Computational models in cardiology

• Published in: Nature reviews cardiology 2019-02, Vol.16 (2), p.100-111
• Main Authors: Niederer, Steven A., Lumens, Joost, Trayanova, Natalia A.
• Format: Article
• Language: English
• Subjects: 631/114; 692/4019/592/75; 692/700/1421; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiology - methods; Cardiology - trends; Cardiovascular diseases; Cardiovascular research; Computational biology; Electrophysiology; Humans; Medicine; Medicine & Public Health; Methods; Patient-Specific Modeling; Patients; Precision Medicine; Review Article; Simulation
• ISSN: 1759-5002; 1759-5010
• DOI: 10.1038/s41569-018-0104-y

The treatment of individual patients in cardiology practice increasingly relies on advanced imaging, genetic screening and devices. As the amount of imaging and other diagnostic data increases, paralleled by the greater capacity to personalize treatment, the difficulty of using the full array of measurements of a patient to determine an optimal treatment seems also to be paradoxically increasing. Computational models are progressively addressing this issue by providing a common framework for integrating multiple data sets from individual patients. These models, which are based on physiology and physics rather than on population statistics, enable computational simulations to reveal diagnostic information that would have otherwise remained concealed and to predict treatment outcomes for individual patients. The inherent need for patient-specific models in cardiology is clear and is driving the rapid development of tools and techniques for creating personalized methods to guide pharmaceutical therapy, deployment of devices and surgical interventions. Computational models are increasingly used in cardiology to integrate multiple data sets from individual patients and create virtual-patient simulations. In this Review, Niederer and colleagues discuss how multi-scale models of cardiac electrophysiology and mechanics can support diagnostic assessment and clinical decision-making and pave the way to personalized cardiac care. Key points Computational models of the heart have an important and growing role in cardiology, enabling patients to be diagnosed and treated on the basis of their specific pathophysiology. Simulations provide the link between the effects of genetic mutations, physiological regulations or drugs on protein function and emergent cellular and tissue function or clinical phenotypes. Models representing an individual patient or a specific pathology are now used to identify the mechanisms underpinning a disease, improve patient selection and predict clinical outcomes. Predictive modelling also contributes to the development of new diagnostics and devices and to the tailoring of therapies for individual patients. Translational barriers remain regarding model personalization, speed and detail of the simulations and how to communicate model predictions to cardiologists within a clinical environment.