Estimating prognosis in patients with acute myocardial infarction using personalized computational heart models

Biomechanical computational models have potential prognostic utility in patients after an acute ST-segment-elevation myocardial infarction (STEMI). In a proof-of-concept study, we defined two groups (1) an acute STEMI group (n = 6, 83% male, age 54 +/- 12 years) complicated by left ventricular (LV) systolic dysfunction; (2) an age-and sex-matched hyper-control group (n = 6, 83% male, age 46 +/- 14 years), no prior history of cardiovascular disease and normal systolic blood pressure (SBP <130 mmHg). Cardiac MRI was performed in the patients (2 days & 6 months post-STEMI) and the volunteers, and biomechanical heart models were synthesized for each subject. The candidate parameters included normalized active tension (AT(norm)) and active tension at the resting sarcomere length (T-req, reflecting required contractility). Myocardial contractility was inversely determined from personalized heart models by matching CMR-imaged LV dynamics. Compared with controls, patients with recent STEMI exhibited increased LV wall active tension when normalized by SBP. We observed a linear relationship between T-req 2 days post-MI and global longitudinal strain 6 months later (r = 0.86; p = 0.03). T-req may be associated with changes in LV function in the longer term in STEMI patients complicated by LV dysfunction. Further studies seem warranted.