Analysis of the influence of modelling assumptions on the prediction of the elastic properties of cardiac fibres

Abstract

Although several numerical models of the human heart have been proposed in the literature, there are still several discrepancies among the results predicted by each model. These discrepancies can be attributed to the fact that each model has a number of assumptions and simplifications, which can limit the scope and precision of the numerical predictions obtained. Moreover, none of the works reported in the literature have assessed the influence of modelling assumptions on the predicted cardiac fiber elastic properties. In this paper a new passive mechanical model that combines the left ventricular (LV) pressure–volume in-vivo measurements with an indirect approach based on the finite element method (FEM), is proposed and used to analyze the influence of different modelling assumptions on the estimated elastic properties of the cardiac fiber. This analysis is carried out by varying modelling assumptions that are common to existing passive mechanical models. The results have shown that although the different modelling assumptions have a significant effect on the predicted value of the fiber elastic properties, they tend to lead to the same results. This suggests that simplified passive numerical models in combination with adjustment factors, are valid in comparison with more refined and complex LV passive models.     

Initiation and stability of reentry in two coupled excitable fibers

Reentry in the heart is the repeated excitation of the same tissue by a single excitation wave; it is responsible for several types of cardiac arrhythmia. The simplest model which permits the phenomenon of reentry is two laterally coupled excitable fibers; in this paper we examine such a model in order to establish a basis for the understanding of the fundamental physical processes underlying the process of reentry. Two versions of the FitzHugh-Nagumo equations are used to develop complementary numerical and analytical results for the coupled fiber model. On the basis of numerical studies, regions of qualitatively different behaviour are mapped in the parameter space of excitation threshold and coupling strength between the fibers, and the effect of the rate of recovery is explored. Some of these regions are also obtained analytically, in good agreement with the numerical results. Finally, the results are discussed in the light of recent work on the role of the anisotropy of cardiac tissue in the initiation of reentrant activity in the heart.     

Electrical Wave Propagation in an Anisotropic Model of the Left Ventricle Based on Analytical Description of Cardiac Architecture

We develop a numerical approach based on our recent analytical model of fiber structure in the left ventricle of the human heart. A special curvilinear coordinate system is proposed to analytically include realistic ventricular shape and myofiber directions. With this anatomical model, electrophysiological simulations can be performed on a rectangular coordinate grid. We apply our method to study the effect of fiber rotation and electrical anisotropy of cardiac tissue (i.e., the ratio of the conductivity coefficients along and across the myocardial fibers) on wave propagation using the ten Tusscher–Panfilov (2006) ionic model for human ventricular cells. We show that fiber rotation increases the speed of cardiac activation and attenuates the effects of anisotropy. Our results show that the fiber rotation in the heart is an important factor underlying cardiac excitation. We also study scroll wave dynamics in our model and show the drift of a scroll wave filament whose velocity depends non-monotonically on the fiber rotation angle; the period of scroll wave rotation decreases with an increase of the fiber rotation angle; an increase in anisotropy may cause the breakup of a scroll wave, similar to the mother rotor mechanism of ventricular fibrillation.     

On the electrotonic spread in cardiac muscle of the mouse

As an appropriate model which can simulate the cardiac working muscle with respect to the passive electrical spread, a lattice whose sides have linear cable properties is presented, and the passive potential spread on the model is mathematically analyzed in the fiber direction. Distribution of electrotonic potential in the fiber direction was measured with a pair of intracellular microelectrodes in the cardiac muscle fiber of mouse. By employing “pencil type” microelectrodes potential distribution in the transverse direction within a fiber was also measured. This transverse effect was differentiated from the longitudinal potential distribution. A tonically applied potential at any point of a cell interior spreads continuously in a manner described by a Bessel function. Using appropriate electrical and morphological parameters the experimental results proved to fit the curve obtained from numerical calculation on the model. The apparent length constant obtained for smaller distances (less than 100 μ) from the current source was 70 μ, and it increases as the distance becomes larger. At a point inside the fiber the resistance to the extracellular fluid ranged from 200 to 600 KΩ. The influence of coupling resistance between current and recording electrodes on the measurement of electrotonic potential was examined for small interelectrode distance.     

Modeling left ventricular dynamics with characteristic deformation modes

A computationally efficient method is described for simulating the dynamics of the left ventricle (LV) in three dimensions. LV motion is represented as a combination of a limited number of deformation modes, chosen to represent observed cardiac motions while conserving volume in the LV wall. The contribution of each mode to wall motion is determined by a corresponding time-dependent deformation variable. The principle of virtual work is applied to these deformation variables, yielding a system of ordinary differential equations for LV dynamics, including effects of muscle fiber orientations, active and passive stresses, and surface tractions. Passive stress is governed by a transversely isotropic elastic model. Active stress acts in the fiber direction and incorporates length–tension and force–velocity properties of cardiac muscle. Preload and afterload are represented by lumped vascular models. The variational equations and their numerical solutions are verified by comparison to analytic solutions of the strong form equations. Deformation modes are constructed using Fourier series with an arbitrary number of terms. Greater numbers of deformation modes increase deformable model resolution but at increased computational cost. Simulations of normal LV motion throughout the cardiac cycle are presented using models with 8, 23, or 46 deformation modes. Aggregate quantities that describe LV function vary little as the number of deformation modes is increased. Spatial distributions of stress and strain change as more deformation modes are included, but overall patterns are conserved. This approach yields three-dimensional simulations of the cardiac cycle on a clinically relevant time-scale.

     

Mathematical modelling of the dependence of the performance of the left ventrical of the heart on preload and afterload

Results of the numerical simulation of the end-diastolic, end-systolic, and stroke volumes of the left ventricle of the heart are presented. The simulation was based on a published simple kinetic model of cardiac muscle and approximation of the ventricle geometry with thick-wall cylinder where the fiber orientation varied linearly from sub-epicardium towards sub-endocardium. Blood flow was modeled with a liner compartment model. This simplified approach provides correct dependencies of the stroke volume on the preand afterload, namely end-diastolic pressure and peripheral resistance. The calculations show that the stroke volume is independent of arterial compliance and blood inertia.     

Scroll wave dynamics in a three-dimensional cardiac tissue model: roles of restitution, thickness, and fiber rotation

Scroll wave (vortex) breakup is hypothesized to underlie ventricular fibrillation, the leading cause of sudden cardiac death. We simulated scroll wave behaviors in a three-dimensional cardiac tissue model, using phase I of the Luo-Rudy (LR1) action potential model. The effects of action potential duration (APD) restitution, tissue thickness, filament twist, and fiber rotation were studied. We found that APD restitution is the major determinant of scroll wave behavior and that instabilities arising from APD restitution are the main determinants of scroll wave breakup in this cardiac model. We did not see a "thickness-induced instability" in the LR1 model, but a minimum thickness is required for scroll breakup in the presence of fiber rotation. The major effect of fiber rotation is to maintain twist in a scroll wave, promoting filament bending and thus scroll breakup. In addition, fiber rotation induces curvature in the scroll wave, which weakens conduction and further facilitates wave break.     

An inverse modeling approach for stress estimation in mitral valve anterior leaflet valvuloplasty for in-vivo valvular biomaterial assessment

Estimation of regional tissue stresses in the functioning heart valve remains an important goal in our understanding of normal valve function and in developing novel engineered tissue strategies for valvular repair and replacement. Methods to accurately estimate regional tissue stresses are thus needed for this purpose, and in particular to develop accurate, statistically informed means to validate computational models of valve function. Moreover, there exists no currently accepted method to evaluate engineered heart valve tissues and replacement heart valve biomaterials undergoing valvular stresses in blood contact. While we have utilized mitral valve anterior leaflet valvuloplasty as an experimental approach to address this limitation, robust computational techniques to estimate implant stresses are required. In the present study, we developed a novel numerical analysis approach for estimation of the in-vivo stresses of the central region of the mitral valve anterior leaflet (MVAL) delimited by a sonocrystal transducer array. The in-vivo material properties of the MVAL were simulated using an inverse FE modeling approach based on three pseudo-hyperelastic constitutive models: the neo-Hookean, exponential-type isotropic, and full collagen–fiber mapped transversely isotropic models. A series of numerical replications with varying structural configurations were developed by incorporating measured statistical variations in MVAL local preferred fiber directions and fiber splay. These model replications were then used to investigate how known variations in the valve tissue microstructure influence the estimated ROI stresses and its variation at each time point during a cardiac cycle. Simulations were also able to include estimates of the variation in tissue stresses for an individual specimen dataset over the cardiac cycle. Of the three material models, the transversely anisotropic model produced the most accurate results, with ROI averaged stresses at the fully-loaded state of  432.6±46.5 kPa and 241.4±40.5 kPa in the radial and circumferential directions, respectively. We conclude that the present approach can provide robust instantaneous mean and variation estimates of tissue stresses of the central regions of the MVAL.     

A mixed finite element formulation for a non-linear,transversely isotropic material model for the cardiac tissue

In this paper we present a mixed finite element method for modeling the passive properties of the myocardium. The passive properties are described by a non-linear, transversely isotropic, hyperelastic material model, and the myocardium is assumed to be almost incompressible. Single-field, pure displacement-based formulations are known to cause numerical difficulties when applied to incompressible or slightly compressible material cases. This paper presents an alternative approach in the form of a mixed formulation, where a separately interpolated pressure field is introduced as a primary unknown in addition to the displacement field. Moreover, a constraint term is included in the formulation to enforce (almost) incompressibility. Numerical results presented in the paper demonstrate the difficulties related to employing a pure displacement-based method, applying a set of physically relevant material parameter values for the cardiac tissue. The same problems are not experienced for the proposed mixed method. We show that the mixed formulation provides reasonable numerical results for compressible as well as nearly incompressible cases, also in situations of large fiber stretches. There is good agreement between the numerical results and the underlying analytical models.     

A mixed finite element formulation for a non-linear, transversely isotropic material model for the cardiac tissue

In this paper we present a mixed finite element method for modeling the passive properties of the myocardium. The passive properties are described by a non-linear, transversely isotropic, hyperelastic material model, and the myocardium is assumed to be almost incompressible. Single-field, pure displacement-based formulations are known to cause numerical difficulties when applied to incompressible or slightly compressible material cases. This paper presents an alternative approach in the form of a mixed formulation, where a separately interpolated pressure field is introduced as a primary unknown in addition to the displacement field. Moreover, a constraint term is included in the formulation to enforce (almost) incompressibility. Numerical results presented in the paper demonstrate the difficulties related to employing a pure displacement-based method, applying a set of physically relevant material parameter values for the cardiac tissue. The same problems are not experienced for the proposed mixed method. We show that the mixed formulation provides reasonable numerical results for compressible as well as nearly incompressible cases, also in situations of large fiber stretches. There is good agreement between the numerical results and the underlying analytical models.     

A numerically efficient model for simulation of defibrillation in an active bidomain sheet of myocardium

Presented here is an efficient algorithm for solving the bidomain equations describing myocardial tissue with active membrane kinetics. An analysis of the accuracy shows advantages of this numerical technique over other simple and therefore popular approaches. The modular structure of the algorithm provides the critical flexibility needed in simulation studies: fiber orientation and membrane kinetics can be easily modified. The computational tool described here is designed specifically to simulate cardiac defibrillation, i. e., to allow modeling of strong electric shocks applied to the myocardium extracellularly. Accordingly, the algorithm presented also incorporates modifications of the membrane model to handle the high transmembrane voltages created in the immediate vicinity of the defibrillation electrodes.     

Oblique dipole layer potentials applied to electrocardiology

We study the properties of the potential field generated by an oblique dipole layer. This field arises, for instance, in describing the potential elicited by a depolarization wavefront spreading in the myocardium when a dependence of the potential on the cardiac fiber orientation is introduced. The representation of cardiac bioelectric sources by means of an oblique dipole layer leads to a mathematical structure which generalizes the classical solid angle theory used in electrocardiology, which has been challenged by recent experimental evidence, and links models previously proposed with a view to adequately reproduce the potential observed in experiments. We investigate also the relationship between our model and an intracellular current model and we derive potential jump formulae for some models which account for the anisotropic structure of the myocardium. The potential generated by an oblique dipole layer is considered both for unbounded and bounded domains. In the latter case an integral boundary equation is derived and we study its solvability. A numerical procedure for solving this integral equation by means of the finite element method with collocation is outlined.     

Nonequilibrium Arrhythmic States and Transitions in a Mathematical Model for Diffuse Fibrosis in Human Cardiac Tissue

We present a comprehensive numerical study of spiral-and scroll-wave dynamics in a state-of-the-art mathematical model for human ventricular tissue with fiber rotation, transmural heterogeneity, myocytes, and fibroblasts. Our mathematical model introduces fibroblasts randomly, to mimic diffuse fibrosis, in the ten Tusscher-Noble-Noble-Panfilov (TNNP) model for human ventricular tissue; the passive fibroblasts in our model do not exhibit an action potential in the absence of coupling with myocytes; and we allow for a coupling between nearby myocytes and fibroblasts. Our study of a single myocyte-fibroblast (MF) composite, with a single myocyte coupled to fibroblasts via a gap-junctional conductance , reveals five qualitatively different responses for this composite. Our investigations of two-dimensional domains with a random distribution of fibroblasts in a myocyte background reveal that, as the percentage of fibroblasts increases, the conduction velocity of a plane wave decreases until there is conduction failure. If we consider spiral-wave dynamics in such a medium we find, in two dimensions, a variety of nonequilibrium states, temporally periodic, quasiperiodic, chaotic, and quiescent, and an intricate sequence of transitions between them; we also study the analogous sequence of transitions for three-dimensional scroll waves in a three-dimensional version of our mathematical model that includes both fiber rotation and transmural heterogeneity. We thus elucidate random-fibrosis-induced nonequilibrium transitions, which lead to conduction block for spiral waves in two dimensions and scroll waves in three dimensions. We explore possible experimental implications of our mathematical and numerical studies for plane-, spiral-, and scroll-wave dynamics in cardiac tissue with fibrosis.     

Electromechanical feedback with reduced cellular connectivity alters electrical activity in an infarct injured left ventricle: a finite element model study

Myocardial infarction (MI) significantly alters the structure and function of the heart. As abnormal strain may drive heart failure and the generation of arrhythmias, we used computational methods to simulate a left ventricle with an MI over the course of a heartbeat to investigate strains and their potential implications to electrophysiology. We created a fully coupled finite element model of myocardial electromechanics consisting of a cellular physiological model, a bidomain electrical diffusion solver, and a nonlinear mechanics solver. A geometric mesh built from magnetic resonance imaging (MRI) measurements of an ovine left ventricle suffering from a surgically induced anteroapical infarct was used in the model, cycled through the cardiac loop of inflation, isovolumic contraction, ejection, and isovolumic relaxation. Stretch-activated currents were added as a mechanism of mechanoelectric feedback. Elevated fiber and cross fiber strains were observed in the area immediately adjacent to the aneurysm throughout the cardiac cycle, with a more dramatic increase in cross fiber strain than fiber strain. Stretch-activated channels decreased action potential (AP) dispersion in the remote myocardium while increasing it in the border zone. Decreases in electrical connectivity dramatically increased the changes in AP dispersion. The role of cross fiber strain in MI-injured hearts should be investigated more closely, since results indicate that these are more highly elevated than fiber strain in the border of the infarct. Decreases in connectivity may play an important role in the development of altered electrophysiology in the high-stretch regions of the heart.     

A biophysical model for defibrillation of cardiac tissue.

We propose a new model for electrical activity of cardiac tissue that incorporates the effects of cellular microstructure. As such, this model provides insight into the mechanism of direct stimulation and defibrillation of cardiac tissue after injection of large currents. To illustrate the usefulness of the model, numerical stimulations are used to show the difference between successful and unsuccessful defibrillation of large pieces of tissue.     

Optimal control approach to termination of re-entry waves in cardiac electrophysiology

This work proposes an optimal control approach for the termination of re-entry waves in cardiac electrophysiology. The control enters as an extracellular current density into the bidomain equations which are well established model equations in the literature to describe the electrical behavior of the cardiac tissue. The optimal control formulation is inspired, in part, by the dynamical systems behavior of the underlying system of differential equations. Existence of optimal controls is established and the optimality system is derived formally. The numerical realization is described in detail and numerical experiments, which demonstrate the capability of influencing and terminating reentry phenomena, are presented.     

Determinants of left ventricular shape change during filling

Left ventricular shape and shape change are easy to measure and their analysis has been proposed as a noninvasive method to determine myocardial anisotropy. In preparation for applying this approach to studies of rats with experimentally induced cardiac hypertrophy, the goals of this study were to describe normal shape changes during diastolic filling in the rat and to utilize a finite-element model to estimate the relative importance of three factors that determine left ventricular shape change during filling: global chamber compliance, fiber to crossfiber stiffness ratio, and fiber architecture. The results suggest that left ventricular shape change is least sensitive to fiber to cross fiber stiffness ratio, and that this will likely limit the practical utility of using shape changes to diagnose changes in myocardial anisotropy.     

A damage model for the percutaneous triple hemisection technique for tendo-achilles lengthening

A full understanding of the mechanisms of action in the percutaneous triple hemisection technique for tendo-achilles lengthening has yet to be acquired and therefore, an accurate prediction of the amount of lengthening that occurs is difficult to make. The purpose of this research was to develop a phenomenological damage model that utilizes both matrix and fiber damage and replicates the observed behavior of the tendon tissue during the lengthening process. Matrix damage was triggered and evolved relative to shear strain and the fiber damage was triggered and evolved relative to fiber stretch. Three examples are given to show the effectiveness of the model. Implementation of the damage model provides a tool for studying this common procedure, and may allow for numerical investigation of alternative surgical approaches that could reduce the incidence rates of severe over-lengthening.