Growth and remodeling of the left ventricle: A case study of myocardial infarction and surgical ventricular restoration

Doron Klepach, Lik Chuan Lee, Jonathan F. Wenk, Mark B. Ratcliffe, Tarek I. Zohdi, Jose L. Navia, Ghassan S. Kassab, Ellen Kuhl, Julius M. Guccione

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

Cardiac growth and remodeling in the form of chamber dilation and wall thinning are typical hallmarks of infarct-induced heart failure. Over time, the infarct region stiffens, the remaining muscle takes over function, and the chamber weakens and dilates. Current therapies seek to attenuate these effects by removing the infarct region or by providing structural support to the ventricular wall. However, the underlying mechanisms of these therapies are unclear, and the results remain suboptimal. Here we show that myocardial infarction induces pronounced regional and transmural variations in cardiac form. We introduce a mechanistic growth model capable of predicting structural alterations in response to mechanical overload. Under a uniform loading, this model predicts non-uniform growth. Using this model, we simulate growth in a patient-specific left ventricle. We compare two cases, growth in an infarcted heart, pre-operative, and growth in the same heart, after the infarct was surgically excluded, post-operative. Our results suggest that removing the infarct and creating a left ventricle with homogeneous mechanical properties does not necessarily reduce the driving forces for growth and remodeling. These preliminary findings agree conceptually with clinical observations.

Original languageEnglish
Pages (from-to)134-141
Number of pages8
JournalMechanics Research Communications
Volume42
DOIs
StatePublished - Jun 2012

Bibliographical note

Funding Information:
This work was supported by an award from the American Heart Association and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI grant UL1 RR024131. We further acknowledge support through the NSF CAREER award CMMI-0952021 and through the NIH grants R01 HL077921, R01 HL086400, R01 HL084431, and R01 HL063348.

Keywords

  • Biomechanics
  • Cardiac
  • Finite elements
  • Growth
  • Infarct
  • Remodeling

ASJC Scopus subject areas

  • Civil and Structural Engineering
  • General Materials Science
  • Condensed Matter Physics
  • Mechanics of Materials
  • Mechanical Engineering

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