Electro-Mechanical Whole-Heart Digital Twins: A Fully Coupled Multi-Physics Approach

Abstract

Mathematical models of the human heart are evolving to become a cornerstone of precision medicine and support clinical decision making by providing a powerful tool to understand the mechanisms underlying pathophysiological conditions. In this study, we present a detailed mathematical description of a fully coupled multi-scale model of the human heart, including electrophysiology, mechanics, and a closed-loop model of circulation. State-of-the-art models based on human physiology are used to describe membrane kinetics, excitation-contraction coupling and active tension generation in the atria and the ventricles. Furthermore, we highlight ways to adapt this framework to patient specific measurements to build digital twins. The validity of the model is demonstrated through simulations on a personalized whole heart geometry based on magnetic resonance imaging data of a healthy volunteer. Additionally, the fully coupled model was employed to evaluate the effects of a typical atrial ablation scar on the cardiovascular system. With this work, we provide an adaptable multi-scale model that allows a comprehensive personalization from ion channels to the organ level enabling digital twin modeling.

A Fully-Coupled Electro-Mechanical Whole-Heart Computational Model: Influence of Cardiac Contraction on the ECG

“…Electrical excitation and wave propagation in the myocardium were simulated as part of our electro-mechanical simulation framework (Gerach et al, 2021 ). The electrophysiological part is based on the verified framework acCELLerate (Seemann et al, 2010 ; Niederer et al, 2011 ).…”

“…In recent years, cardiac mechanical modeling has steadily advanced in terms of complexity (Gurev et al, 2015 ; Augustin et al, 2016 ; Gerach et al, 2021 ) and physiological accuracy (Fritz et al, 2014 ; Pfaller et al, 2019 ). The present study builds on this, and presents a human electro-mechanically coupled 4-chamber whole-heart model, embedded into the torso.…”

Causes of altered ventricular mechanics in hypertrophic cardiomyopathy: an in-silico study

“…The entire volume mesh consisted of 48,780 nodes and 90,801 cells. In the LV, there were two elements transmurally, which suffices to obtain correct deformation according to the convergence analysis conducted by Gerach et al [34]. We used quadratic tetrahedral elements to discretize the volume and linear triangular elements for the surfaces.…”

“…To calculate the external forces, we included a closed-loop circulatory model and a pericardial model. The circulatory model provides a pressure-volume relation in the four chambers and delivers the pressure values, which are acting on the endocardial surfaces [34]. The closed-loop model ensures that the total blood volume in the circulatory system is preserved over several heart beats.…”

“…The closed-loop model ensures that the total blood volume in the circulatory system is preserved over several heart beats. The model is strongly coupled to the finite-element model as described by Gerach et al [34]. The input parameters and the initial conditions are provided in Additional file 1: Tables S1 and S2).…”