title: Patient-specific modeling of left ventricular electromechanics as a driver for haemodynamic analysis.
abstract: OBJECTIVE
  Models of blood flow in the left ventricle (LV) and aorta are an important tool for analysing the interplay between LV deformation and flow patterns. Typically, image-based kinematic models describing endocardial motion are used as an input to blood flow simulations. While such models are suitable for analysing the hemodynamic status quo, they are limited in predicting the response to interventions that alter afterload conditions. Mechano-fluidic models using biophysically detailed electromechanical (EM) models have the potential to overcome this limitation, but are more costly to build and compute. We report our recent advancements in developing an automated workflow for the creation of such CFD ready kinematic models to serve as drivers of blood flow simulations.
  
  
  RESULTS
  EM models of the LV and aortic root were created for four pediatric patients treated for either aortic coarctation or aortic valve disease. Using MRI, ECG and invasive pressure recordings, anatomy as well as electrophysiological, mechanical and circulatory model components were personalized.
  
  
  RESULTS
  The implemented modeling pipeline was highly automated and allowed model construction and execution of simulations of a patient's heartbeat within 1 day. All models reproduced clinical data with acceptable accuracy.
  
  
  CONCLUSIONS
  Using the developed modeling workflow, the use of EM LV models as driver of fluid flow simulations is becoming feasible. While EM models are costly to construct, they constitute an important and nontrivial step towards fully coupled electro-mechano-fluidic (EMF) models and show promise as a tool for predicting the response to interventions which affect afterload conditions.
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.|Department of Mechanical Engineering, University of California, 5126 Etcheverry Hall, Berkeley, CA 94720, USA.
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Augustin
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.
authors.forename: Andrew
authors.initials: A
authors.lastname: Crozier
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.
authors.forename: Aurel
authors.initials: A
authors.lastname: Neic
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.
authors.forename: Anton J
authors.initials: AJ
authors.lastname: Prassl
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.
authors.forename: Elias
authors.initials: E
authors.lastname: Karabelas
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Tiago
authors.initials: T
authors.lastname: Ferreira da Silva
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Joao F
authors.initials: JF
authors.lastname: Fernandes
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria.|Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Fernando
authors.initials: F
authors.lastname: Campos
authors.affiliation: Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: Titus
authors.initials: T
authors.lastname: Kuehne
authors.affiliation: Institute of Biophysics, Medical University of Graz, Harrachgasse 21/IV, 8010 Graz, Austria gernot.plank@medunigraz.at.
authors.forename: Gernot
authors.initials: G
authors.lastname: Plank
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D001021:Aortic Valve / Q000503:physiopathology*; D001331:Automation; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization; D002648:Child; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D057188:Workflow
keywords: Computer model; Left ventricular electromechanics ; Personalization