title: Patient-specific modelling of head-up tilt.
abstract: Short-term cardiovascular responses to head-up tilt (HUT) involve complex cardiovascular regulation in order to maintain blood pressure at homoeostatic levels. This manuscript presents a patient-specific model that uses heart rate as an input to fit the dynamic changes in arterial blood pressure data during HUT. The model contains five compartments representing arteries and veins in the upper and lower body of the systemic circulation, as well as the left ventricle facilitating pumping of the heart. A physiologically based submodel describes gravitational pooling of the blood into the lower extremities during HUT, and a cardiovascular regulation model adjusts cardiac contractility and vascular resistance to the blood pressure changes. Nominal parameter values are computed from patient-specific data and literature estimates. The model is rendered patient specific via the use of parameter estimation techniques. This process involves sensitivity analysis, prediction of a subset of identifiable parameters, and non-linear optimization. The approach proposed here was applied to the analysis of aortic and carotid HUT data from five healthy young subjects. Results showed that it is possible to identify a subset of model parameters that can be estimated allowing the model to fit changes in arterial blood pressure observed at the level of the carotid bifurcation. Moreover, the model estimates physiologically reasonable values for arterial and venous blood pressures, blood volumes and cardiac output for which data are not available.
authors: Department of Mathematics, North Carolina State University, Raleigh, NC 27695, USA.
authors: Nakeya D
authors: ND
authors: Williams
authors: Department of Science, Systems and Models, Roskilde University, 4000 Roskilde, Denmark.
authors: Øistein
authors: Ø
authors: Wind-Willassen
authors: Department of Mathematics, North Carolina State University, Raleigh, NC 27695, USA.
authors: Andrew A
authors: AA
authors: Wright
authors: Coordinating Research Centre, Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
authors: Jesper
authors: J
authors: Mehlsen
authors: Department of Science, Systems and Models, Roskilde University, 4000 Roskilde, Denmark.
authors: Johnny T
authors: JT
authors: Ottesen
authors: Department of Mathematics, North Carolina State University, Raleigh, NC 27695, USA msolufse@ncsu.edu.
authors: Mette S
authors: MS
authors: Olufsen
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D001810:Blood Volume / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D008297:Male; D055641:Mathematical Concepts; D008955:Models, Cardiovascular; D009200:Myocardial Contraction / Q000502:physiology; D011187:Posture / Q000502:physiology*; D016683:Supine Position / Q000502:physiology; D018667:Tilt-Table Test; D014655:Vascular Resistance / Q000502:physiology
keywords: cardiovascular system dynamics; head-up tilt; parameter estimation; sensitivity analysis; subset selection