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In patients with dyssynchronous heart failure (DHF), cardiac conduction abnormalities cause the regional distribution of myocardial work to be non-homogeneous. Cardiac resynchronization therapy (CRT) using an implantable, programmed biventricular pacemaker/defibrillator, can improve the synchrony of contraction between the right and left ventricles in DHF, resulting in reduced morbidity and mortality and increased quality of life. Since regional work depends on wall stress, which cannot be measured in patients, we used computational methods to investigate regional work distributions and their changes after CRT. We used three-dimensional multi-scale patient-specific computational models parameterized by anatomic, functional, hemodynamic, and electrophysiological measurements in eight patients with heart failure and left bundle branch block (LBBB) who received CRT. To increase clinical translatability, we also explored whether streamlined computational methods provide accurate estimates of regional myocardial work. We found that CRT increased global myocardial work efficiency with significant improvements in non-responders. Reverse ventricular remodeling after CRT was greatest in patients with the highest heterogeneity of regional work at baseline, however the efficacy of CRT was not related to the decrease in overall work heterogeneity or to the reduction in late-activated regions of high myocardial work. Rather, decreases in early-activated regions of myocardium performing negative myocardial work following CRT best explained patient variations in reverse remodeling. These findings were also observed when regional myocardial work was estimated using ventricular pressure as a surrogate for myocardial stress and changes in endocardial surface area as a surrogate for strain. These new findings suggest that CRT promotes reverse ventricular remodeling in human dyssynchronous heart failure by increasing regional myocardial work in early-activated regions of the ventricles, where dyssynchrony is specifically associated with hypoperfusion, late systolic stretch, and altered metabolic activity and that measurement of these changes can be performed using streamlined approaches. Author summary: Cardiac resynchronization therapy (CRT) can improve the synchrony of contraction between the right and left ventricles in DHF and reduce morbidity and mortality and increase quality of life. However, regional work before CRT and changes with CRT are not well understood. We used three-dimensional multi-scale patient-specific computational models parameterized by anatomic, functional, hemodynamic, and electrophysiological measurements to assess changes in eight patients with heart failure and left bundle branch block (LBBB) who received CRT. To increase clinical translatability, we also explored the utility of streamlined methods to estimate regional myocardial work. We found that CRT increased global myocardial work efficiency with significant improvements in non-responders. Reverse ventricular remodeling after CRT was greatest in patients with the highest heterogeneity of regional work at baseline. Decreases in early-activated regions of myocardium performing negative myocardial work with CRT best explained patient variations in reverse remodeling. These findings were also observed when regional myocardial work was estimated using ventricular pressure as a surrogate for myocardial stress and changes in endocardial surface area as a surrogate for strain. These findings suggest that CRT promotes reverse ventricular remodeling in human dyssynchronous heart failure by increasing regional myocardial work in early-activated regions of the ventricles and that measurement of these changes can be performed using streamlined approaches. [ABSTRACT FROM AUTHOR]

Computational modeling provides a potentially powerful way to integrate structural properties measured in vitro to physiological functions measured in vivo. Focusing on the various scales (cell-tissue-organ-system), we give an overview of the importance and applications of numerical models of ventricular anatomy, electrophysiology, mechanics, and circulatory models. The integration of these models in one multiscale model of cardiac electromechanics is discussed in the light of applications to hypothesis generation, diagnosis, surgery (planning, training, and outcome of interventions), and therapies. Special attention is paid to practical use in terms of computational demand. Because of growing computer power and the development of efficient algorithms, we expect that real-time simulations with multiscale models of cardiac electromechanics become feasible in 2008 (despite the increasing complexity of models due to data accumulation on molecular and cellular mechanisms). [ABSTRACT FROM AUTHOR]

The aim of this study is development a prototype computational model of the pig heart that can be used to predict physiological responses to a penetrating wound injury. The pig has been chosen for this model studies because it shares many anatomical similarities with humans. Three‐dimensional cubic Hermite finite element meshes based on detailed measurements of porcine anatomy combined into an integrated anatomic model. The pig ventricular model includes detailed left and right ventricular geometry and myofiber and laminar sheet orientations throughout the mesh [1]. The cardiac mesh was refined and monodomain equations for action potential propagation solved using well‐established collocation‐Galerkin finite element methods [2]. The membrane kinetic equations for the action potential model was based on detailed cellular models of transmembrane ionic fluxes and intracellular calcium fluxes in canine ventricular myocytes and human atrial myocytes. We modified the anisotropic myocardial conductivity tensor on the endocardial surface of the ventricles by making use of a surface model fitted to measured of Purkinje fiber network anatomy. The mechanical model compute regional three‐dimensional stress and strain distributions using anisotropic constitutive laws referred to local material coordinate axes defined by local myofiber and laminar sheet orientations. Passive myocardial mechanics modeled using exponential orthotropic strain energy functions. Active systolic myocardial stresses computed from a multi‐scale model that uses crossbridge theory to predict calcium‐activated sarcomere length‐ and velocity‐dependent tension filament tension. Since the electrical and mechanical models use a common finite element mesh as the parent parametric framework and both models are solved within our custom finite element package, it is straightforward to couple these models, as we have recently done for a model of coupled ventricular electromechanics [3]. We apply the coupled electromechanical model to predict alterations in regional diastolic and systolic wall mechanics associated with rhythm disturbances and possible arrhythmias with decreased blood volume, tamponade, myocardial injury, and regional ischemia caused by a penetrating wound. [ABSTRACT FROM AUTHOR]