Collaborating Investigator(s): Natalia Trayanova, PhD
Institution: Johns Hopkins

Dr. Trayanova is one of the current leaders in the application of multiscale simulation to cardiac rhythm disturbances (arrhythmias) and their treatment through techniques such as defibrillation and catheter ablation. She and her group have pioneered advances in computational modeling of activation in the heart and in the geometric modeling of cardiac tissues and whole hearts, e.g., in the use of rule-based algorithms to assign details of myocardial fiber structure and the assignment of altered electrophysiology to regions of the atria based on MRI imaging.

This project is an extension of the existing collaborator role that Dr. Trayanova and her group have had in the present Center and recognizes both the success to date and the exciting opportunities for future progress. Dr. Trayanova seeks to leverage a career of experience in creating realistic simulations of cardiac electrical activity to the clinical setting and this is also the focus of this DBP relationship. The demands of rapidly creating accurate models of the thorax and hearts of each patient under the clinical time constraints are enormous and require a careful balance between precision and speed. From this need comes a natural drive to the Image and Geometric Analysis TR&D, which is well placed to improve both segmentation and mesh generation for such models. Within the aspects of image analysis, the analysis of the shape of the heart is another driving aspect of this relationship. Dr. Trayanova has already carried out preliminary studies using very simple geometric elements of heart shape and has one of the largest collections of segmented heart geometries from patients to which we will apply sophisticated statistical shape analysis.

This DBP is also an ideal partner for the Simulation & Estimation TR&D in the general setting of simulation and estimation and also in evaluating the role of uncertainty, especially because the results of their simulations are set to become part of clinical practice. Physicians (and their patients) require information on the confidence and accuracy of the predictions that will guide diagnosis and therapy and uncertainty quantification seeks to provide such estimates. This DBP will also drive the Simulation & Estimation TR&D as it presents an ideal opportunity to develop support for integration of third-party simulation tools within the SCIRun framework. Dr. Trayanova is one of the original users and drivers for the CARP simulation software, and within the Center, we have already developed applications that leverage CARP and SCIRun for improved integration and management of simulations. Another area of new potential within this DBP is the application of cardiac inverse solution approaches to the problems that Dr. Trayanova traditionally approaches from a forward sense.

Finally, this DBP is closely related to the Marrouche/CARMA DBP, with which there have already been interactions with the aim of extracting patient-specific models of patients with atrial fibrosis from the CARMA studies and then using simulations to study the underlying mechanisms of atrial fibrillation. The Center will facilitate these interactions with the specific goal of uncovering the putative mechanistic relationship between structural features of the remodeled, fibrotic, and scarred heart and reentry and arrhythmias.

This project is highly innovative for its potential to touch so many aspects of computational medicine as it can be applied to diseases of the heart. Dr. Trayanova is poised to provide physicians with a means to predict arrhythmias from image data and then to use the power of simulation to guide therapies. Such disruptive technology represents the absolute cutting edge of computation cardiology.