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Cardiovascular disease kills around 1.9 million
people every year in the European Union (EU), with
the associated annual health costs estimated at EUR
105 billion. Around half of these deaths occur in
people who have previously had a heart attack, most
of whom will develop heart failure before they die.
There are currently around 10 million heart failure
patients in the EU and it is one of the commonest
medical reasons for hospitalization in adults.
Finding better ways to manage and treat coronary
heart disease and chronic heart failure is therefore
seen as one of the most effective ways of reducing
the human cost and financial burden of these
debilitating conditions.
The newly created ‘euHeart’ consortium, which
comprises 16 research, academic, industrial and
medical organizations from six different European
countries, will work to improve the diagnosis,
therapy planning and treatment of cardiovascular
disease by developing computer models that simulate
the normal and disease-related behavior of each
individual patient’s heart and the aorta.
Supplied with information about how specific
cardiovascular diseases affect heart function at
molecular, cellular, tissue and organ level, these
computer models have the potential to allow doctors
to investigate the effects of different therapy
choices on a virtual model of the patient’s heart
and aorta, before going ahead with the option that
offers the best clinical outcome. The availability
of clinical decision support tools that utilize
these personalized heart models could therefore
improve the outcome for patients with
life-threatening conditions such as heart failure,
coronary artery disease, heart rhythm disorders and
congenital heart defects.
From molecules to organs
A characteristic of biological complexity is the
intrinsic interaction of physiological behaviors
across a range of time scales and anatomical levels.
The computer models developed in the euHeart project
will therefore relate what happens at cellular and
microvascular levels to what happens at tissue
level, and what happens at tissue level to what
happens at organ level. This will require the
integration and interconnection of existing and
future models from many different areas of
biological research, including molecular biology,
biochemistry, biophysics, anatomy and physiology – a
task that will be facilitated by the use of
standardized markup languages such as CellML and
FieldML to describe them.
Patient-specific
Most importantly, the resultant comprehensive model
will be adaptable to reflect the condition of a
specific patient’s heart, using anatomical and
functional information obtained via diagnostic
techniques such as medical imaging (CT, MRI,
ultrasound, etc.), blood flow and blood pressure
measurements or electrocardiograms. At the
intra-cellular level, the model could even take into
account specific gene defects in individual
patients.
By having an accurate personalized model of the
patient’s heart to work with, doctors may be able to
gain a deeper understanding of the patient’s
disease. This could allow them to make more accurate
diagnoses, predict the likely effectiveness of
different treatment therapies and improve therapy
planning. In addition, the models could lead to
improvements in the development and programming of
implantable devices such as pacemakers, left
ventricular assist devices (auxiliary pumps) and
endografts (special mesh tubes that reinforce
arteries).
Therapy planning
Because of the need to build the model over time,
particularly in relation to incorporating
molecular-level to organ-level disease pathologies
for diagnostic purposes, the first applications are
likely to be in the area of therapy planning for
pre-diagnosed conditions such as heart arrhythmias
(abnormal heart rhythms that in some cases can lead
to sudden cardiac arrest).
Heart arrhythmias normally result from abnormal
electrical activity in the heart and are sometimes
treated by a minimally invasive procedure known as
radio-frequency (RF) ablation. During this
procedure, a catheter is inserted into the patient’s
heart in order to measure the heart’s electrical
activity. The tissue responsible for propagating
abnormal electrical signals is then destroyed using
heat produced by an RF field (similar to microwave
heating) generated at the tip of the catheter. The
procedure is time-consuming and relies heavily on
the doctors’ experience to decide which tissue to
destroy – a task that is complicated by the fact
that the electrical activity in every patient’s
heart is subtly different. With the aid of a
computerized model that reflects the patient’s
unique heart structure and function, including its
electrical activity, doctors may be able to test the
results of destroying different areas of tissue
before they operate on the patient.
In addition to RF ablation therapy for arrhythmias,
other clinical focus areas for the euHeart project
include heart failure (cardiac resynchronization
therapy and congenital cardiac surgery and left
ventricular assist devices), coronary artery
disease, and diseases/defects in the heart valves
and aorta.
Work packages
The euHeart project is broken up into a number of
work-packages that include database
management/validation for individual (sub-) models
and their coupling together into larger
structural/functional models; the development of
appropriate mark-up languages and communication
infrastructures for model description/exchange; the
personalization of anatomical models from image
data; and the biophysical (structural and
functional) personalization of the models. The
clinical relevance of the project will be ensured by
additional application work-packages that will focus
on specific model development for each of the
clinical focus areas listed above – tailoring the
model to specific diseases.
Funding
The euHeart project, for which Philips Research is
acting as project coordinator, will run for four
years and has a budget of around 19 million Euro, of
which approximately 14 million Euro will be funded
by the European Union as part of the EU 7th
Framework Program. The project forms part of the
Virtual Physiological Human (VPH) initiative – an
international collaborative effort that aims to
produce a computer model of the entire human body so
that it can be investigated as a single complex
system.
euHeart Consortium membership (in alphabetical
order):
Academic Medical Center Amsterdam (Netherlands)
Berlin Heart (Germany)
Deutsches Krebsforschungszentrum (Germany)
HemoLab (Netherlands)
Hospital Clínico San Carlos de Madrid Insalud
(Spain)
Institut National de la Santé et de la Recherche
Médicale (France)
Institut National de Recherche en Informatique et en
Automatique (France)
King’s College London (United Kingdom)
Philips Healthcare (Netherlands, Spain)
Philips Research (Germany)
PolyDimensions (Germany)
Universitat Pompeu Fabra (Spain)
University of Karlsruhe (Germany)
University of Oxford (United Kingdom)
University of Sheffield (United Kingdom)
Volcano Europe SA/NV (Belgium)
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