An effective algorithm for the generation of patient-specific Purkinje networks in computational electrocardiology

The Purkinje network is responsible for the fast and coordinated distribution of the electrical impulse in the ventricle that triggers its contraction. Therefore, it is necessary to model its presence to obtain an accurate patient-specific model of the ventricular electrical activation. In this paper, we present an efficient algorithm for the generation of a patient-specific Purkinje network, driven by measures of the electrical activation acquired on the endocardium. The proposed method provides a correction of an initial network, generated by means of a fractal law, and it is based on the solution of Eikonal problems both in the muscle and in the Purkinje network. We present several numerical results both in an ideal geometry with synthetic data and in a real geometry with patient-specific clinical measures. These results highlight an improvement of the accuracy provided by the patient-specific Purkinje network with respect to the initial one. In particular, a cross-validation test shows an accuracy increase of 19% when only the 3% of the total points are used to generate the network, whereas an increment of 44% is observed when a random noise equal to 20% of the maximum value of the clinical data is added to the measures. (C) 2014 Elsevier Inc. All rights reserved.

Fast simulations of patient-specific haemodynamics of coronary artery bypass grafts based on a POD-Galerkin method and a vascular shape parametrization

Elena Faggiano, Andrea Manzoni, Alfio Quarteroni, Gianluigi Rozza

In this work a reduced-order computational framework for the study of haemodynamics in three-dimensional patient-specific configurations of coronary artery bypass grafts dealing with a wide range of scenarios is proposed. We combine several efficient algorithms to face at the same time both the geometrical complexity involved in the description of the vascular network and the huge computational cost entailed by time dependent patient-specific flow simulations. Medical imaging procedures allow to reconstruct patient-specific configurations from clinical data. A centerlines-based parametrization is proposed to efficiently handle geometrical variations. POD-Galerkin reduced-order models are employed to cut down large computational costs. This computational framework allows to characterize blood flows for different physical and geometrical variations relevant in the clinical practice, such as stenosis factors and anastomosis variations, in a rapid and reliable way. Several numerical results are discussed, highlighting the computational performance of the proposed framework, as well as its capability to carry out sensitivity analysis studies, so far out of reach. In particular, a reduced-order simulation takes only a few minutes to run, resulting in computational savings of 99% of CPU time with respect to the full-order discretization. Moreover, the error between full-order and reduced-order solutions is also studied, and it is numerically found to be less than 1% for reduced-order solutions obtained with just O(100) online degrees of freedom. (C) 2016 Elsevier Inc. All rights reserved.

Elsevier2016

Optimal control of mass transfer in peritoneal dialysis

Diego Mastalli

The aim of this work is to set up mathematical models and numerical methods to investigate the mass transfer process occurring during the peritoneal dialysis (PD) therapy. More precisely the final goal is the set up of tools to find for each patient submitted to PD the best therapy profile to purify blood and remove water from the patients. First, we build up specific mathematical models to represent the physical phenomena we are interested in. As discussed in chapter 1, starting from the Kedem-Katchalsky equations, we end up with a systems of nonlinear ordinary differential equations describing the various aspects of the physical problem. Then, we propose a method based on nonlinear programming techniques to solve the inverse problem arising from the need to assess the peritoneal membrane characteristics which are not directly measurable on the patient. Thanks to its flexibility we are able to support the main standard tests nowadays in use to assess the kinetic properties of the peritoneum. We devise a suitable parametrization of the control function (DPD Dynamic Peritoneal Dialysis) that allows to improve the standard PD profiles with a larger set of treatments. Then we propose an optimization algorithm to improve the PD efficiency. Moreover, in the framework of control theory, we devise an algorithm based on the maximum principle of Pontryagin for switched systems to investigate deeply the PD optimal control problem. Afterwards we carry out numerical simulations, investigating the main inputs influencing the peritoneal dialysis efficiency. Specifically we show an extensive comparison between the APD (Automated Peritoneal Dialysis) and DPD (Dynamic Peritoneal Dilaysis) in order to assess the conditions under which DPD allows to improve the PD performance. Then a numerical investigation based on the algorithm devised for switched systems is carried out to assess the adequacy of DPD. Moreover we set up a procedure to reach an efficiency target and minimize the patient's exposure to glucose in order to improve the PD biocompatibility. Finally, we present the validation results of the mathematical model in order to verify its accuracy. A comparison between the APD and DPD is presented. Moreover we carry out a statistical analysis to assess the error distribution related to the most relevant quantities in order to evaluate strengths and weaknesses of this model and to identify the needs for a further improvement.

EPFL2006

Optimal control of mass transfer in peritoneal dialysis

Diego Mastalli

EPFL2006