Parameter Inference in the Pulmonary Circulation of Mice

This study focuses on parameter inference in a pulmonary blood cir- culation model for mice. It utilises a fluid dynamics network model that takes selected parameter values and aims to mimic features of the pulmonary haemody- namics under normal physiological and pathological conditions. This is of medical relevance as it allows monitoring of the progression of pulmonary hypertension. Constraint nonlinear optimization is successfully used to learn the parameter values

MCMC with Delayed Acceptance using a Surrogate Model with an Application to Cardiovascular Fluid Dynamics

Parameter estimation and uncertainty quantification in physiological modelling is a vital step towards personalised medicine. Current state-of-the-art in this research area performs parameter optimisation, with very limited uncertainty quantification. This paper demonstrates the advantage of novel sampling methods, applied on a complex biological PDE system of the pulmonary circulation. The aim is to find an efficient and accurate method for the inference and uncertainty quantification of unknown parameters, relevant for disease diagnosis (pulmonary hypertension) from limited and noisy blood pressure data. The data likelihood is expensive to evaluate as it requires solving numerically a system of PDEs. Therefore, having a model that best trades off accuracy and computational efficiency is of uppermost importance. In this study, we employ fast Bayesian methods, namely MCMC algorithms coupled with emulation using Gaussian Processes, to achieve a computational speed-up. We compare the Delayed Rejection Adaptive Metropolis algorithm in a History Matching framework to the delayed acceptance Adaptive Metropolis algorithm. The first algorithm draws samples from the approximate posterior distribution, while the latter is guaranteed to generate samples from the exact posterior distribution asymptotically. In this paper we propose and derive the n-steps ahead delayed acceptance Metropolis-Hastings algorithm, which is a generalisation of the classical 1-step ahead delayed acceptance Metropolis-Hastings. We show the superiority of the n-steps ahead algorithm over the 1-step ahead method

Influence of image segmentation on one-dimensional fluid dynamics predictions in the mouse pulmonary arteries

Computational fluid dynamics (CFD) models are emerging as tools for assisting in diagnostic assessment of cardiovascular disease. Recent advances in image segmentation has made subject-specific modelling of the cardiovascular system a feasible task, which is particularly important in the case of pulmonary hypertension (PH), which requires a combination of invasive and non-invasive procedures for diagnosis. Uncertainty in image segmentation can easily propagate to CFD model predictions, making uncertainty quantification crucial for subject-specific models. This study quantifies the variability of one-dimensional (1D) CFD predictions by propagating the uncertainty of network geometry and connectivity to blood pressure and flow predictions. We analyse multiple segmentations of an image of an excised mouse lung using different pre-segmentation parameters. A custom algorithm extracts vessel length, vessel radii, and network connectivity for each segmented pulmonary network. We quantify uncertainty in geometric features by constructing probability densities for vessel radius and length, and then sample from these distributions and propagate uncertainties of haemodynamic predictions using a 1D CFD model. Results show that variation in network connectivity is a larger contributor to haemodynamic uncertainty than vessel radius and length

Numerical simulation of blood flow and pressure drop in the pulmonary arterial and venous circulation

A novel multiscale mathematical and computational model of the pulmonary circulation is presented and used to analyse both arterial and venous pressure and flow. This work is a major advance over previous studies by Olufsen et al. (Ann Biomed Eng 28:1281–1299, 2012) which only considered the arterial circulation. For the first three generations of vessels within the pulmonary circulation, geometry is specified from patient-specific measurements obtained using magnetic resonance imaging (MRI). Blood flow and pressure in the larger arteries and veins are predicted using a nonlinear, cross-sectional-area-averaged system of equations for a Newtonian fluid in an elastic tube. Inflow into the main pulmonary artery is obtained from MRI measurements, while pressure entering the left atrium from the main pulmonary vein is kept constant at the normal mean value of 2 mmHg. Each terminal vessel in the network of ‘large’ arteries is connected to its corresponding terminal vein via a network of vessels representing the vascular bed of smaller arteries and veins. We develop and implement an algorithm to calculate the admittance of each vascular bed, using bifurcating structured trees and recursion. The structured-tree models take into account the geometry and material properties of the ‘smaller’ arteries and veins of radii ≥ 50 μ m. We study the effects on flow and pressure associated with three classes of pulmonary hypertension expressed via stiffening of larger and smaller vessels, and vascular rarefaction. The results of simulating these pathological conditions are in agreement with clinical observations, showing that the model has potential for assisting with diagnosis and treatment for circulatory diseases within the lung

Deep phenotyping of cardiac function in heart transplant patients using cardiovascular systems models

Heart transplant patients are followed with periodic right heart catheterizations (RHCs) to identify post-transplant complications and guide treatment. Post-transplant positive outcomes are associated with a steady reduction of right ventricular and pulmonary arterial pressures, toward normal levels of right-side pressure (about 20mmHg) measured by RHC. This study shows more information about patient progression is obtained by combining standard RHC measures with mechanistic computational cardiovascular systems models. This study shows: to understand how cardiovascular system models can be used to represent a patient's cardiovascular state, and to use these models to track post-transplant recovery and outcome. To obtain reliable parameter estimates comparable within and across datasets, we use sensitivity analysis, parameter subset selection, and optimization to determine patient specific mechanistic parameter that can be reliably extracted from the RHC data. Patient-specific models are identified for ten patients from their first post-transplant RHC and longitudinal analysis is done for five patients. Results of sensitivity analysis and subset selection show we can reliably estimate seven non-measurable quantities including ventricular diastolic relaxation, systemic resistance, pulmonary venous elastance, pulmonary resistance, pulmonary arterial elastance, pulmonary valve resistance and systemic arterial elastance. Changes in parameters and predicted cardiovascular function post-transplant are used to evaluate cardiovascular state during recovery in five patients. Of these five patients, only one patient showed inconsistent trends during recovery in ventricular pressure-volume relationships and power output. At a four-year recovery time point this patient exhibited biventricular failure along with graft dysfunction while the remaining four exhibited no cardiovascular complications.Comment: 53 Pages (including supplement), 9 figures in manuscript, 9 figures in supplemen

Deep phenotyping of cardiac function in heart transplant patients using cardiovascular system models

Heart transplant patients are followed with periodic right heart catheterizations (RHCs) to identify post‐transplant complications and guide treatment. Post‐transplant positive outcomes are associated with a steady reduction of right ventricular and pulmonary arterial pressures, toward normal levels of right‐side pressure (about 20 mmHg) measured by RHC. This study shows that more information about patient progression is obtained by combining standard RHC measures with mechanistic computational cardiovascular system models. The purpose of this study is twofold: to understand how cardiovascular system models can be used to represent a patient’s cardiovascular state, and to use these models to track post‐transplant recovery and outcome. To obtain reliable parameter estimates comparable within and across datasets, we use sensitivity analysis, parameter subset selection, and optimization to determine patient‐specific mechanistic parameters that can be reliably extracted from the RHC data. Patient‐specific models are identified for 10 patients from their first post‐transplant RHC, and longitudinal analysis is carried out for five patients. Results of the sensitivity analysis and subset selection show that we can reliably estimate seven non‐measurable quantities; namely, ventricular diastolic relaxation, systemic resistance, pulmonary venous elastance, pulmonary resistance, pulmonary arterial elastance, pulmonary valve resistance and systemic arterial elastance. Changes in parameters and predicted cardiovascular function post‐transplant are used to evaluate the cardiovascular state during recovery of five patients. Of these five patients, only one showed inconsistent trends during recovery in ventricular pressure–volume relationships and power output. At the four‐year post‐transplant time point this patient exhibited biventricular failure along with graft dysfunction while the remaining four exhibited no cardiovascular complications.Key pointsRight heart catheterization data from clinical records of heart transplant patients are used to identify patient‐specific models of the cardiovascular system.These patient‐specific cardiovascular models represent a snapshot of cardiovascular function at a given post‐transplant recovery time point.This approach is used to describe cardiac function in 10 heart transplant patients, five of which had multiple right heart catheterizations allowing an assessment of cardiac function over time.These patient‐specific models are used to predict cardiovascular function in the form of right and left ventricular pressure‐volume loops and ventricular power, an important metric in the clinical assessment of cardiac function.Outcomes for the longitudinally tracked patients show that our approach was able to identify the one patient from the group of five that exhibited post‐transplant cardiovascular complications.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156242/2/tjp14120.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156242/1/tjp14120_am.pd

Inference in Cardiovascular Modelling Subject to Medical Interventions

Pulmonary hypertension (PH), i.e., high blood pressure in the lungs, is a serious medical condition that can damage the right ventricle of the heart and ultimately lead to heart failure. Standard diagnostic procedures are based on right-heart catheterization, which is an invasive technique that can potentially have serious side effects. Recent methodological advancements in fluid dynamics modelling of the pulmonary blood circulation system promise to mathematically predict the blood pressure based on non-invasive measurements of the blood flow. Thus, subsequent to PH diagnostication, further investigations would no longer require catheterization. However, in order for these alternative techniques to be applicable in the clinic, accurate model calibration and parameter estimation are paramount. Medical interventions taken to combat high blood pressure (as predicted from the mathematical model) alter the underlying cardiovascular physiology, thus interfering with the parameter estimation procedure. In the present study, we have carried out a series of cardiovascular simulations to assess the reliability of cardiovascular physiological parameter estimation in the presence of medical interventions. Our principal result is that if the closed-loop effect of medical interventions is accounted for, the model calibration provides accurate parameter estimates. This finding has important implications for the applicability of cardio-physiological modelling in the clinical practice

Assessing model mismatch and model selection in a Bayesian uncertainty quantification analysis of a fluid-dynamics model of pulmonary blood circulation

This study uses Bayesian inference to quantify the uncertainty of model parameters and haemodynamic predictions in a one-dimensional pulmonary circulation model based on an integration of mouse haemodynamic and micro-computed tomography imaging data. We emphasize an often neglected, though important source of uncertainty: in the mathematical model form due to the discrepancy between the model and the reality, and in the measurements due to the wrong noise model (jointly called ‘model mismatch’). We demonstrate that minimizing the mean squared error between the measured and the predicted data (the conventional method) in the presence of model mismatch leads to biased and overly confident parameter estimates and haemodynamic predictions. We show that our proposed method allowing for model mismatch, which we represent with Gaussian processes, corrects the bias. Additionally, we compare a linear and a nonlinear wall model, as well as models with different vessel stiffness relations. We use formal model selection analysis based on the Watanabe Akaike information criterion to select the model that best predicts the pulmonary haemodynamics. Results show that the nonlinear pressure–area relationship with stiffness dependent on the unstressed radius predicts best the data measured in a control mouse

Modeling the Afferent Dynamics of the Baroreflex Control System

In this study we develop a modeling framework for predicting baroreceptor firing rate as a function of blood pressure. We test models within this framework both quantitatively and qualitatively using data from rats. The models describe three components: arterial wall deformation, stimulation of mechanoreceptors located in the BR nerve-endings, and modulation of the action potential frequency. The three sub-systems are modeled individually following well-established biological principles. The first submodel, predicting arterial wall deformation, uses blood pressure as an input and outputs circumferential strain. The mechanoreceptor stimulation model, uses circumferential strain as an input, predicting receptor deformation as an output. Finally, the neural model takes receptor deformation as an input predicting the BR firing rate as an output. Our results show that nonlinear dependence of firing rate on pressure can be accounted for by taking into account the nonlinear elastic properties of the artery wall. This was observed when testing the models using multiple experiments with a single set of parameters. We find that to model the response to a square pressure stimulus, giving rise to post-excitatory depression, it is necessary to include an integrate-and-fire model, which allows the firing rate to cease when the stimulus falls below a given threshold. We show that our modeling framework in combination with sensitivity analysis and parameter estimation can be used to test and compare models. Finally, we demonstrate that our preferred model can exhibit all known dynamics and that it is advantageous to combine qualitative and quantitative analysis methods