Influence of cardiac tissue anisotropy on re-entrant activation in computational models of ventricular fibrillation

The aim of this study was to establish the role played by anisotropic diffusion in (i) the number of filaments and epicardial phase singularities that sustain ventricular fibrillation in the heart, (ii) the lifetimes of filaments and phase singularities, and (iii) the creation and annihilation dynamics of filaments and phase singularities. A simplified monodomain model of cardiac tissue was used, with membrane excitation described by a simplified 3-variable model. The model was configured so that a single re-entrant wave was unstable, and fragmented into multiple re-entrant waves. Re-entry was then initiated in tissue slabs with varying anisotropy ratio. The main findings of this computational study are: (i) anisotropy ratio influenced the number of filaments Sustaining simulated ventricular fibrillation, with more filaments present in simulations with smaller values of transverse diffusion coefficient, (ii) each re-entrant filament was associated with around 0.9 phase singularities on the surface of the slab geometry, (iii) phase singularities were longer lived than filaments, and (iv) the creation and annihilation of filaments and phase singularities were linear functions of the number of filaments and phase singularities, and these relationships were independent of the anisotropy ratio. This study underscores the important role played by tissue anisotropy in cardiac ventricular fibrillation

Doctor of Philosophy

dissertationTreatment and management of heart disease is challenging due to the heart's limited ability to self-repair. Although current approaches to manage heart disease, such as pharmacotherapy, medical devices, lifestyle changes, and heart transplantation, have improved and extended the quality of life for millions of individuals, they have inherent shortcomings. Future strategies to manage heart disease will likely be based upon a combination of biological and engineering approaches through cell therapy and tissue engineering strategies, both of which have the potential to regenerate the myocardium and improve cardiac function. However, a key hurdle in applying biological approaches is our limited ability to produce reliable tissue to study disease progression and tissue development, therapeutic intervention, drug discovery, or tissue replacement. Establishing hallmarks of the native myocardium in engineered cardiac tissue is a central goal and appears to be required for creating functional tissue that can serve as a surrogate for in vitro testing or the eventual replacement of diseased or injured myocardium. The objective of this research was to apply an engineering approach to develop tools and methods to produce engineered cardiac tissue and characterize both native and engineered cardiac tissue. Three phases of research included: 1) the development and utilization of a framework to characterize microstructure in living cardiac tissue using confocal microscopy and local dye delivery, 2) the development a next-generation bioreactor capable of continuously monitoring force-displacement in engineered tissue, and 3) the application of confocal imaging and image analysis to quantitatively describe features of the native myocardium, focusing on myocyte geometry and spatial distribution of a major gap junction protein connexin-43, in both engineered tissue and native tissue

Comparison of diffusion tensor imaging by cardiovascular magnetic resonance and gadolinium enhanced 3D image intensity approaches to investigation of structural anisotropy in explanted rat hearts

Background: Cardiovascular magnetic resonance (CMR) can through the two methods 3D FLASH and diffusion tensor imaging (DTI) give complementary information on the local orientations of cardiomyocytes and their laminar arrays. Methods: Eight explanted rat hearts were perfused with Gd-DTPA contrast agent and fixative and imaged in a 9.4T magnet by two types of acquisition: 3D fast low angle shot (FLASH) imaging, voxels 50 × 50 × 50 μm, and 3D spin echo DTI with monopolar diffusion gradients of 3.6 ms duration at 11.5 ms separation, voxels 200 × 200 × 200 μm. The sensitivity of each approach to imaging parameters was explored. Results:The FLASH data showed laminar alignments of voxels with high signal, in keeping with the presumed predominance of contrast in the interstices between sheetlets. It was analysed, using structure-tensor (ST) analysis, to determine the most (v 1 ST ), intermediate (v 2 ST ) and least (v 3 ST ) extended orthogonal directions of signal continuity. The DTI data was analysed to determine the most (e 1 DTI ), intermediate (e 2 DTI ) and least (e 3 DTI ) orthogonal eigenvectors of extent of diffusion. The correspondence between the FLASH and DTI methods was measured and appraised. The most extended direction of FLASH signal (v 1 ST ) agreed well with that of diffusion (e 1 DTI ) throughout the left ventricle (representative discrepancy in the septum of 13.3 ± 6.7°: median ± absolute deviation) and both were in keeping with the expected local orientations of the long-axis of cardiomyocytes. However, the orientation of the least directions of FLASH signal continuity (v 3 ST ) and diffusion (e 3 ST ) showed greater discrepancies of up to 27.9 ± 17.4°. Both FLASH (v 3 ST ) and DTI (e 3 DTI ) where compared to directly measured laminar arrays in the FLASH images. For FLASH the discrepancy between the structure-tensor calculated v 3 ST and the directly measured FLASH laminar array normal was of 9 ± 7° for the lateral wall and 7 ± 9° for the septum (median ± inter quartile range), and for DTI the discrepancy between the calculated v 3 DTI and the directly measured FLASH laminar array normal was 22 ± 14° and 61 ± 53.4°. DTI was relatively insensitive to the number of diffusion directions and to time up to 72 hours post fixation, but was moderately affected by b-value (which was scaled by modifying diffusion gradient pulse strength with fixed gradient pulse separation). Optimal DTI parameters were b = 1000 mm/s2 and 12 diffusion directions. FLASH acquisitions were relatively insensitive to the image processing parameters explored. Conclusions: We show that ST analysis of FLASH is a useful and accurate tool in the measurement of cardiac microstructure. While both FLASH and the DTI approaches appear promising for mapping of the alignments of myocytes throughout myocardium, marked discrepancies between the cross myocyte anisotropies deduced from each method call for consideration of their respective limitations

Cardiac cell modelling: Observations from the heart of the cardiac physiome project

In this manuscript we review the state of cardiac cell modelling in the context of international initiatives such as the IUPS Physiome and Virtual Physiological Human Projects, which aim to integrate computational models across scales and physics. In particular we focus on the relationship between experimental data and model parameterisation across a range of model types and cellular physiological systems. Finally, in the context of parameter identification and model reuse within the Cardiac Physiome, we suggest some future priority areas for this field

Computational Modeling of Cardiac Biomechanics

The goal of this dissertation was to develop a realistic and patient-specific computational model of the heart that ultimately would help medical scientists to better diagnose and treat heart diseases. In order to achieve this goal, a three dimensional finite element model of the heart was created using magnetic resonance images of the beating pig heart. This model was loaded by the pressure of blood inside the left ventricle which was measured by synchronous catheterization. A recently developed structurally based constitutive model of the myocardium was incorporated in the finite element solver to model passive left ventricular myocardium. Additionally, an unloading algorithm originally designed for arteries was adapted to estimate the stress-free geometry of the heart from its partially-loaded geometry obtained from magnetic resonance imaging. Finally, a regionally varying growth module was added to the computational model to predict eccentric hypertrophy of the heart under various pathological conditions that result in volume overload of the heart. The computational model was validated using experimental data obtained from porcine heart such as in vivo strains measured from magnetic resonance imaging

Novel cardiovascular magnetic resonance phenotyping of the myocardium

INTRODUCTION Left ventricular (LV) microstructure is unique, composed of a winding helical pattern of myocytes and rotating aggregations of myocytes called sheetlets. Hypertrophic cardiomyopathy (HCM) is a cardiovascular disease characterised by left ventricular hypertrophy (LVH), however the link between LVH and underlying microstructural aberration is poorly understood. In vivo cardiovascular diffusion tensor imaging (cDTI) is a novel cardiovascular MRI (CMR) technique, capable of characterising LV microstructural dynamics non-invasively. In vivo cDTI may therefore improve our understanding microstructural-functional relationships in health and disease. METHODS AND RESULTS The monopolar diffusion weighted stimulated echo acquisition mode (DW-STEAM) sequence was evaluated for in vivo cDTI acquisitions at 3Tesla, in healthy volunteers (HV), patients with hypertensive LVH, and HCM patients. Results were contextualised in relation to extensively explored technical limitations. cDTI parameters demonstrated good intra-centre reproducibility in HCM, and good inter-centre reproducibility in HV. In all subjects, cDTI was able to depict the winding helical pattern of myocyte orientation known from histology, and the transmural rate of change in myocyte orientation was dependent on LV size and thickness. In HV, comparison of cDTI parameters between systole and diastole revealed an increase in transmural gradient, combined with a significant re-orientation of sheetlet angle. In contrast, in HCM, myocyte gradient increased between phases, however sheetlet angulation retained a systolic-like orientation in both phases. Combined analysis with hypertensive patients revealed a proportional decrease in sheetlet mobility with increasing LVH. CONCLUSION In vivo DW-STEAM cDTI can characterise LV microstructural dynamics non-invasively. The transmural rate of change in myocyte angulation is dependent on LV size and wall thickness, however inter phase changes in myocyte orientation are unaffected by LVH. In contrast, sheetlet dynamics demonstrate increasing dysfunction, in proportion to the degree of LVH. Resolving technical limitations is key to advancing this technique, and improving the understanding of the role of microstructural abnormalities in cardiovascular disease expression.Open Acces

Three-dimensional cardiac computational modelling: methods, features and applications

[EN] The combination of computational models and biophysical simulations can help to interpret an array of experimental data and contribute to the understanding, diagnosis and treatment of complex diseases such as cardiac arrhythmias. For this reason, three-dimensional (3D) cardiac computational modelling is currently a rising field of research. The advance of medical imaging technology over the last decades has allowed the evolution from generic to patient-specific 3D cardiac models that faithfully represent the anatomy and different cardiac features of a given alive subject. Here we analyse sixty representative 3D cardiac computational models developed and published during the last fifty years, describing their information sources, features, development methods and online availability. This paper also reviews the necessary components to build a 3D computational model of the heart aimed at biophysical simulation, paying especial attention to cardiac electrophysiology (EP), and the existing approaches to incorporate those components. We assess the challenges associated to the different steps of the building process, from the processing of raw clinical or biological data to the final application, including image segmentation, inclusion of substructures and meshing among others. We briefly outline the personalisation approaches that are currently available in 3D cardiac computational modelling. Finally, we present examples of several specific applications, mainly related to cardiac EP simulation and model-based image analysis, showing the potential usefulness of 3D cardiac computational modelling into clinical environments as a tool to aid in the prevention, diagnosis and treatment of cardiac diseases.This work was partially supported by the "VI Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica" from the Ministerio de Economia y Competitividad of Spain (TIN2012-37546-C03-01 and TIN2011-28067) and the European Commission (European Regional Development Funds - ERDF - FEDER) and by "eTorso project" (GVA/2013-001404) from the Generalitat Valenciana (Spain). ALP is financially supported by the program "Ayudas para contratos predoctorales para la formacion de doctores" from the Ministerio de Economia y Competitividad of Spain (BES-2013-064089).López Pérez, AD.; Sebastián Aguilar, R.; Ferrero De Loma-Osorio, JM. (2015). 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Doctor of Philosophy

dissertationDoes strain induce changes in the electrical properties of the heart? Does strain affect the microstructure of cardiac myocytes? Others have considered these questions, but have been limited in their findings. I addressed the first question by measuring conduction velocity in papillary muscles in rest conditions and during applied strain. I also applied streptomycin, a nonselective stretch ion channel blocker, in the above conditions. In control, conduction velocity increased with strain before conduction block occurred. When streptomycin was applied conduction velocity peaked at a higher strain, but conduction block remained unchanged. Changes in electrical properties of papillary muscle allowed for changes in conduction velocity. Although streptomycin did not alter the strain at which conduction block occurred, it did shift the peak conduction velocity to a higher strain. The second question was addressed by imaging isolated cardiac ventricular myocytes in varying degrees of contraction and strain using confocal microscopy. The length of transverse tubules (t-tubules), along with cross-section ellipticity, and orientation in myocytes were analyzed for cells in 16% contraction, rest, and 16% strain. Cells in contraction showed an increase in length of t-tubules with less elliptical cross-sections compared to cells in rest. Strained cells showed a decrease in length of t-tubules with less elliptical cross-sections than cells at rest. The orientation of t-tubule cross-sections changed in a similar manner when comparing contracted and strained cells with cells at rest. The transfer of strain to the t-tubule system supports the hypothesis that the motion of t-tubules during contraction and stretch may constitute a mechanism for pumping extracellular fluid

Doctor of Philosophy

dissertationDiffusion tensor MRI (DT-MRI or DTI) has been proven useful for characterizing biological tissue microstructure, with the majority of DTI studies having been performed previously in the brain. Other studies have shown that changes in DTI parameters are detectable in the presence of cardiac pathology, recovery, and development, and provide insight into the microstructural mechanisms of these processes. However, the technical challenges of implementing cardiac DTI in vivo, including prohibitive scan times inherent to DTI and measuring small-scale diffusion in the beating heart, have limited its widespread usage. This research aims to address these technical challenges by: (1) formulating a model-based reconstruction algorithm to accurately estimate DTI parameters directly from fewer MRI measurements and (2) designing novel diffusion encoding MRI pulse sequences that compensate for the higher-order motion of the beating heart. The model-based reconstruction method was tested on undersampled DTI data and its performance was compared against other state-of-the-art reconstruction algorithms. Model-based reconstruction was shown to produce DTI parameter maps with less blurring and noise and to estimate global DTI parameters more accurately than alternative methods. Through numerical simulations and experimental demonstrations in live rats, higher-order motion compensated diffusion-encoding was shown to successfully eliminate signal loss due to motion, which in turn produced data of sufficient quality to accurately estimate DTI parameters, such as fiber helix angle. Ultimately, the model-based reconstruction and higher-order motion compensation methods were combined to characterize changes in the cardiac microstructure in a rat model with inducible arterial hypertension in order to demonstrate the ability of cardiac DTI to detect pathological changes in living myocardium