Human biventricular electromechanical simulations on the progression of electrocardiographic and mechanical abnormalities in post-myocardial infarction

• DOI: 10.1093/europace/euaa405
• Publication Date: 2020-12-14T20:22:01Z
• Authors: Zhinuo J Wang; Alfonso Santiago; Xin Zhou; Lei Wang; Francesca Margara; Francesc Levrero-...; Arka Das; Chris Kelly; Erica Dall'Armellina; Mariano Vazquez; Blanca Rodriguez
• Keywords: Ejection fraction; Systole; Myocardial Infarction; Stroke Volume; Computer simulation; Electrocardiograms; Ventricular Function, Left; Electrocardiogram; 3. Good health; Myocardial infarction; Electrocardiography; 03 medical and health sciences; 0302 clinical medicine; Àrees temàtiques de la UPC::Informàtica::Arquitectura de computadors::Arquitectures paral·leles; Electromechanical simulations; Simulació per ordinador; Supplement Papers; Computer modelling; Humans; :Informàtica::Arquitectura de computadors::Arquitectures paral·leles [Àrees temàtiques de la UPC]

Abstract

Aims Develop, calibrate and evaluate with clinical data a human electromechanical modelling and simulation framework for multiscale, mechanistic investigations in healthy and post-myocardial infarction (MI) conditions, from ionic to clinical biomarkers.

Methods and results Human healthy and post-MI electromechanical simulations were conducted with a novel biventricular model, calibrated and evaluated with experimental and clinical data, including torso/biventricular anatomy from clinical magnetic resonance, state-of-the-art human-based membrane kinetics, excitation–contraction and active tension models, and orthotropic electromechanical coupling. Electromechanical remodelling of the infarct/ischaemic region and the border zone were simulated for ischaemic, acute, and chronic states in a fully transmural anterior infarct and a subendocardial anterior infarct. The results were compared with clinical electrocardiogram and left ventricular ejection fraction (LVEF) data at similar states. Healthy model simulations show LVEF 63%, with 11% peak systolic wall thickening, QRS duration and QT interval of 100 ms and 330 ms. LVEF in ischaemic, acute, and chronic post-MI states were 56%, 51%, and 52%, respectively. In linking the three post-MI simulations, it was apparent that elevated resting potential due to hyperkalaemia in the infarcted region led to ST-segment elevation, while a large repolarization gradient corresponded to T-wave inversion. Mechanically, the chronic stiffening of the infarct region had the benefit of improving systolic function by reducing infarct bulging at the expense of reducing diastolic function by inhibiting inflation.

Conclusion Our human-based multiscale modelling and simulation framework enables mechanistic investigations into patho-physiological electrophysiological and mechanical behaviour and can serve as testbed to guide the optimization of pharmacological and electrical therapies.