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      Patient-Specific Cardiovascular Computational Modeling: Diversity of Personalization and Challenges

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          Abstract

          Patient-specific computer models have been developed representing a variety of aspects of the cardiovascular system spanning the disciplines of electrophysiology, electromechanics, solid mechanics, and fluid dynamics. These physiological mechanistic models predict macroscopic phenomena such as electrical impulse propagation and contraction throughout the entire heart as well as flow and pressure dynamics occurring in the ventricular chambers, aorta, and coronary arteries during each heartbeat. Such models have been used to study a variety of clinical scenarios including aortic aneurysms, coronary stenosis, cardiac valvular disease, left ventricular assist devices, cardiac resynchronization therapy, ablation therapy, and risk stratification. After decades of research, these models are beginning to be incorporated into clinical practice directly via marketed devices and indirectly by improving our understanding of the underlying mechanisms of health and disease within a clinical context.

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          Most cited references42

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          Preparing for precision medicine.

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            Basic mathematical and electromagnetic concepts of the biomagnetic inverse problem.

            J Sarvas (1986)
            In this paper basic mathematical and physical concepts of the biomagnetic inverse problem are reviewed with some new approaches. The forward problem is discussed for both homogeneous and inhomogeneous media. Geselowitz' formulae and a surface integral equation are presented to handle a piecewise homogeneous conductor. The special cases of a spherically symmetric conductor and a horizontally layered medium are discussed in detail. The non-uniqueness of the solution of the magnetic inverse problem is discussed and the difficulty caused by the contribution of the electric potential to the magnetic field outside the conductor is studied. As practical methods of solving the inverse problem, a weighted least-squares search with confidence limits and the method of minimum norm estimate are discussed.
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              Patient-specific modeling of cardiovascular mechanics.

              Advances in numerical methods and three-dimensional imaging techniques have enabled the quantification of cardiovascular mechanics in subject-specific anatomic and physiologic models. Patient-specific models are being used to guide cell culture and animal experiments and test hypotheses related to the role of biomechanical factors in vascular diseases. Furthermore, biomechanical models based on noninvasive medical imaging could provide invaluable data on the in vivo service environment where cardiovascular devices are employed and on the effect of the devices on physiologic function. Finally, patient-specific modeling has enabled an entirely new application of cardiovascular mechanics, namely predicting outcomes of alternate therapeutic interventions for individual patients. We review methods to create anatomic and physiologic models, obtain properties, assign boundary conditions, and solve the equations governing blood flow and vessel wall dynamics. Applications of patient-specific models of cardiovascular mechanics are presented, followed by a discussion of the challenges and opportunities that lie ahead.
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                Author and article information

                Contributors
                301-796-2486 , Richard.Gray@fda.hhs.gov
                Journal
                J Cardiovasc Transl Res
                J Cardiovasc Transl Res
                Journal of Cardiovascular Translational Research
                Springer US (New York )
                1937-5387
                1937-5395
                6 March 2018
                6 March 2018
                2018
                : 11
                : 2
                : 80-88
                Affiliations
                [1 ]ISNI 0000 0001 2243 3366, GRID grid.417587.8, Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, , Food and Drug Administration, ; Silver Spring, MD 20993 USA
                [2 ]Silver Spring, USA
                Author notes

                Associate Editor Jeffrey W. Holmes oversaw the review of this article

                Article
                9792
                10.1007/s12265-018-9792-2
                5908828
                29512059
                1a6d8a3c-af22-42e5-aa74-a162a1442ed3
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 13 December 2017
                : 2 February 2018
                Categories
                Review
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2018

                Cardiovascular Medicine
                computer modeling,patient-specific,precision medicine
                Cardiovascular Medicine
                computer modeling, patient-specific, precision medicine

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