ARVC triangle" and the superimposition of the MTR and fat fraction allowed the identification of fibrotic regions in areas without the presence of fat. The healthy heart exhibited twice less fat than the ARVC heart (31.9%, 28.7% and 1.3% of fat in the same regions, respectively). Localization of fat and fibrosis were confirmed by means of histology. This non-destructive approach allows the investigation of structural remodeling in human pathologies where fibrosis and/or fatty tissue infiltrations are expected to occur.

Simulation of voltage-sensitive optical signals in three-dimensional slabs of cardiac tissue: application to transillumination and coaxial imaging methods.

Voltage-sensitive dyes are an important tool in visualizing electrical activity in cardiac tissue. Until today, they have mainly been applied in cardiac electrophysiology to subsurface imaging. In the present study, we assess different imaging methods used in optical tomography with respect to their effectiveness in visualizing 3D cardiac activity. To achieve this goal, we simulate optical signals produced by excitation fronts initiated at different depths inside the myocardial wall and compare their properties for various imaging modes. Specifically, we consider scanning and broad-field illumination, including trans- and epi-illumination. We focus on the lateral optical resolution and signal intensity, as a function of the source depth. Optical diffusion theory is applied to derive a computationally efficient approximation of the point-spread function and to predict voltage-sensitive signals. Computations were performed both for fluorescent and absorptive voltage-sensitive dyes. Among all the above-mentioned methods, fluorescent coaxial scanning yields the best resolution (<2.5 mm) and gives the most information about the intramural cardiac activity.

Transition from ventricular fibrillation to ventricular tachycardia: a simulation study on the role of Ca(2+)-channel blockers in human ventricular tissue.

We study the effect of blocking the L-type Ca(2+)-channel on fibrillation in simulations in two-dimensional (2D) isotropic sheets of ventricular tissue and in a three-dimensional anisotropic anatomical model of human ventricles, using a previously developed model of human ventricular cells. Ventricular fibrillation (VF) was obtained as a result of spiral wave breakup and consisted of a varying number of chaotically wandering wavelets activating tissue at a frequency of about 6.0 Hz. We show that blocking the Ca(2+)-current by 75% can convert ventricular fibrillation into a periodic regime with a small number of stable spiral waves, ranging from six in 2D sheets of 25 x 25 cm to a single spiral in the anatomical model of human ventricles. The dominant frequency during this process changed to about 10.0 Hz in the 2D simulations, but to only 5.0 Hz in the whole heart simulations where a single spiral wave anchored around an anatomical obstacle. We show that the observed effects were due to a flattening of the electrical restitution curve, which prevented the generation of wave breaks and stabilized the activation patterns.

Intramural wave propagation in cardiac tissue: asymptotic solutions and cusp waves.

The cardiac muscle is well known to conduct electric impulses anisotropically, showing a larger conduction velocity along than across fibers. Fiber orientation is not uniform within the cardiac wall, but rotates by as much as 180 degrees throughout the wall thickness. Numerical simulations and experiments have indicated that this rotational anisotropy considerably affects the spread of excitation in cardiac tissue: the wave front shows a complex intramural shape with trailing cusps. The cusps can travel across layers and reach the epicardial and endocardial surfaces where they cause apparent accelerations of propagation. In the present study we provide an analytical description of the asymptotic wave front, as well as of cusp waves. We investigate the motion of cusp waves, based on the assumption that they occur at the intersection of asymptotic solutions, and we show that our theoretical analysis is in close agreement with numerical simulations. The asymptotic solutions are found to be determined purely by the fiber organization within the cardiac wall, independent of the excitable properties of cardiac tissue.

Spiral wave stability in cardiac tissue with biphasic restitution.

Human ventricular tissue as well as several animal ventricular preparations show a biphasic shape of the action potential duration restitution curve, with a local maximum at low diastolic intervals. We study numerically how the location and properties of this nonmonotonicity affect the stability of spiral waves. We find that, depending on the slopes of the ascending and of the descending parts of the restitution curve, we can have either stable rotation of the spiral wave or spiral breakup. We identify two types of spiral breakup: one due to a steep positive slope and another due to a steep negative slope in the restitution curve. We discuss the differences in their manifestation and possible implications. We also find that increasing the slope of the descending part of the restitution curve increases the meandering of the spiral wave, due to the repeated occurrence of conduction blocks near the spiral wave tip.

Models of cardiac tissue electrophysiology: progress, challenges and open questions.

Models of cardiac tissue electrophysiology are an important component of the Cardiac Physiome Project, which is an international effort to build biophysically based multi-scale mathematical models of the heart. Models of tissue electrophysiology can provide a bridge between electrophysiological cell models at smaller scales, and tissue mechanics, metabolism and blood flow at larger scales. This paper is a critical review of cardiac tissue electrophysiology models, focussing on the micro-structure of cardiac tissue, generic behaviours of action potential propagation, different models of cardiac tissue electrophysiology, the choice of parameter values and tissue geometry, emergent properties in tissue models, numerical techniques and computational issues. We propose a tentative list of information that could be included in published descriptions of tissue electrophysiology models, and used to support interpretation and evaluation of simulation results. We conclude with a discussion of challenges and open questions.

A computationally efficient electrophysiological model of human ventricular cells.

Recent experimental and theoretical results have stressed the importance of modeling studies of reentrant arrhythmias in cardiac tissue and at the whole heart level. We introduce a six-variable model obtained by a reformulation of the Priebe-Beuckelmann model of a single human ventricular cell. The reformulated model is 4.9 times faster for numerical computations and it is more stable than the original model. It retains the action potential shape at various frequencies, restitution of action potential duration, and restitution of conduction velocity. We were able to reproduce the main properties of epicardial, endocardial, and M cells by modifying selected ionic currents. We performed a simulation study of spiral wave behavior in a two-dimensional sheet of human ventricular tissue and showed that spiral waves have a frequency of 3.3 Hz and a linear core of approximately 50-mm diameter that rotates with an average frequency of 0.62 rad/s. Simulation results agreed with experimental data. In conclusion, the proposed model is suitable for efficient and accurate studies of reentrant phenomena in human ventricular tissue.