Using machine learning to characterize heart failure across the scales

Heart failure is a progressive chronic condition in which the heart undergoes detrimental changes in structure and function across multiple scales in time and space. Multiscale models of cardiac growth can provide a patient-specific window into the progression of heart failure and guide personalized treatment planning. Yet, the predictive potential of cardiac growth models remains poorly understood. Here, we quantify predictive power of a stretch-driven growth model using a chronic porcine heart failure model, subject-specific multiscale simulation, and machine learning techniques. We combine hierarchical modeling, Bayesian inference, and Gaussian process regression to quantify the uncertainty of our experimental measurements during an 8-week long study of volume overload in six pigs. We then propagate the experimental uncertainties from the organ scale through our computational growth model and quantify the agreement between experimentally measured and computationally predicted alterations on the cellular scale. Our study suggests that stretch is the major stimulus for myocyte lengthening and demonstrates that a stretch-driven growth model alone can explain $$52.7\%$$52.7% of the observed changes in myocyte morphology. We anticipate that our approach will allow us to design, calibrate, and validate a new generation of multiscale cardiac growth models to explore the interplay of various subcellular-, cellular-, and organ-level contributors to heart failure. Using machine learning in heart failure research has the potential to combine information from different sources, subjects, and scales to provide a more holistic picture of the failing heart and point toward new treatment strategies.

[1]  J. Wong,et al.  Generating fibre orientation maps in human heart models using Poisson interpolation , 2014, Computer methods in biomechanics and biomedical engineering.

[2]  J. Paton,et al.  Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes , 2016, Heart.

[3]  Jeffrey W Holmes,et al.  Candidate mechanical stimuli for hypertrophy during volume overload. , 2004, Journal of applied physiology.

[4]  Joakim Sundnes,et al.  Uncertainty in cardiac myofiber orientation and stiffnesses dominate the variability of left ventricle deformation response , 2018, International journal for numerical methods in biomedical engineering.

[5]  Patrick Segers,et al.  Kinematic boundary conditions substantially impact in silico ventricular function , 2018, International journal for numerical methods in biomedical engineering.

[6]  F. S. Costabal,et al.  Machine learning in drug development: Characterizing the effect of 30 drugs on the QT interval using Gaussian process regression, sensitivity analysis, and uncertainty quantification. , 2019, Computer methods in applied mechanics and engineering.

[7]  John Salvatier,et al.  Probabilistic programming in Python using PyMC3 , 2016, PeerJ Comput. Sci..

[8]  Theo Arts,et al.  Adaptation to mechanical load determines shape and properties of heart and circulation: the CircAdapt model. , 2005, American journal of physiology. Heart and circulatory physiology.

[9]  K E Muffly,et al.  Structural Remodeling of Cardiac Myocytes in Patients With Ischemic Cardiomyopathy , 1992, Circulation.

[10]  Gerhard A Holzapfel,et al.  Constitutive modelling of passive myocardium: a structurally based framework for material characterization , 2009, Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences.

[11]  Houman Owhadi,et al.  Gaussian processes A hands-on tutorial , 2017 .

[12]  S. Göktepe,et al.  Computational modeling of passive myocardium , 2011 .

[13]  Eric Jones,et al.  SciPy: Open Source Scientific Tools for Python , 2001 .

[14]  Gernot Plank,et al.  Influence of myocardial fiber/sheet orientations on left ventricular mechanical contraction , 2013 .

[15]  Ellen Kuhl,et al.  The importance of mechano-electrical feedback and inertia in cardiac electromechanics. , 2017, Computer methods in applied mechanics and engineering.

[16]  Roy C. P. Kerckhoffs,et al.  A single strain-based growth law predicts concentric and eccentric cardiac growth during pressure and volume overload. , 2012, Mechanics research communications.

[17]  E Kuhl,et al.  A virtual sizing tool for mitral valve annuloplasty , 2017, International journal for numerical methods in biomedical engineering.

[18]  Dorota Kurowicka,et al.  Generating random correlation matrices based on vines and extended onion method , 2009, J. Multivar. Anal..

[19]  P. Kerkhof,et al.  Characterizing Heart Failure in the Ventricular Volume Domain , 2015, Clinical Medicine Insights. Cardiology.

[20]  Ellen Kuhl,et al.  Computational modeling of hypertensive growth in the human carotid artery , 2014, Computational mechanics.

[21]  A. Gelman Prior distributions for variance parameters in hierarchical models (comment on article by Browne and Draper) , 2004 .

[22]  Ellen Kuhl,et al.  Kinematics of cardiac growth: in vivo characterization of growth tensors and strains. , 2012, Journal of the mechanical behavior of biomedical materials.

[23]  Sanford P. Bishop,et al.  Adaptations of the left ventricle to chronic pressure overload , 1976 .

[24]  Paris Perdikaris,et al.  Numerical Gaussian Processes for Time-Dependent and Nonlinear Partial Differential Equations , 2017, SIAM J. Sci. Comput..

[25]  W. Stahel,et al.  Log-normal Distributions across the Sciences: Keys and Clues , 2001 .

[26]  Bernardo M. Rocha,et al.  Effects of left ventricle wall thickness uncertainties on cardiac mechanics , 2019, Biomechanics and modeling in mechanobiology.

[27]  Ellen Kuhl,et al.  Frontiers in growth and remodeling. , 2012, Mechanics research communications.

[28]  P. Hunter,et al.  Laminar structure of the heart: a mathematical model. , 1997, The American journal of physiology.

[29]  J. Omens,et al.  Stress and strain as regulators of myocardial growth. , 1998, Progress in biophysics and molecular biology.

[30]  E Kuhl,et al.  Computational modeling of growth: systemic and pulmonary hypertension in the heart , 2011, Biomechanics and modeling in mechanobiology.

[31]  Roy C. P. Kerckhoffs,et al.  A single strain-based growth law predicts concentric and eccentric cardiac growth during pressure and volume overload , 2012 .

[32]  Colleen M. Witzenburg,et al.  A Comparison of Phenomenologic Growth Laws for Myocardial Hypertrophy , 2017, Journal Of Elasticity.

[33]  Andreas Menzel,et al.  Modelling of anisotropic growth in biological tissues , 2005 .

[34]  Henry F. Inman,et al.  The overlapping coefficient as a measure of agreement between probability distributions and point estimation of the overlap of two normal densities , 1989 .

[35]  J D Humphrey,et al.  Perspectives on biological growth and remodeling. , 2011, Journal of the mechanics and physics of solids.

[36]  Sean P Sheehy,et al.  Sarcomere alignment is regulated by myocyte shape. , 2008, Cell motility and the cytoskeleton.

[37]  A. Gerdes,et al.  Myocyte changes in heart failure. , 2012, Heart failure clinics.

[38]  Andrew Gelman,et al.  Data Analysis Using Regression and Multilevel/Hierarchical Models , 2006 .

[39]  Ellen Kuhl,et al.  Growing matter: a review of growth in living systems. , 2014, Journal of the mechanical behavior of biomedical materials.

[40]  M. Rayner,et al.  Cardiovascular disease in Europe: epidemiological update 2016. , 2016, European heart journal.

[41]  Theo Arts,et al.  Computational modeling of volumetric soft tissue growth: application to the cardiac left ventricle , 2009, Biomechanics and modeling in mechanobiology.

[42]  Y. Kihara,et al.  Adaptations of the left ventricle to chronic volume overload induced by mitral regurgitation in conscious dogs , 1985, Heart and Vessels.

[43]  Jon C. Aster,et al.  Robbins & Cotran Pathologic Basis of Disease , 2014 .

[44]  Harold T. Dodge,et al.  Left Ventricular Tension and Stress in Man , 1963, Circulation research.

[45]  I. LeGrice,et al.  Shear properties of passive ventricular myocardium. , 2002, American journal of physiology. Heart and circulatory physiology.

[46]  Ellen Kuhl,et al.  The Living Heart Project: A robust and integrative simulator for human heart function. , 2014, European journal of mechanics. A, Solids.

[47]  M. Kleiber Body size and metabolic rate. , 1947, Physiological reviews.

[48]  W Grossman,et al.  Cardiac hypertrophy: useful adaptation or pathologic process? , 1980, The American journal of medicine.

[49]  Daniel B. Ennis,et al.  Construction and Validation of Subject-Specific Biventricular Finite-Element Models of Healthy and Failing Swine Hearts From High-Resolution DT-MRI , 2018, Front. Physiol..

[50]  Serdar Göktepe,et al.  A multiscale model for eccentric and concentric cardiac growth through sarcomerogenesis. , 2010, Journal of theoretical biology.

[51]  L C Lee,et al.  Mathematical modeling of cardiac growth and remodeling , 2016, Wiley interdisciplinary reviews. Systems biology and medicine.

[52]  Brian P. Baillargeon,et al.  Modeling Pathologies of Diastolic and Systolic Heart Failure , 2015, Annals of Biomedical Engineering.

[53]  Richard N. Mitchell,et al.  Comprar Pocket Companion To Robbins And Cotran Pathologic Basis Of Disease + Online Access 9th Ed. | R. Mitchell | 9781455754168 | Elsevier España , 2016 .

[54]  Gerhard Sommer,et al.  Biomechanical properties and microstructure of human ventricular myocardium. , 2015, Acta biomaterialia.

[55]  H. Nanjo,et al.  Cardiovascular , Pulmonary and Renal Pathology Weaving Hypothesis of Cardiomyocyte Sarcomeres Discovery of Periodic Broadening and Narrowing of Intercalated Disk during Volume-Load Change , 2010 .

[56]  Markus Böl,et al.  Stretching Skeletal Muscle: Chronic Muscle Lengthening through Sarcomerogenesis , 2012, PloS one.

[57]  Daniel Burkhoff,et al.  Single-beat estimation of end-diastolic pressure-volume relationship: a novel method with potential for noninvasive application. , 2006, American journal of physiology. Heart and circulatory physiology.

[58]  Paris Perdikaris,et al.  Machine learning of linear differential equations using Gaussian processes , 2017, J. Comput. Phys..

[59]  Ellen Kuhl,et al.  Use it or lose it: multiscale skeletal muscle adaptation to mechanical stimuli , 2014, Biomechanics and Modeling in Mechanobiology.

[60]  Jack Lee,et al.  Multiphysics and multiscale modelling, data–model fusion and integration of organ physiology in the clinic: ventricular cardiac mechanics , 2016, Interface Focus.

[61]  A. McCulloch,et al.  Stress-dependent finite growth in soft elastic tissues. , 1994, Journal of biomechanics.

[62]  Serdar Göktepe,et al.  A generic approach towards finite growth with examples of athlete's heart, cardiac dilation, and cardiac wall thickening , 2010 .

[63]  W Grossman,et al.  Wall stress and patterns of hypertrophy in the human left ventricle. , 1975, The Journal of clinical investigation.

[64]  A. Gerdes,et al.  Structural remodeling and mechanical dysfunction of cardiac myocytes in heart failure. , 1995, Journal of molecular and cellular cardiology.

[65]  Marc A Pfeffer,et al.  Controversies in ventricular remodelling , 2006, The Lancet.

[66]  E. Kuhl,et al.  Multiscale characterization of heart failure. , 2019, Acta biomaterialia.