Computational models of ventricular mechanics and adaptation in response to right-ventricular pressure overload

Abstract

Pulmonary arterial hypertension (PAH) is associated with substantial remodeling of the right ventricle (RV), which may at first be compensatory but at a later stage becomes detrimental to RV function and patient survival. Unlike the left ventricle (LV), the RV remains understudied, and with its thin-walled crescent shape, it is often modeled simply as an appendage of the LV. Furthermore, PAH diagnosis is challenging because it often leaves the LV and systemic circulation largely unaffected. Several treatment strategies such as atrial septostomy, right ventricular assist devices (RVADs) or RV resynchronization therapy have been shown to improve RV function and the quality of life in patients with PAH. However, evidence of their long-term efficacy is limited and lung transplantation is still the most effective and curative treatment option. As such, the clinical need for improved diagnosis and treatment of PAH drives a strong need for increased understanding of drivers and mechanisms of RV growth and remodeling (G&R), and more generally for targeted research into RV mechanics pathology. Computational models stand out as a valuable supplement to experimental research, offering detailed analysis of the drivers and consequences of G&R, as well as a virtual test bench for exploring and refining hypotheses of growth mechanisms. In this review we summarize the current efforts towards understanding RV G&R processes using computational approaches such as reduced-order models, three dimensional (3D) finite element (FE) models, and G&R models. In addition to an overview of the relevant literature of RV computational models, we discuss how the models have contributed to increased scientific understanding and to potential clinical treatment of PAH patients.

A perfectly imperfect engine: Utilizing the digital twin paradigm in pulmonary hypertension

“…Omics and image data, 84 HIF, 85 general intracellular, 86 NO, 87 metabolism 27 Intercellular Angiogenesis, 88,89 extracellular matrix remodeling 90 Physics/flow dynamics Pulmonary circulation (pulmonary hypertension [PH]), 91 cardiac hypertrophy, 92 neonatal PH, 93 ventricular mechanics 94 Prognosis Pulmonary system, 95 drug combinations cancer, 96 nanoparticle drug delivery cancer 97 Clinical trials In silico trials, 98 drug design 99 Mathematical model…”

Advancing clinical translation of cardiac biomechanics models: a comprehensive review, applications and future pathways

“…This integration was the focus of the review by Bracamonte et al [5], that is, on patient-specific inverse modelling. Several authors have summarised the main challenges of modelling cardiovascular mechanics, restricting their reviews to specific aspects of cardiac biomechanics, such as multiscale modelling [6] or computational models of specific pathologies [7][8][9].…”

A computational study of right ventricular mechanics in a rat model of pulmonary arterial hypertension

“…Despite the link between RV function and patient survival in PAH, there has been limited research attention given to RV remodeling compared to LV remodeling in systemic hypertension ( Odeigah et al, 2022 ). This limited research has created a knowledge gap in regards to our understanding of how PAH-induced remodeling affects RV function.…”