Physical-Statistical Modeling and Optimization of Cardiovascular Systems

Heart disease remains the No.1 leading cause of death in U.S. and in the world. To improve cardiac care services, there is an urgent need of developing early diagnosis of heart diseases and optimal intervention strategies. As such, it calls upon a better understanding of the pathology of heart diseases. Computer simulation and modeling have been widely applied to overcome many practical and ethical limitations in in-vivo, ex-vivo, and whole-animal experiments. Computer experiments provide physiologists and cardiologists an indispensable tool to characterize, model and analyze cardiac function both in healthy and in diseased heart. Most importantly, simulation modeling empowers the analysis of causal relationships of cardiac dysfunction from ion channels to the whole heart, which physical experiments alone cannot achieve. Growing evidences show that aberrant glycosylation have dramatic influence on cardiac and neuronal function. Variable but modest reduction in glycosylation among congenital disorders of glycosylation (CDG) subtypes has multi-system effects leading to a high infant mortality rate. In addition, CDG in all young patients tends to cause Atrial Fibrillation (AF), i.e., the most common sustained cardiac arrhythmia. The mortality rate from AF has been increasing in the past two decades. Due to the increasing healthcare burden of AF, studying the AF mechanisms and developing optimal ablation strategies are now urgently needed. Very little is known about how glycosylation modulates cardiac electrical signaling. It is also a significant challenge to experimentally connect the changes at one organizational level (e.g.,electrical conduction among cardiac tissue) to measured changes at another organizational level (e.g., ion channels). In this study, we integrate the data from in vitro experiments with in-silico models to simulate the effects of reduced glycosylation on the gating kinetics of cardiac ion channel, i.e., hERG channels, Na+ channels, K+ channels, and to predict the glycosylation modulation dynamics in individual cardiac cells and tissues. The complex gating kinetics of Na+ channels is modeled with a 9-state Markov model that have voltage-dependent transition rates of exponential forms. The model calibration is quite a challenge as the Markov model is non-linear, non-convex, ill-posed, and has a large parametric space. We developed a new metamodel-based simulation optimization approach for calibrating the model with the in-vitro experimental data. This proposed algorithm is shown to be efficient in learning the Markov model of Na+ model. Moreover, it can be easily transformed and applied to many other optimization problems in computer modeling. In addition, the understanding of AF initiation and maintenance has remained sketchy at best. One salient problem is the inability to interpret intracardiac recordings, which prevents us from reconstructing the rhythmic mechanisms for AF, due to multiple wavelets\u27 circulating, clashing and continuously changing direction in the atria. We are designing computer experiments to simulate the single/multiple activations on atrial tissues and the corresponding intra-cardiac signals. This research will create a novel computer-aided decision support tool to optimize AF ablation procedures