Background-Coronary blood flow peaks in diastole when aortic blood pressure has fallen. Current models fail to completely explain this phenomenon. We present a new approach-using wave intensity analysis-to explain this phenomenon in normal subjects and to evaluate the effects of left ventricular hypertrophy (LVH). Method and Results-We measured simultaneous pressure and Doppler velocity with intracoronary wires in the left main stem, left anterior descending, and circumflex arteries of 20 subjects after a normal coronary arteriogram. Wave intensity analysis was used to identify and quantify individual pressure and velocity waves within the coronary artery circulation.A consistent pattern of 6 predominating waves was identified. Ninety-four percent of wave energy, accelerating blood forward along the coronary artery, came from 2 waves: first a pushing wave caused by left ventricular ejection-the dominant forward-traveling pushing wave; and later a suction wave caused by relief of myocardial microcirculatory compression-the dominant backward-traveling suction wave. The dominant backward-traveling suction wave (18.2Ϯ13.7ϫ10 3 W m Ϫ2 s

The augmentation index predicts cardiovascular mortality and is usually explained as a distally reflected wave adding to the forward wave generated by systole. We propose that the capacitative properties of the aorta (the arterial reservoir) also contribute significantly to the augmentation index and have calculated the contribution of the arterial reservoir, independently of wave reflection, and assessed how these contributions change with aging. In 15 subjects (aged 53 ± 10 yr), we measured pressure and Doppler velocity simultaneously in the proximal aorta using intra-arterial wires. We calculated the components of augmentation pressure in two ways: 1) into forward and backward (reflected) components by established separation methods, and 2) using an approach that accounts for an additional reservoir component. When the reservoir was ignored, augmentation pressure (22.7 ± 13.9 mmHg) comprised a small forward wave (peak pressure = 6.5 ± 9.4 mmHg) and a larger backward wave (peak pressure = 16.2 ± 7.6 mmHg). After we took account of the reservoir, the contribution to augmentation pressure of the backward wave was reduced by 64% to 5.8 ± 4.4 mmHg (P < 0.001), forward pressure was negligible, and reservoir pressure was the largest component (peak pressure = 19.8 ± 9.3 mmHg). With age, reservoir pressure increased progressively (9.9 mmHg/decade, r = 0.69, P < 0.001). In conclusion, the augmentation index is principally determined by aortic reservoir function and other elastic arteries and only to a minor extent by reflected waves. Reservoir function rather than wave reflection changes markedly with aging, which accounts for the age-related changes in the aortic pressure waveform.

Abstract. Alya is a multi-physics simulation code developed at Barcelona Supercomputing Center (BSC). From its inception Alya code is designed using advanced High Performance Computing programming techniques to solve coupled problems on supercomputers efficiently. The target domain is engineering, with all its particular features: complex geometries and unstructured meshes, coupled multi-physics with exotic coupling schemes and physical models, ill-posed problems, flexibility needs for rapidly including new models, etc. Since its beginnings in 2004, Alya has scaled well in an increasing number of processors when solving single-physics problems such as fluid mechanics, solid mechanics, acoustics, etc. Over time, we have made a concerted effort to maintain and even improve scalability for multi-physics problems. This poses challenges on multiple fronts, including: numerical models, parallel implementation, physical coupling models, algorithms and solution schemes, meshing process, etc. In this paper, we introduce Alya's main features and focus particularly on its solvers. We present Alya's performance up to 100.000 processors in Blue Waters, the NCSA supercomputer with selected multi-physics tests that are representative of the engineering world. The tests are incompressible flow in a human respiratory system, low Mach combustion problem in a kiln furnace, and coupled electro-mechanical contraction of the heart. We show scalability plots for all cases and discuss all aspects of such simulations, including solver convergence.Key words. Multi-physics coupling, Parallelisation, Computational Mechanics 1. Introduction. Across a range of engineering fields, the use of computational models is pervasive in the whole design and manufacturing process. In complex systems, High Performance Computing (HPC) plays an essential role in simulation and modelling. Researchers and manufacturing teams depend on HPC to create safe cars and energy-efficient aircraft as well as effective communication systems and efficient supply chain models. Availability of advanced HPC technologies has also fundamentally altered the investigative paradigm in the field of biomechanics. But paradoxically, for many engineers and researchers, the existing hardware and software cannot be used to solve their problems. There are many reasons why this happens, but we focus here in only two. On one hand, current HPC systems lack the computational power, network bandwidth and data storage needed for solving tomorrow's real-world engineering challenges. On the other hand, while emerging peta-scale computing is already a strategic enabler of large-scale simulations in many scientific areas (such as astronomy, biology and chemistry), even the most powerful hardware will fail to deliver on its full potential unless matched with simulation software designed specifically for such environments.Several papers describe the effort of performing large-scale simulations on supercomputers, covering key areas: molecular dynamics [26], mantle convection in solid earth dynami...

The development and clinical use of patient-specific models of the heart is now a feasible goal. Models have the potential to aid in diagnosis and support decision-making in clinical cardiology. Several groups are now working on developing multi-scale models of the heart for understanding therapeutic mechanisms and better predicting clinical outcomes of interventions such as cardiac resynchronization therapy. Here we describe the methodology for generating a patient-specific model of the failing heart with a myocardial infarct and left ventricular bundle branch block. We discuss some of the remaining challenges in developing reliable patient-specific models of cardiac electromechanical activity, and identify some of the main areas for focusing future research efforts. Key challenges include: efficiently generating accurate patient-specific geometric meshes and mapping regional myofiber architecture to them; modeling electrical activation patterns based on cellular alterations in human heart failure, and estimating regional tissue conductivities based on clinically available electrocardiographic recordings; estimating unloaded ventricular reference geometry and material properties for biomechanical simulations; and parameterizing systemic models of circulatory dynamics from available hemodynamic measurements.

Abstract-Wave reflection is thought to be important in the augmentation of blood pressure. However, identification of distal reflections sites remains unclear. One possible explanation for this is that wave reflection is predominately determined by an amalgamation of multiple proximal small reflections rather than large discrete reflections originating from the distal peripheries. In 19 subjects (age, 35-73 years), sensor-tipped intra-arterial wires were used to measure pressure and Doppler velocity at 10-cm intervals along the aorta, starting at the aortic root. Incident and reflected waves were identified and timings and magnitudes quantified using wave intensity analysis. Mean wave speed increased along the length of the aorta (proximal, 6.8Ϯ0.9 m/s; distal, 10.7Ϯ1.5 m/s). The incident wave was tracked moving along the aorta, taking 55Ϯ4 ms to travel from the aortic root to the distal aorta. However, the timing to the refection site distance did not differ between proximal and distal aortic measurement sites (proximal aorta, 48Ϯ5 ms versus distal aorta, 42Ϯ4 ms; Pϭ0.3). We performed a second analysis using aortic waveforms in a nonlinear model of pulse-wave propagation. This demonstrated very similar results to those observed in vivo and also an exponential attenuation in reflection magnitude. There is no single dominant refection site in or near the distal aorta. Rather, there are multiple reflection sites along the aorta, for which the contributions are attenuated with distance. We hypothesize that rereflection of reflected waves leads to wave entrapment, preventing distal waves being seen in the proximal aorta. Key Words: pressure augmentation Ⅲ pulse wave propagation Ⅲ wave reflection Ⅲ aging and disease Ⅲ 1D modeling Ⅲ wave tracking Ⅲ pulse wave velocity Ⅲ augmentation index W ave reflection is thought to be an important mechanism of augmentation of blood pressure with aging and in disease. This hypothesis assumes that the forward-traveling (incident) wave from cardiac ejection is reflected back toward the heart at sites of impedance mismatch. Several investigators have tried to identify the principal reflection locations, based on estimates of wave speed and time of return of the reflected wave, usually arriving at differing conclusions. [1][2][3][4] Others have taken an alternative approach, instead, identifying changes in aortic composition or aortic diameter as being most important in the determination of reflection sites. Furthermore, a recent meta-analysis has found that reflection timing changes little with aging (despite the expected increases in pulse wave velocity), supporting the findings from the Framingham Study, which showed a lengthening of distance to an apparent reflection site with aging. 5,6 One explanation for these findings is that the reflection site is not fixed but is dynamically determined by sites of impedance mismatch, tapering, and composition of the aorta.We set out to explore this by measuring incident and reflected waves along the aorta to quantify how the reflected wave ti...

In this work, we present a fully coupled fluid-electro-mechanical model of a 50th percentile human heart. The model is implemented on Alya, the BSC multi-physics parallel code, capable of running efficiently in supercomputers. Blood in the cardiac cavities is modeled by the incompressible Navier-Stokes equations and an arbitrary Lagrangian-Eulerian (ALE) scheme. Electrophysiology is modeled with a monodomain scheme and the O'Hara-Rudy cell model. Solid mechanics is modeled with a total Lagrangian formulation for discrete strains using the Holzapfel-Ogden cardiac tissue material model. The three problems are simultaneously and bidirectionally coupled through an electromechanical feedback and a fluid-structure interaction scheme. In this paper, we present the scheme in detail and propose it as a computational cardiac workbench.

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Background: In the era of increasingly successful corrective interventions in patients with congenital heart disease (CHD), global and regional myocardial remodeling are emerging as important sources of long-term morbidity/mortality. Changes in organization of the myocardium in CHD, and in its mechanical properties, conduction, and blood supply, result in altered myocardial function both before and after surgery. To gain a better understanding and develop appropriate and individualized treatment strategies, the microscopic organization of cardiomyocytes, and their integration at a macroscopic level, needs to be completely understood. The aim of this study is to describe, for the first time, in 3 dimensions and nondestructively the detailed remodeling of cardiac microstructure present in a human fetal heart with complex CHD. Methods and Results: Synchrotron X-ray phase-contrast imaging was used to image an archival midgestation formalin-fixed fetal heart with right isomerism and complex CHD and compare with a control fetal heart. Analysis of myocyte aggregates, at detail not accessible with other techniques, was performed. Macroanatomic and conduction system changes specific to the disease were clearly observable, together with disordered myocyte organization in the morphologically right ventricle myocardium. Electrical activation simulations suggested altered synchronicity of the morphologically right ventricle. Conclusions: We have shown the potential of X-ray phase-contrast imaging for studying cardiac microstructure in the developing human fetal heart at high resolution providing novel insight while preserving valuable archival material for future study. This is the first study to show myocardial alterations occur in complex CHD as early as midgestation.