MRI-Based Computational Torso/Biventricular Multiscale Models to Investigate the Impact of Anatomical Variability on the ECG QRS Complex
MRI-Based Computational Torso/Biventricular Multiscale Models to Investigate the Impact of Anatomical Variability on the ECG QRS Complex
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DOI：
10.3389/fphys.2019.01103
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发表时间：
2019-08-27
影响因子：
4
通讯作者：
Rodriguez, Blanca
中科院分区：
文献类型：
--
作者：
Minchole, Ana;Zacur, Ernesto;Rodriguez, Blanca
目的：患者解剖差异是心电图变异性的重要来源，它们可能损害病理性电生理异常的识别。本研究旨在利用计算机模拟量化心室和躯干解剖结构的可变性对12导联心电图QRS复合物差异的贡献。方法：提出了一种计算管道，可以使用临床标准磁共振成像（MRI）中基于人体躯干/双心室解剖的电生理模型进行计算机模拟。心室模型包括以生物物理详细的O'Hara Rudy模型为代表的膜动力学，该模型针对组织异质性进行了修改，并包括基于Streeter规则的纤维取向。通过结合临床标准mri获得的心室和躯干解剖结构，并辅以身体的统计形状模型，生成了265个躯干/双心室模型。在265个人体躯干/双心室电生理模型上模拟12导联心电图，并对每个人体躯干-双心室模型的每个导联QRS形态学、持续时间和振幅进行量化。结果：肢体导联QRS形态主要由心室解剖决定，心前导联尤其是V1 ~ V4的QRS形态主要由心脏在躯干内的位置决定。躯干室性取向的差异可以解释从单相到双相QRS复合物的形态学变异。QRS持续时间主要受心肌容量的影响，躯干解剖和体位对QRS持续时间影响不大。所有导联心肌体积每增加cm(3)， QRS持续时间平均增加0.12 +/- 0.05 ms，而躯干体积的变化几乎不影响QRS持续时间。结论：基于临床MRI的人体躯干/双心室模型的计算机模拟可以量化12导联心电图QRS复合体变异的解剖学原因。所展示的人体模型也为它们作为计算机临床试验的试验台铺平了道路。
Aims: Patient-to-patient anatomical differences are an important source of variability in the electrocardiogram, and they may compromise the identification of pathological electrophysiological abnormalities. This study aims at quantifying the contribution of variability in ventricular and torso anatomies to differences in QRS complexes of the 12-lead ECG using computer simulations.Methods: A computational pipeline is presented that enables computer simulations using human torso/biventricular anatomically based electrophysiological models from clinically standard magnetic resonance imaging (MRI). The ventricular model includes membrane kinetics represented by the biophysically detailed O'Hara Rudy model modified for tissue heterogeneity and includes fiber orientation based on the Streeter rule. A population of 265 torso/biventricular models was generated by combining ventricular and torso anatomies obtained from clinically standard MRIs, augmented with a statistical shape model of the body. 12-lead ECGs were simulated on the 265 human torso/biventricular electrophysiology models, and QRS morphology, duration and amplitude were quantified in each ECG lead for each of the human torso-biventricular models.Results: QRS morphologies in limb leads are mainly determined by ventricular anatomy, while in the precordial leads, and especially V1 to V4, they are determined by heart position within the torso. Differences in ventricular orientation within the torso can explain morphological variability from monophasic to biphasic QRS complexes. QRS duration is mainly influenced by myocardial volume, while it is hardly affected by the torso anatomy or position. An average increase of 0.12 +/- 0.05 ms in QRS duration is obtained for each cm(3) of myocardial volume across all the leads while it hardly changed due to changes in torso volume.Conclusion: Computer simulations using populations of human torso/biventricular models based on clinical MRI enable quantification of anatomical causes of variability in the QRS complex of the 12-lead ECG. The human models presented also pave the way toward their use as testbeds in silico clinical trials.