Modeling and simulation of the electric activity of the heart using graphic processing units

Mathematical modelling and simulation of the electric activity of the heart (cardiac electrophysiology) offers and ideal framework to combine clinical and experimental data in order to help understanding the underlying mechanisms behind the observed respond under physiological and pathological conditions. In this regard, solving the electric activity of the heart possess a big challenge, not only because of the structural complexities inherent to the heart tissue, but also because of the complex electric behaviour of the cardiac cells. The multi- scale nature of the electrophysiology problem makes difficult its numerical solution, requiring temporal and spatial resolutions of 0.1 ms and 0.2 mm respectively for accurate simulations, leading to models with millions degrees of freedom that need to be solved for thousand time steps. Solution of this problem requires the use of algorithms with higher level of parallelism in multi-core platforms. In this regard the newer programmable graphic processing units (GPU) has become a valid alternative due to their tremendous computational horsepower. This thesis develops around the implementation of an electrophysiology simulation software entirely developed in Compute Unified Device Architecture (CUDA) for GPU computing. The software implements fully explicit and semi-implicit solvers for the monodomain model, using operator splitting and the finite element method for space discretization. Performance is compared with classical multi-core MPI based solvers operating on dedicated high-performance computer clusters. Results obtained with the GPU based solver show enormous potential for this technology with accelerations over 50× for three-dimensional problems when using an implicit scheme for the parabolic equation, whereas accelerations reach values up to 100× for the explicit implementation. The implemented solver has been applied to study pro-arrhythmic mechanisms during acute ischemia. In particular, we investigate on how hyperkalemia affects the vulnerability window to reentry and the reentry patterns in the heterogeneous substrate caused by acute regional ischemia using an anatomically and biophysically detailed human biventricular model. A three dimensional geometrically and anatomically accurate regionally ischemic human heart model was created. The ischemic region was located in the inferolateral and posterior side of the left ventricle mimicking the occlusion of the circumflex artery, and the presence of a washed-out zone not affected by ischemia at the endocardium has been incorporated. Realistic heterogeneity and fi er anisotropy has also been considered in the model. A highly electrophysiological detailed action potential model for human has been adapted to make it suitable for modeling ischemic conditions (hyperkalemia, hipoxia, and acidic conditions) by introducing a formulation of the ATP-sensitive K+ current. The model predicts the generation of sustained re-entrant activity in the form single and double circus around a blocked area within the ischemic zone for K+ concentrations bellow 9mM, with the reentrant activity associated with ventricular tachycardia in all cases. Results suggest the washed-out zone as a potential pro-arrhythmic substrate factor helping on establishing sustained ventricular tachycardia.Colli-Franzone P, Pavarino L. A parallel solver for reaction-diffusion systems in computational electrocardiology, Math. Models Methods Appl. Sci. 14 (06):883-911, 2004.Colli-Franzone P, Deu hard P, Erdmann B, Lang J, Pavarino L F. Adaptivity in space and time for reaction-diffusion systems in electrocardiology, SIAM J. Sci. Comput. 28 (3):942-962, 2006.Ferrero J M(Jr), Saiz J, Ferrero J M, Thakor N V. Simulation of action potentials from metabolically impaired cardiac myocytes: Role of atp-sensitive K+ current. Circ Res, 79(2):208-221, 1996.Ferrero J M (Jr), Trenor B. Rodriguez B, Saiz J. Electrical acticvity and reentry during acute regional myocardial ischemia: Insights from simulations.Int J Bif Chaos, 13:3703-3715, 2003.Heidenreich E, Ferrero J M, Doblare M, Rodriguez J F. Adaptive macro finite elements for the numerical solution of monodomain equations in cardiac electrophysiology, Ann. Biomed. Eng. 38 (7):2331-2345, 2010.Janse M J, Kleber A G. Electrophysiological changes and ventricular arrhythmias in the early phase of regional myocardial ischemia. Circ. Res. 49:1069-1081, 1981.ten Tusscher K HWJ, Panlov A V. Alternans and spiral breakup in a human ventricular tissue model. Am. J.Physiol. Heart Circ. Physiol. 291(3):1088-1100, 2006.<br /

lifex-ep: a robust and efficient software for cardiac electrophysiology simulations

Background: Simulating the cardiac function requires the numerical solution of multi-physics and multi-scale mathematical models. This underscores the need for streamlined, accurate, and high-performance computational tools. Despite the dedicated endeavors of various research teams, comprehensive and user-friendly software programs for cardiac simulations, capable of accurately replicating both normal and pathological conditions, are still in the process of achieving full maturity within the scientific community. Results: This work introduces lifex-ep, a publicly available software for numerical simulations of the electrophysiology activity of the cardiac muscle, under both normal and pathological conditions. lifex-ep employs the monodomain equation to model the heart's electrical activity. It incorporates both phenomenological and second-generation ionic models. These models are discretized using the Finite Element method on tetrahedral or hexahedral meshes. Additionally, lifex-ep integrates the generation of myocardial fibers based on Laplace-Dirichlet Rule-Based Methods, previously released in Africa et al., 2023, within lifex-fiber. As an alternative, users can also choose to import myofibers from a file. This paper provides a concise overview of the mathematical models and numerical methods underlying lifex-ep, along with comprehensive implementation details and instructions for users. lifex-ep features exceptional parallel speedup, scaling efficiently when using up to thousands of cores, and its implementation has been verified against an established benchmark problem for computational electrophysiology. We showcase the key features of lifex-ep through various idealized and realistic simulations conducted in both normal and pathological scenarios. Furthermore, the software offers a user-friendly and flexible interface, simplifying the setup of simulations using self-documenting parameter files. Conclusions: lifex-ep provides easy access to cardiac electrophysiology simulations for a wide user community. It offers a computational tool that integrates models and accurate methods for simulating cardiac electrophysiology within a high-performance framework, while maintaining a user-friendly interface. lifex-ep represents a valuable tool for conducting in silico patient-specific simulations

On the Incorporation of Obstacles in a Fluid Flow Problem Using a Navier-Stokes-Brinkman Penalization Approach

Simulating the interaction of fluids with immersed moving solids is playing an important role for gaining a better quantitative understanding of how fluid dynamics is altered by the presence of obstacles and which forces are exerted on the solids by the moving fluid. Such problems appear in various contexts, ranging from numerous technical applications such as turbines to medical problems such as the regulation of hemodyamics by valves. Typically, the numerical treatment of such problems is posed within a fluid structure interaction (FSI) framework. General FSI models are able to capture bidirectional interactions, but are challenging to solve and computationally expensive. Simplified methods offer a possible remedy by achieving better computational efficiency to broaden the scope to demanding application problems with focus on understanding the effect of solids on altering fluid dynamics. In this study we report on the development of a novel method for such applications. In our method rigid moving obstacles are incorporated in a fluid dynamics context using concepts from porous media theory. Based on the Navier-Stokes-Brinkman equations which augments the Navier-Stokes equation with a Darcy drag term our method represents solid obstacles as time-varying regions containing a porous medium of vanishing permeability. Numerical stabilization and turbulence modeling is dealt with by using a residual based variational multiscale formulation. The key advantages of our approach -- computational efficiency and ease of implementation -- are demonstrated by solving a standard benchmark problem of a rotating blood pump posed by the Food and Drug Administration Agency (FDA). Validity is demonstrated by conducting a mesh convergence study and by comparison against the extensive set of experimental data provided for this benchmark

Multiscale Cohort Modeling of Atrial Electrophysiology : Risk Stratification for Atrial Fibrillation through Machine Learning on Electrocardiograms

Patienten mit Vorhofflimmern sind einem fünffach erhöhten Risiko für einen ischämischen Schlaganfall ausgesetzt. Eine frühzeitige Erkennung und Diagnose der Arrhythmie würde ein rechtzeitiges Eingreifen ermöglichen, um möglicherweise auftretende Begleiterkrankungen zu verhindern. Eine Vergrößerung des linken Vorhofs sowie fibrotisches Vorhofgewebe sind Risikomarker für Vorhofflimmern, da sie die notwendigen Voraussetzungen für die Aufrechterhaltung der chaotischen elektrischen Depolarisation im Vorhof erfüllen. Mithilfe von Techniken des maschinellen Lernens könnten Fibrose und eine Vergrößerung des linken Vorhofs basierend auf P Wellen des 12-Kanal Elektrokardiogramms im Sinusrhythmus automatisiert identifiziert werden. Dies könnte die Basis für eine nicht-invasive Risikostrat- ifizierung neu auftretender Vorhofflimmerepisoden bilden, um anfällige Patienten für ein präventives Screening auszuwählen. Zu diesem Zweck wurde untersucht, ob simulierte Vorhof-Elektrokardiogrammdaten, die dem klinischen Trainingssatz eines maschinellen Lernmodells hinzugefügt wurden, zu einer verbesserten Klassifizierung der oben genannten Krankheiten bei klinischen Daten beitra- gen könnten. Zwei virtuelle Kohorten, die durch anatomische und funktionelle Variabilität gekennzeichnet sind, wurden generiert und dienten als Grundlage für die Simulation großer P Wellen-Datensätze mit genau bestimmbaren Annotationen der zugrunde liegenden Patholo- gie. Auf diese Weise erfüllen die simulierten Daten die notwendigen Voraussetzungen für die Entwicklung eines Algorithmus für maschinelles Lernen, was sie von klinischen Daten unterscheidet, die normalerweise nicht in großer Zahl und in gleichmäßig verteilten Klassen vorliegen und deren Annotationen möglicherweise durch unzureichende Expertenannotierung beeinträchtigt sind. Für die Schätzung des Volumenanteils von linksatrialem fibrotischen Gewebe wurde ein merkmalsbasiertes neuronales Netz entwickelt. Im Vergleich zum Training des Modells mit nur klinischen Daten, führte das Training mit einem hybriden Datensatz zu einer Reduzierung des Fehlers von durchschnittlich 17,5 % fibrotischem Volumen auf 16,5 %, ausgewertet auf einem rein klinischen Testsatz. Ein Long Short-Term Memory Netzwerk, das für die Unterscheidung zwischen gesunden und P Wellen von vergrößerten linken Vorhöfen entwickelt wurde, lieferte eine Genauigkeit von 0,95 wenn es auf einem hybriden Datensatz trainiert wurde, von 0,91 wenn es nur auf klinischen Daten trainiert wurde, die alle mit 100 % Sicherheit annotiert wurden, und von 0,83 wenn es auf einem klinischen Datensatz trainiert wurde, der alle Signale unabhängig von der Sicherheit der Expertenannotation enthielt. In Anbetracht der Ergebnisse dieser Arbeit können Elektrokardiogrammdaten, die aus elektrophysiologischer Modellierung und Simulationen an virtuellen Patientenkohorten resul- tieren und relevante Variabilitätsaspekte abdecken, die mit realen Beobachtungen übereinstim- men, eine wertvolle Datenquelle zur Verbesserung der automatisierten Risikostratifizierung von Vorhofflimmern sein. Auf diese Weise kann den Nachteilen klinischer Datensätze für die Entwicklung von Modellen des maschinellen Lernens entgegengewirkt werden. Dies trägt letztendlich zu einer frühzeitigen Erkennung der Arrhythmie bei, was eine rechtzeitige Auswahl geeigneter Behandlungsstrategien ermöglicht und somit das Schlaganfallrisiko der betroffenen Patienten verringert