Abstract：
Biomechanics-based patient-specific modeling is a promising approach that has proved invaluable for its clinical potential to assess the adversities caused by ischemic heart disease (IHD). In the present study, we propose a framework to find the passive material properties of the myocardium and the unloaded shape of cardiac ventricles simultaneously in patients diagnosed with ischemic cardiomyopathy (ICM). This was achieved by minimizing the difference between the simulated and the target end-diastolic pressure-volume relationships (EDPVRs) using black-box Bayesian optimization, based on the finite element analysis (FEA). End-diastolic (ED) biventricular geometry and the location of the ischemia were determined from cardiac magnetic resonance (CMR) imaging. We employed our pipeline to model the cardiac ventricles of three patients aged between 57 and 66 years, with and without the inclusion of valves. An excellent agreement between the simulated and the target EDPVRs has been reached. Our results revealed that the incorporation of valvular springs typically leads to lower hyperelastic parameters for both healthy and ischemic myocardium, as well as a higher fiber Green strain in the viable regions compared to models without valvular stiffness. Furthermore, the addition of valve-related effects did not result in significant changes in myofiber stress after optimization. We concluded that more accurate results could be obtained when cardiac valves were considered in modeling ventricles. The present novel and practical methodology paves the way for developing digital twins of ischemic cardiac ventricles, providing a non-invasive assessment for designing optimal personalized therapies in precision medicine.
摘要：
基于生物力学的患者特异性建模是一种有前途的方法，已被证明具有评估缺血性心脏病（IHD）引起的逆境的临床潜力。在本研究中,我们提出了一个框架，在诊断为缺血性心肌病（ICM）的患者中同时发现心肌的被动物质特性和心室的无负荷形状。这是通过使用黑盒贝叶斯优化最小化模拟和目标舒张末期压力-容积关系（EDPVR）之间的差异来实现的。基于有限元分析(FEA)。根据心脏磁共振（CMR）成像确定舒张末期（ED）双心室几何形状和缺血位置。我们使用我们的管道来模拟三名年龄在57至66岁之间的患者的心室，有和没有包括阀门。在模拟和目标EDPVR之间已经达到了极好的一致性。我们的结果表明，瓣膜弹簧的掺入通常会导致健康和缺血心肌的超弹性参数降低，与没有瓣膜刚度的模型相比，可行区域的纤维绿色应变也更高。此外，在优化后,添加瓣膜相关效应并没有导致肌纤维应力的显著变化.我们得出的结论是，在心室建模中考虑心脏瓣膜时，可以获得更准确的结果。本新颖实用的方法为开发缺血性心室的数字双胞胎铺平了道路。为精准医学中设计最佳个性化治疗提供非侵入性评估。
