How to Treat the Loss of Beat: Modeling and Simulation of Ventricular Growth and Remodeling and Novel Post-Infarction Therapies

Heart disease is the primary cause of death in industrialized nations. In 2007 alone, an estimated 79 million adults in the U.S., one in three, had one or more types of cardiovascular disease, generating health care costs in excess of $430 billion. A leading cause of congestive heart failure is myocardial infarction. Within the first few hours after the infarct, a complex cascade of events is initiated in the myocardium manifesting itself clinically in disproportionate thinning and dilation of the infarct region accompanied by distortion in form and function of the entire heart, figure 1. As remodeling progresses, volume-overloaded hypertrophy and further deterioration of cardiac function are common natural consequences. Historically, therapies for myocardial infarction have been developed by trial and error methods, as opposed to therapy design and development through scientific understanding of the functional and structural changes in the infarcted tissue. Continuum theories, in combination with modern computer simulation technologies, offer the potential to provide greater insight into the complex pathways of myocardial infarction, and thereby guide the design of successful post-infarction therapies such as direct cell injection into the damaged myocardium¹ and implantation of tissue engineered vascular grafts² as sketched in figure 1.