Atrial fibrillation; the role of virtual heart

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      Deborah ArowoogunDeborah Arowoogun

      ‘Personalised treatment’ is a trendy term in healthcare. The latest advances in science, maths and technology are bringing it to life in ways that previously seemed impossible.

      At University College London, Dr Giorgia Bosi is an engineer creating personalised three dimensional (3D) computer models of people’s hearts, thanks to funding from the BHF. Her aim is to stop harmful blood clots, which can cause stroke, heart attack and vascular dementia.

      She is currently studying atrial fibrillation (AF), the most common type of abnormal heart rhythm. If you have AF, blood may not be pumped out of your heart properly, which means clots can form and be carried to the brain, causing a stroke. That’s why people with AF need to take anticlotting medication for life.

      “I am trying to apply mathematical models to healthcare to improve patient safety,” says Dr Bosi. “Using scans and other patient data, I create a virtual 3D shape of the part of the heart that is relevant in that patient.”

      1.26m people currently diagnosed with atrial fibrillation in the UK

      Dr Bosi is looking at the left atrial appendage – the part of the heart where clots form in people with AF. “Depending on the shape of your left atrial appendage, you have a higher or lower risk of clot formation,” she says.

      “I am trying to classify patients according to their level of risk, which could help us know which patients require which medication. I want to work out if there is a better way to treat them.”

      Her computer modelling shows speed and vorticity (the way flowing liquid rotates) of blood flow. Both can affect the chance of clots forming.

      Dr Bosi has applied these modelling techniques to replacement heart valves, too. Valve replacements can give a new lease of life to people with heart failure caused by valve problems. But replacement can also come with risks, such as leakage, raised risk of clots and heart rhythm problems.

      She has published studies showing that computational modelling can show how different artificial heart valves will fit in an individual patient’s heart, how much the valve will open up and how blood will flow through it. And she’s shown that engineering techniques can tell us more about how the location of the replacement will affect the valve.

      So far, these studies have been based on previous patients, using data collected before their procedure, then checking whether the predictions of the computer models were accurate. The next step is to use simulations before treatment.

      “We call it ‘personalised patient care’,” says Dr Bosi. “It is a patient-specific way of looking at data. You could call it a virtual clinical trial. “You can calculate how a new device will work in the patient to help the clinician make a decision. But also you could test and improve new devices with this modelling. That could reduce the work involved and the animals used in studies. “This technique could be useful for a lot of other things – stents for coronary arteries and brain aneurysms, and repairs for aortic aneurysm.”

      There are still relatively few people working in this new field of research. “The BHF is one of the few funding bodies that have a real vision for this technology,” says Dr Bosi. “It is nice to be one of the people working in this niche. This is lifechanging technology.”
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