A Framework for the generation of digital twins of cardiac electrophysiology from clinical 12-leads ECGs
A Framework for the generation of digital twins of cardiac electrophysiology from clinical 12-leads ECGs
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DOI：
10.1016/j.media.2021.102080
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发表时间：
2021-05-08
影响因子：
10.9
通讯作者：
Plank, Gernot
中科院分区：
文献类型：
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作者：
Gillette, Karli;Gsell, Matthias A. F.;Plank, Gernot
人类电生理学(电生理学)的心脏数字双胞胎(心脏数字双胞胎S)是患者心脏的数字复制品，来自临床数据，与所有可用的临床观察相匹配。由于其固有的预测潜力，CDT作为一种辅助手段在临床决策以及新型EP设备疗法的成本效益、安全性和伦理测试中显示出很高的前景。然而，目前CDT生成中的解剖和功能孪生阶段的工作流程，参考了从临床数据推断模型解剖和参数，对于高级临床和工业应用来说，都不够高效、健壮和准确。我们的研究通过引入以下三个主要限制来解决阻碍高保真CDT常规生成的主要限制：封装与室EP相关的所有因素的全面参数向量；模型内允许无人值守操作模型参数字段的抽象参照系；用于参数推理所需的高效和生物生理详细模拟的新型快进心电(ECG)模型。然后介绍了一种新的产生CDT的工作流程作为概念的初步验证，从临床获得的磁共振图像中对12名受试者在与临床工作流程兼容的合理时间内进行了解剖孪生。在对基本的快进心电模型与黄金标准双域心电模型进行比较后，根据临床获得的12导联心电数据，对单个受试者使用前向Salelli抽样方法进行最佳参数的功能配对。在效率和保真度方面取得的结果表明，我们的工作流非常适合和可行，可以大规模生成生物物理细节的CDT。(C)2021年作者(S)。爱思唯尔B.V.出版，这是一篇基于CC by许可证(http://creativecommons.org/licenses/by/4.0/)的开放获取文章
Cardiac digital twins (Cardiac Digital Twin (CDT)s) of human electrophysiology (Electrophysiology (EP)) are digital replicas of patient hearts derived from clinical data that match like-for-like all available clinical observations. Due to their inherent predictive potential, CDTs show high promise as a complementary modality aiding in clinical decision making and also in the cost-effective, saf e and ethical testing of novel EP device therapies. However, current workflows for both the anatomical and functional twinning phases within CDT generation, referring to the inference of model anatomy and parameters from clinical data, are not sufficiently efficient, robust and accurate for advanced clinical and industrial applications.Our study addresses three primary limitations impeding the routine generation of high-fidelity CDTs by introducing; a comprehensive parameter vector encapsulating all factors relating to the ventricular EP; an abstract reference frame within the model allowing the unattended manipulation of model parameter fields; a novel fast-forward electrocardiogram (Electrocardiogram (ECG)) model for efficient and biophysically-detailed simulation required for parameter inference. A novel workflow for the generation of CDTs is then introduced as an initial proof of concept.Anatomical twinning was performed within a reasonable time compatible with clinical workflows ( < 4h) for 12 subjects from clinically-attained magnetic resonance images. After assessment of the underlying fast forward ECG model against a gold standard bidomain ECG model, functional twinning of optimal parameters according to a clinically-attained 12 lead ECG was then performed using a forward Saltelli sampling approach for a single subject. The achieved results in terms of efficiency and fidelity demonstrate that our workflow is well-suited and viable for generating biophysically-detailed CDTs at scale.(c) 2021 The Author(s). Published by Elsevier B.V.This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )