Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA.
Prog Biophys Mol Biol. 2011 Oct;107(1):147-55. doi: 10.1016/j.pbiomolbio.2011.06.014. Epub 2011 Jul 7.
The development and clinical use of patient-specific models of the heart is now a feasible goal. Models have the potential to aid in diagnosis and support decision-making in clinical cardiology. Several groups are now working on developing multi-scale models of the heart for understanding therapeutic mechanisms and better predicting clinical outcomes of interventions such as cardiac resynchronization therapy. Here we describe the methodology for generating a patient-specific model of the failing heart with a myocardial infarct and left ventricular bundle branch block. We discuss some of the remaining challenges in developing reliable patient-specific models of cardiac electromechanical activity, and identify some of the main areas for focusing future research efforts. Key challenges include: efficiently generating accurate patient-specific geometric meshes and mapping regional myofiber architecture to them; modeling electrical activation patterns based on cellular alterations in human heart failure, and estimating regional tissue conductivities based on clinically available electrocardiographic recordings; estimating unloaded ventricular reference geometry and material properties for biomechanical simulations; and parameterizing systemic models of circulatory dynamics from available hemodynamic measurements.
现在，开发和临床应用患者特异性心脏模型已经成为一个可行的目标。这些模型有可能辅助临床心脏病学的诊断和决策制定。现在，有几个研究小组正在开发心脏多尺度模型，以了解治疗机制，并更好地预测心脏再同步治疗等干预措施的临床结果。在这里，我们描述了生成具有心肌梗死和左束支传导阻滞的衰竭心脏患者特异性模型的方法。我们讨论了开发可靠的心脏机电活动患者特异性模型中尚存的一些挑战，并确定了未来研究工作的主要重点领域。主要挑战包括：高效地生成准确的患者特异性几何网格，并将区域性心肌纤维结构映射到网格上；根据人类心力衰竭中心细胞的改变来模拟电激活模式，并根据临床可用的心电图记录来估计区域性组织电导率；根据可用的血流动力学测量值来估计无负荷心室参考几何形状和生物力学模拟的材料特性；以及根据系统循环动力学模型来参数化。
