Talk by Radomír Chabiniok

The next seminar “Modelling of materials – theory, model reduction and efficient numerical methods” will take place next Monday (December 17, 2018) in K3 from 9:00 till 10:30. The talk will be given by Radomír Chabiniok. Please see the details below.

Speaker: Radomír Chabiniok

Title: Cardiac modeling in clinical practice: Physiology, biophysics & patient-specific management

Biophysical modeling of cardiovascular system has been a very active research field in the past decades [1]. A number of sophisticated models based on physiological and physical assumptions have been created. A diligent work on mathematical analysis of complex problems, creation of efficient numerical schemes and development of computational resources allowed to conduct some significant model-validation studies. Efficient data assimilation techniques allowed to incorporate clinical data to extend the information included in the data but without modeling not accessible, and to increase the predictive capabilities of the models. Translating existing models into clinical practice is the next, and ultimately crucial step.

This task strongly depends on the interaction between clinical and modeling teams. While the clinical team characterizes the problem typically by targeting an important component in diagnosis or decision making for optimal management of a given patient the modeling team contributes by proposing the most suitable techniques to address the given question. The modeling ingredients selected must be compatible with the accuracy requested in the given problem, and the modeling framework must be in line with the time-constraint given by the clinical question. This talk will demonstrate a few examples of clinical modeling topics run between the research group M?DISIM of Inria Saclay Ile-de-France and various clinical partners.

First, the clinical application of modeling for monitoring purposes in patients under general anesthesia or at intensive care units will be presented. A direct collaboration with the Department of Anesthesia, Lariboisiere hospital in Paris, France, with two anesthetists directly included in the Inria modeling team (A. le Gall, MD full-time during his 3-year PhD project, and F. Vallee, MD, half-time) allows to advance this research towards first proof-of-concept works.
Secondly, augmenting the interpretation of clinical exams will be demonstrated on single- ventricle patients in an early-stage heart failure (HF). Such patients undergo a combined cardiovascular magnetic resonance (CMR) and heart catheterisation exam under pharmacological stress. Even such a complex data acquisition may not, however, uncover the underlying major component of their HF. Modeling shows a greatly promising tool to assist in refining the diagnosis the step prior to target the optimal treatment option. This project is pursued in the collaboration of Inria with Biomedical engineering department directly incorporated within St Thomas’ Hospital, King’s College of London, UK. A regular weekly work of an Inria researcher at St Thomas’ hospital and additional visits of a PhD candidate in the Inria lab is another example of a mode of function? of such a translational interdisciplinary research.

Finally, the problem of the optimal timing for a valve replacement therapy in patients with chronically overloaded ventricle will be discussed. It represents an example of addressing a question whether to and when to perform the intervention, and ultimately leads to a need to extend the modeling framework to capture the long-term progress of the pathology. This project is a part of an Associated research team? ToFMOD between Inria and University of Texas Southwestern Medical Center Dallas, with additional contributing partners being King’s College London, Institute for Clinical and Experimental Medicine (IKEM) and Czech Technical University in Prague. The decision was taken to confront and extend the existing long-term models with the patients with repaired Tetralogy of Fallot (rToF) as: 1) ToF is the most common complex congenital heart disease; 2) rToF patients are being followed with regular CMRs every 2-5 years (i.e. the longitudinal data of changes of the heart dilatation prior to intervention, an reverse- remodel-shrinking afterwards are possible to obtain). We believe that the knowledge gathered from the specific congenital heart disease cohort might be in addition to directly impacting the management of rToF patients partially applied in other more common acquired diseases.

All together, such presented modes of interdisciplinary work might lead to increasing a number of successful clinical applications of modelling with the ultimate goal in advancing healthcare.

Inria, M?DISIM research team, Paris-Saclay University, France
LMS, Ecole Polytechnique, CNRS, Paris-Saclay University, France
School of Biomedical Engineering and Imaging Sciences, St Thomas’ Hospital, King’s College London, UK

Literature: [1] R. Chabiniok et al.: Multi-physics and multiscale modelling, data?model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics, Interface Focus 6, 2016