In Silico Clinical Trials for Cardiovascular Disease

Summary

This protocol demonstrates the workflow of the SILICOFCM platform for automatically generating a parametric model of the left ventricle from patient-specific ultrasound images by applying a multi-scale electromechanical model of the heart. This platform enables in silico clinical trials intended to reduce real clinical trials and maximize positive therapeutic outcomes.

Abstract

The SILICOFCM project mainly aims to develop a computational platform for in silico clinical trials of familial cardiomyopathies (FCMs). The unique characteristic of the platform is the integration of patient-specific biological, genetic, and clinical imaging data. The platform allows the testing and optimization of medical treatment to maximize positive therapeutic outcomes. Thus, adverse effects and drug interactions can be avoided, sudden cardiac death can be prevented, and the time between the commencement of drug treatment and the desired result can be shortened. This article presents a parametric model of the left ventricle automatically generated from patient-specific ultrasound images by applying an electromechanical model of the heart. Drug effects were prescribed through specific boundary conditions for inlet and outlet flow, ECG measurements, and calcium function for heart muscle properties. Genetic data from patients were incorporated through the material property of the ventricle wall. Apical view analysis involves segmenting the left ventricle using a previously trained U-net framework and calculating the bordering rectangle based on the length of the left ventricle in the diastolic and systolic cycle. M-mode view analysis includes bordering of the characteristic areas of the left ventricle in the M-mode view. After extracting the dimensions of the left ventricle, a finite elements mesh was generated based on mesh options, and a finite element analysis simulation was run with user-provided inlet and outlet velocities. Users can directly visualize on the platform various simulation results such as pressure-volume, pressure-strain, and myocardial work-time diagrams, as well as animations of different fields such as displacements, pressures, velocity, and shear stresses.

Introduction

The rapid development of information technologies, simulation software packages, and medical devices in recent years provides the opportunity for collecting a large amount of clinical information. Creating comprehensive and detailed computational tools has, therefore, become essential to process specific information from the abundance of available data.

From the physicians' point of view, it is of paramount importance to distinguish "normal" versus "abnormal" phenotypes in a specific patient to estimate disease progression, therapeutic responses, and future risks. Recent computational models have significantly improved t....

Protocol

The protocol in this study was approved by the UK National Health Service Health Research Authority North East-Tyne & Wear South Research Ethics Committee with the reference number 18/NE/0318 on 6 February 2019 and was adopted by the Institutional Review Board of each participating center. The study was conducted within the principles of Good Clinical Practice and following the Declaration of Helsinki. Informed consent was obtained from all subjects involved in the study. The patient information is kept anonymous.

1. Workflow for ultrasound M-mode or Apical view DICOM image analysis and LV parameter extraction

Results

As an example, the workflow for ultrasound M-mode DICOM image analysis and LV parameter extraction is presented in Figure 1. M-mode and apical view could be tested separately or one after another, depending on the parameters of interest. If tested one after another, the results are appended to one common file (separately for systole and diastole phases). If only one view is tested, the values for unknown parameters are taken from the default file input.txt (Figu.......

Discussion

The SILICOFCM project is an in silico clinical trials platform to design virtual patient populations for risk prediction, testing the effects of pharmacological treatment, and reducing animal experiments and human clinical trials. Testing the effects of pharmacological treatment was modeled with prescribed inlet/outlet boundary flow conditions, calcium function, and material wall properties. This platform integrates multiscale methods on the sarcomeric level with whole-heart performance and the functional optimi.......

Materials

Name	Company	Catalog Number	Comments
SILICOFCM project		www.silicofcm.eu	open access for registered users