Abraham E Umo, Brett A Welch, Kilic Arman, Ethan O Kung
medRxiv. 2025 Mar 11:2025.03.10.25323688. doi: 10.1101/2025.03.10.25323688.
The Physiology Simulation Coupled Experiment (PSCOPE) is a hybrid modeling framework designed for mechanistic cardiovascular predictive modeling. It couples a physical fluid experiment with a lumped parameter network simulation to replicate the closed-loop feedback between simulated cardiovascular physiology and fluid dynamics in the physical experiment. This study validates PSCOPE's predictions of post-surgical physiology against clinical data in the context of HeartMate 3 left ventricular assist device implantation.
We designed a protocol to characterize the pre- and post-surgical hemodynamics of three adult HeartMate 3 patients using perioperative clinical measurements acquired from routine intensive care unit monitoring. For each patient, we tuned a lumped parameter network model to match their pre-surgical hemodynamic values, creating a patient-specific simulation of the pre-surgical physiology. The PSCOPE framework then modeled LVAD implantation by coupling these simulations to a physical HeartMate 3 device flow experiment. This hybrid model estimates physiological flow rate and pressure parameters to predict the patients' post-surgical hemodynamics.
The percentage difference between PSCOPE predictions and clinical post-surgical hemodynamics ranged from 0.0% to 44.7% across different hemodynamic parameters in different patients. The predicted cardiac index, mean pulmonary arterial pressure, central venous pressure, and pulmonary arterial wedge pressure together accurately indicated the absence of post-implant right ventricular failure in all patients.
This validation study demonstrates the potential of PSCOPE in assisting LVAD patient management. PSCOPE hemodynamic predictions could help clinicians anticipate and manage post-implant outcomes, such as right ventricular failure, thereby improving the efficacy of surgical planning.
生理模拟耦合实验（PSCOPE）是一种用于心血管机制预测建模的混合建模框架。它将物理流体实验与集总参数网络模拟相结合，以复制物理实验中模拟心血管生理与流体动力学之间的闭环反馈。本研究在HeartMate 3左心室辅助装置植入的背景下，对照临床数据验证了PSCOPE对术后生理状况的预测。
我们设计了一个方案，利用从常规重症监护病房监测中获取的围手术期临床测量数据，对三名成年HeartMate 3患者手术前后的血流动力学进行表征。对于每位患者，我们调整集总参数网络模型以匹配其术前血流动力学值，创建患者特异性的术前生理模拟。然后，PSCOPE框架通过将这些模拟与物理HeartMate 3装置血流实验相结合，对左心室辅助装置植入进行建模。这种混合模型估计生理流速和压力参数，以预测患者术后的血流动力学。
在不同患者的不同血流动力学参数中，PSCOPE预测值与临床术后血流动力学之间的百分比差异范围为0.0%至44.7%。预测的心脏指数、平均肺动脉压、中心静脉压和肺动脉楔压共同准确表明所有患者术后均未出现右心室衰竭。
这项验证研究证明了PSCOPE在辅助左心室辅助装置患者管理方面的潜力。PSCOPE血流动力学预测可以帮助临床医生预测和管理术后结果，如右心室衰竭，从而提高手术规划的有效性。
