Intramyocardial Injections to De-Stiffen the Heart: A Subject-Specific in Silico Approach.
Intramyocardial Injections to De-Stiffen the Heart: A Subject-Specific in Silico Approach.
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DOI：
10.32604/mcb.2019.07364
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发表时间：
2019-01-01
期刊：
影响因子：
--
通讯作者：
Guccione, Julius M
中科院分区：
文献类型：
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作者：
Dabiri, Yaghoub;Sack, Kevin L;Guccione, Julius M
我们假设，在僵硬心肌的关键部位微创注射软化剂可以使左心室（LV）整体去颤。基于物理的有限元模型的LV创建从LV超声心动图图像和压力记录在实验期间在四只猪。结果证实了动物模型的左室软化全身药物。心肌局部去硬导致LV整体去硬。该数学模型用于设计通过局部软化心肌的LV整体去僵硬。在舒张末期压力为23 mmHg时，当8 ml游离壁被心肌内注射覆盖时，舒张末期容积（EDV）增加15.0%，而由于间隔和游离壁中的心肌内注射导致EDV增加26.0%。尽管内膜心肌内注射占据了较低的LV壁体积，但它们导致的EDV（44 ml）与中壁心肌内注射（44 ml）相等，且大于心外膜心肌内注射（41 ml）。使用计算机模拟设置，可以计划局部心肌去硬化的部位，以便在射血分数保留的情况下全面软化心力衰竭中过于僵硬的LV。这种新的治疗方法是建立在受试者特定的数据。在动物模型中对这些模拟结果进行假设检验是必要的。
We hypothesized that minimally invasive injections of a softening agent at strategic locations in stiff myocardium could de-stiffen the left ventricle (LV) globally. Physics-based finite element models of the LV were created from LV echocardiography images and pressures recorded during experiments in four swine. Results confirmed animal models of LV softening by systemic agents. Regional de-stiffening of myocardium led to global de-stiffening of LV. The mathematical set up was used to design LV global de-stiffening by regional softening of myocardium. At an end diastolic pressure of 23 mmHg, when 8 ml of the free wall was covered by intramyocardial injections, end diastolic volume (EDV) increased by 15.0%, whereas an increase up to 11 ml due to intramyocardial injections in the septum and free wall led to a 26.0% increase in EDV. Although the endocardial intramyocardial injections occupied a lower LV wall volume, they led to an EDV (44 ml) that was equal compared to intramyocardial injections in the mid-wall (44 ml) and larger compared to intramyocardial injections in the epicardium (41 ml). Using an in silico set up, sites of regional myocardium de-stiffening could be planned in order to globally soften overly stiff LV in heart failure with preserved ejection fraction. This novel treatment is built on subject-specific data. Hypothesis-testing of these simulation findings in animal models is warranted.