Hemodynamic Phenotypes of Hypertension Based on Cardiac Output and Systemic Vascular Resistance
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Mahajan, Shiwani (ORCID:000000025617489X)↗
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Mock circulatory loop generated database for dynamic characterization of pressure-based cardiac output monitoring systems
Not Available
Farahmand, Masoud (ORCID:0000000271401958)↗
EMD-57033 Augments the Contractility in Porcine Myocardium by Promoting the Activation of Myosin in Thick Filaments
Sufficient cardiac contractility is necessary to ensure the sufficient cardiac output to provide an adequate end-organ perfusion. Inadequate cardiac output and the diminished perfusion of vital organs from depressed myocardium contractility is a hallmark end-stage of heart failure. There are no available therapeutics that directly target contractile proteins to improve the myocardium contractility and reduce mortality. The purpose of this study is to present a proof of concept to aid in the development of muscle activators (myotropes) for augmenting the contractility in clinical heart failure. Here we use a combination of cardiomyocyte mechanics, the biochemical quantification of the ATP turnover, and small angle X-ray diffraction on a permeabilized porcine myocardium to study the mechanisms of EMD-57033 (EMD) for activating myosin. We show that EMD increases the contractility in a porcine myocardium at submaximal and systolic calcium concentrations. Biochemical assays show that EMD decreases the proportion of myosin heads in the energy sparing super-relaxed (SRX) state under relaxing conditions, which are less likely to interact with actin during contraction. Structural assays show that EMD moves the myosin heads in relaxed muscles from a structurally ordered state close to the thick filament backbone, to a disordered state closer to the actin filament, while simultaneously inducing structural changes in the troponin complex on the actin filament. The dual effects of EMD on activating myosin heads and the troponin complex provides a proof of concept for the use of small molecule muscle activators for augmenting the contractility in heart failure.
59 BASIC BIOLOGICAL SCIENCES↗
Myosin in autoinhibited off state(s), stabilized by mavacamten, can be recruited in response to inotropic interventions
Mavacamten is a FDA-approved small-molecule therapeutic designed to regulate cardiac function at the sarcomere level by selectively but reversibly inhibiting the enzymatic activity of myosin. It shifts myosin toward ordered off states close to the thick filament backbone. It remains elusive whether these myosin heads in the off state(s) can be recruited in response to physiological stimuli when required to boost cardiac output. We show that cardiac myosins stabilized in these off state(s) by mavacamten are recruitable by 1) Ca 2+ , 2) increased chronotropy [heart rate (HR)], 3) stretch, and 4) β-adrenergic (β-AR) stimulation, all known physiological inotropic interventions. At the molecular level, we show that Ca 2+ increases myosin ATPase activity by shifting mavacamten-stabilized myosin heads from the inactive super-relaxed state to the active disordered relaxed state. At the myofilament level, both Ca 2+ and passive lengthening can shift mavacamten-ordered off myosin heads from positions close to the thick filament backbone to disordered on states closer to the thin filaments. In isolated rat cardiomyocytes, increased stimulation rates enhanced shortening fraction in mavacamten-treated cells. This observation was confirmed in vivo in telemetered rats, where left-ventricular dP/dt max , an index of inotropy, increased with HR in mavacamten-treated animals. Finally, we show that β-AR stimulation in vivo increases left-ventricular function and stroke volume in the setting of mavacamten. Our data demonstrate that the mavacamten-promoted off states of myosin in the thick filament are at least partially activable, thus preserving cardiac reserve mechanisms.
59 BASIC BIOLOGICAL SCIENCES↗
Model-based approach to investigate equipment-induced error in pressure-waveform derived hemodynamic measurements
Advanced hemodynamic monitoring systems have provided less invasive methods for estimating pressure-derived measurements such as pressure-derived cardiac output (CO) measurements. These devices apply algorithms to arterial pressure waveforms recorded via pressure recording components that transmit the pressure signal to a pressure monitor. While standards have been developed for pressure monitoring equipment, it is unclear how the equipment-induced error can affect secondary measurements from pressure waveforms. We propose an approach for modelling different components of a pressure monitoring system and use this model-based approach to investigate the effect of different pressure recording configurations on pressure-derived hemodynamic measurements. The proposed model-based approach is a three-step process. (1) Modelling the response of pressure recording components using bench tests; (2) verifying the identified models through nonparametric equivalence tests; and (3) assessing the effects of pressure recording components on pressure-derived measurements. To delineate the application of this approach, we performed a series of model-based analyses to quantify the combined effect of a wide range of tubing configurations with various damping ratios and natural frequencies and monitors with different bandwidths on pressure waveforms and CO measurements by six pulse contour algorithms. Model-based results show the error in pressure-derived CO measurements because of tubing configurations with different natural frequencies and damping ratios. Tubing configurations with low natural frequencies (<23 Hz) altered characteristics of pressure waveforms in a way that affected the CO measurement, some by as much as 20%. Our method can serve as a tool to quantify the performance of pressure recording systems with different dynamic properties. In conclusion, this approach can be applied to investigate the effects of physiologic signal recording configurations on various pressure-derived hemodynamic measurements.
42 ENGINEERING↗
Acute total body ionizing gamma radiation induces long-term adverse effects and immediate changes in cardiac protein oxidative carbonylation in the rat
Radiation-induced heart disease presents a significant challenge in the event of an accidental radiation exposure as well as to cancer patients who receive acute doses of irradiation as part of radiation therapy. We utilized the spontaneously hypertensive Wistar-Kyoto rat model, previously shown to demonstrate drug-induced cardiomyopathy, to evaluate the acute and long-term effects of sub-lethal total body gamma irradiation at two, four, and fiftytwo weeks. We further examined irreversible oxidative protein carbonylation in the heart immediately following irradiation in the normotensive Wistar-Kyoto rat. Both males and females sustained weight loss and anemic conditions compared to untreated controls over a one-year period as reflected by reduced body weight and low red blood cell count. Increased inflammation was detected by elevated IL-6 serum levels selectively in males at four weeks. Serum cardiac troponin T and I analyses revealed signs of cardiomyopathy at earlier timepoints, but high variability was observed, especially at one year. Echocardiography at two weeks following 5.0Gy treatment revealed a significant decrease in cardiac output in females and a significant decrease in both diastolic and systolic volumes in males. Following 10.0Gy irradiation in the normotensive Wistar-Kyoto rat, the heart tissue showed an increase in total protein oxidative carbonylation accompanied by DNA damage indicated by an increase in γ-H2AX. Using proteomic analyses, we identified several novel proteins which showed a marked difference in carbonylation including those of mitochondrial origin and most notably, cardiac troponin T, one of the key proteins involved in cardiomyocyte contractility. Overall, we present findings of acute oxidative protein damage, DNA damage, cardiac troponin T carbonylation, and long-term cardiomyopathy in the irradiated animals.
59 BASIC BIOLOGICAL SCIENCES↗
A physiologically based pharmacokinetic (PBPK) model to align dosimetry of the isobutyl metabolic series in rats and humans
Here, we developed a physiologically based pharmacokinetic (PBPK) model in rats and humans for the isobutyl metabolic series including isobutyl acetate, isobutanol, isobutyraldehyde, and isobutyric acid. Chemical manufactures routinely use these compounds as solvents, for chemical synthesis, as potential biofuels, de-icing fluids, and additives for food and/or fragrance in consumer products. Human exposure to isobutyl compounds can occur through inhalation or oral routes. We previously developed a PBPK model for the propyl metabolic series and utilized it as a framework to create the isobutyl PBPK model due to the chemical similarities between the two series. To support model development, we measured in vitro metabolism of isobutyl acetate in rat and human blood and liver S9 fractions. Compared to rats, humans demonstrated faster isobutyl acetate hydrolysis in liver S9 fractions, while the hydrolysis rates in blood were similar between the two species. We used concentrations of isobutyl compounds measured in air and blood from rats exposed to isobutyl acetate and isobutanol as well as other published data to further parameterize the model. Following exposure to either isobutyl acetate or isobutanol, we observed isobutanol concentrations highest among the isobutyl compounds in the blood of rats. Overall, the model accurately predicts measured time course concentrations of isobutyl acetate, isobutanol, and isobutyric acid in available data in rats and humans. Sensitivity analyses identified alveolar ventilation rates, isobutyl metabolism rates, and cardiac output as the most sensitive parameters affecting concentrations of isobutyl compounds in blood. The isobutyl PBPK model enables comparisons of internal dose metrics across various isobutyl compound exposures and species and allows for calculation of equivalent external exposures that result in the same dose metric. Regulators can employ this PBPK model to predict and align internal dose metrics of isobutyl compounds for risk assessment purposes.
2-methyl-1-propanol↗
Pre-Symptomatic COVID Screening
Temperature checks for fever are extensively used for preliminary COVID screenings but are ineffective during the incubation stage of infection when a person is asymptotic. Researchers at the European Centre for Disease Prevention and Control concluded that approximately 75% of passengers infected with COVID-19 and traveling from affected Chinese cities would not be detected by early screening. Core body temperature is normally kept within a narrow range and has the smallest relative standard deviation of all vital signs. Heat in the body is prioritized around internal organs at the expense of the periphery by controlling blood flow. In fact, blood flow to the skin may vary by a factor of 100 depending on thermal conditions. This adaptation causes rapid temperature fluctuations in different skin regions from changes in cardiac output, metabolism, and likely cytokine diffusion during inflammation that would not be seen in average core body temperature. Current IR and thermal scanners used for temperature checks are not necessarily reflective of core body temperatures and require cautious interpretation as they frequently result in false positive and false negative diagnosis. Hand held thermometers measure average skin temperatures and can get readings that differ from core body temperature by as much as 7°. Rather than focusing on a core body temperature threshold assessment we believe that variability of temperature patterns using a novel wearable transdermal microneedle sensor will be more sensitive to infections in the incubation stage and propose to develop a wearable transdermal temperature sensor using established Sandia microneedle technology for pre-symptomatic COVID screening that can additionally be used to monitor disease progression at later stages.
47 OTHER INSTRUMENTATION↗
Pre Symptomatic COVID Screening
Temperature checks for fever are extensively used for preliminary COVID screenings but are ineffective during the incubation stage of infection when a person is asymptotic. Researchers at the European Centre for Disease Prevention and Control concluded that approximately 75% of passengers infected with COVID-19 and traveling from affected Chinese cities would not be detected by early screening. Core body temperature is normally kept within a narrow range and has the smallest relative standard deviation of all vital signs. Heat in the body is prioritized around internal organs at the expense of the periphery by controlling blood flow. In fact, blood flow to the skin may vary by a factor of 100 depending on thermal conditions. This adaptation causes rapid temperature fluctuations in different skin regions from changes in cardiac output, metabolism, and likely cytokine diffusion during inflammation that would not be seen in average core body temperature. Current IR and thermal scanners used for temperature checks are not necessarily reflective of core body temperatures and require cautious interpretation as they frequently result in false positive and false negative diagnosis. Hand held thermometers measure average skin temperatures and can get readings that differ from core body temperature by as much as 7°. Rather than focusing on a core body temperature threshold assessment we believe that variability of temperature patterns using a novel wearable transdermal microneedle sensor will be more sensitive to infections in the incubation stage and propose to develop a wearable transdermal temperature sensor using established Sandia microneedle technology for pre symptomatic COVID screening that can additionally be used to monitor disease progression at later stages.
59 BASIC BIOLOGICAL SCIENCES↗
Design and execution of a verification, validation, and uncertainty quantification plan for a numerical model of left ventricular flow after LVAD implantation
Left ventricular assist devices (LVADs) are implantable pumps that act as a life support therapy for patients with severe heart failure. Despite improving the survival rate, LVAD therapy can carry major complications. Particularly, the flow distortion introduced by the LVAD in the left ventricle (LV) may induce thrombus formation. While previous works have used numerical models to study the impact of multiple variables in the intra-LV stagnation regions, a comprehensive validation analysis has never been executed. The main goal of this work is to present a model of the LV-LVAD system and to design and follow a verification, validation and uncertainty quantification (VVUQ) plan based on the ASME V&V40 and V&V20 standards to ensure credible predictions. The experiment used to validate the simulation is the SDSU cardiac simulator, a bench mock-up of the cardiovascular system that allows mimicking multiple operation conditions for the heart-LVAD system. The numerical model is based on Alya, the BSC’s in-house platform for numerical modelling. Alya solves the Navier-Stokes equation with an Arbitrary Lagrangian-Eulerian (ALE) formulation in a deformable ventricle and includes pressure-driven valves, a 0D Windkessel model for the arterial output and a LVAD boundary condition modeled through a dynamic pressure-flow performance curve. The designed VVUQ plan involves: (a) a risk analysis and the associated credibility goals; (b) a verification stage to ensure correctness in the numerical solution procedure; (c) a sensitivity analysis to quantify the impact of the inputs on the four quantities of interest (QoIs) (average aortic root flow $Q^{avg}_{Ao}$, maximum aortic root flow $Q^{max}_{Ao}$, average LVAD flow $Q^{avg}_{VAD}$, and maximum LVAD flow $Q^{max}_{VAD}$; (d) an uncertainty quantification using six validation experiments that include extreme operating conditions. Numerical code verification tests ensured correctness of the solution procedure and numerical calculation verification showed a grid convergence index (GCI)95% <3.3%. The total Sobol indices obtained during the sensitivity analysis demonstrated that the ejection fraction, the heart rate, and the pump performance curve coefficients are the most impactful inputs for the analysed QoIs. The Minkowski norm is used as validation metric for the uncertainty quantification. It shows that the midpoint cases have more accurate results when compared to the extreme cases. The total computational cost of the simulations was above 100 [core-years] executed in around three weeks time span in Marenostrum IV supercomputer. This work details a novel numerical model for the LV-LVAD system, that is supported by the design and execution of a VVUQ plan created following recognised international standards. We present a methodology demonstrating that stringent VVUQ according to ASME standards is feasible but computationally expensive.
59 BASIC BIOLOGICAL SCIENCES↗
Personalized and uncertainty-aware coronary hemodynamics simulations: From Bayesian estimation to improved multi-fidelity uncertainty quantification
Non-invasive simulations of coronary hemodynamics have improved clinical risk stratification and treatment outcomes for coronary artery disease, compared to relying on anatomical imaging alone. However, simulations typically use empirical approaches to distribute total coronary flow amongst the arteries in the coronary tree, which ignores patient variability, the presence of disease, and other clinical factors. Further, uncertainty in the clinical data often remains unaccounted for in the modeling pipeline. We present an end-to-end uncertainty-aware pipeline to (1) personalize coronary flow simulations by incorporating vessel-specific coronary flows as well as cardiac function; and (2) predict clinical and biomechanical quantities of interest with improved precision, while accounting for uncertainty in the clinical data. We assimilate patient-specific measurements of myocardial blood flow from clinical CT myocardial perfusion imaging to estimate branch-specific coronary artery flows. Simulated noise in the clinical data is used to estimate the joint posterior distributions of the model parameters using adaptive Markov Chain Monte Carlo sampling. Additionally, the posterior predictive distribution for the relevant quantities of interest is determined using a new approach combining multi-fidelity Monte Carlo estimation with non-linear, data-driven dimensionality reduction. This leads to improved correlations between high- and low-fidelity model outputs. Our framework accurately recapitulates clinically measured cardiac function as well as branch-specific coronary flows under measurement noise uncertainty. We observe substantial reductions in confidence intervals for estimated quantities of interest compared to single-fidelity Monte Carlo estimation and state-of-the-art multi-fidelity Monte Carlo methods. This holds especially true for quantities of interest that showed limited correlation between the low- and high-fidelity model predictions. In addition, the proposed multi-fidelity Monte Carlo estimators are significantly cheaper to compute than traditional estimators, under a specified confidence level or variance. The proposed pipeline for personalized and uncertainty-aware predictions of coronary hemodynamics is based on routine clinical measurements and recently developed techniques for CT myocardial perfusion imaging. The proposed pipeline offers significant improvements in precision and reduction in computational cost.
Bayesian parameter estimation↗
Machine learning based reconstruction of intracardiac electrical behavior based on electrocardiograms
A computer-based system and process are disclosed for reconstructing the internal electrical behavior of a patient's heart based partly or wholly on the patient's electrocardiogram (ECG). The output of the process may include, for example, a cardiac activation map, and/or a representation of transmembrane potentials over time. The process advantageously does not require any medical imaging of the patient, and does not require any special medical equipment. For example, the patient's activation map and transmembrane potentials may be reconstructed based solely on a preexisting or newly-obtained 12-lead cardiac ECG of the patient. The process makes use of a machine learning model, such as a neural network based model, trained with actual and/or simulated ECGs and intracardiac electrical data (typically transmembrane potentials) of many thousands of patients. Because an insufficient quantity of such data exists for actual patients, model training may be performed using ECGs and intracardiac electrical data obtained through computer simulations.
Blake, Robert↗
Myosin dilated cardiomyopathy mutation S532P disrupts actomyosin interactions, leading to altered muscle kinetics, reduced locomotion, and cardiac dilation in Drosophila
Dilated cardiomyopathy (DCM), a life-threatening disease characterized by pathological heart enlargement, can be caused by myosin mutations that reduce contractile function. To better define the mechanistic basis of this disease, we employed the powerful genetic and integrative approaches available in Drosophila melanogaster. To this end, we generated and analyzed the first fly model of human myosin–induced DCM. The model reproduces the S532P human β-cardiac myosin heavy chain DCM mutation, which is located within an actin-binding region of the motor domain. In concordance with the mutation’s location at the actomyosin interface, steady-state ATPase and muscle mechanics experiments revealed that the S532P mutation reduces the rates of actin-dependent ATPase activity and actin binding and increases the rate of actin detachment. The depressed function of this myosin form reduces the number of cross-bridges during active wing beating, the power output of indirect flight muscles, and flight ability. Further, S532P mutant hearts exhibit cardiac dilation that is mutant gene dose–dependent. Our study shows that Drosophila can faithfully model various aspects of human DCM phenotypes and suggests that impaired actomyosin interactions in S532P myosin induce contractile deficits that trigger the disease.
59 BASIC BIOLOGICAL SCIENCES↗