Elex Biotech (United States)

Abstract State-of-the-art cardiac electromechanical modelling and simulation form the basis for recent developments in cardiac Digital Twin technologies. However, a comprehensive evaluation of electromechanical models at cellular, tissue, and organ level has yet to be performed that addresses both ECG and pressure-volume biomarkers. Such an evaluation would build credibility for applications of cardiac Digital Twins in clinical research and therapy development. We aimed to follow ASME V&V40 standards to develop a strategy for calibration, validation, and uncertainty quantification of ventricular electromechanical Digital Twins under healthy conditions. We performed a multi-scaled review of ventricular electromechanics to compile a dataset for calibration and validation incorporating ECG, pressure-volume, displacement, and strain biomarkers. When applied to a biventricular multiscale model, we achieved healthy calibrated values for the QRS duration (89 ms), QT interval (360 ms), left ventricular ejection fraction (LVEF) (51 %), peak systolic pressure (14 kPa), end diastolic (110 mL) and end systolic volumes (50 mL), peak ejection flow rate (180 mL/ms). Model validation was performed by comparison to displacement and strain biomarkers including systolic atrioventricular plane displacement (1.5 cm), systolic fibre strain (−0.18) and longitudinal strain (−0.15). Sensitivity analysis of model parameters at cellular and ventricular scales was also performed. We quantified the effects of variability in ionic conductance, mechanical stiffness, cross-bridge cycling dynamics, and systemic circulation on action potential and active tension dynamics at the cellular scale, and on ECG, pressure-volume, displacement, and strain biomarkers at the ventricular scale. Simulations showed that the relationship between healthy LVEF and T wave biomarkers was primarily underpinned by variability in L-type calcium channel conductance and SERCA activity through multi-scale effects. In this study, we pave the way towards credible cardiac electromechanical Digital Twins by setting the basis for a strategy for calibration and validation based on both ECG and mechanical biomarkers.

Sudden death after myocardial infarction (MI) is associated with electrophysiological heterogeneities and ionic current remodelling. Low ejection fraction (EF) is used in risk stratification, but its mechanistic links with pro-arrhythmic heterogeneities are unknown. We aim to provide mechanistic explanations of clinical phenotypes in acute and chronic MI, from ionic current remodelling to ECG and EF, using human electromechanical modelling and simulation to augment experimental and clinical investigations. A human ventricular electromechanical modelling and simulation framework is constructed and validated with rich experimental and clinical datasets, incorporating varying degrees of ionic current remodelling as reported in literature. In acute MI, T-wave inversion and Brugada phenocopy were explained by conduction abnormality and local action potential prolongation in the border zone. In chronic MI, upright tall T-waves highlight large repolarisation dispersion between the border and remote zones, which promoted ectopic propagation at fast pacing. Post-MI EF at resting heart rate was not sensitive to the extent of repolarisation heterogeneity and the risk of repolarisation abnormalities at fast pacing. T-wave and QT abnormalities are better indicators of repolarisation heterogeneities than EF in post-MI.