A simulation approach to guide therapeutic intervention in advanced heart failure

Introduction Simulation in the context of patient-specific modelling has the potential to become a clinically applicable tool for detailed evaluation of the cardiovascular system and decision-making to guide therapeutic intervention. Models based on pressure-volume relationship and lumped parameter representation of the cardiovascular system may be a suitable choice because of their simplicity and versatility. This approach has great potential for application in advanced heart failure for the selection and optimisation of device-based treatment. Methods We sought to investigate the value of simulation in the context of heart failure patients already discussed at a multidisciplinary team meeting with a view to predict or guide further management. CARDIOSIM©, a software package developed by the Cardiovascular Numerical Modelling Lab based at the Institute of Clinical Physiology and consisting of lumped parameter models, modified time-varying elastance and pressure-volume analysis of ventricular function, was used for this purpose. Results & Discussion The outcome of the simulations addressed the value of a more quantitative approach in the clinical decision process with agreement between simulated haemodynamic data and measurements from echocardiography and right heart catheter. Conclusion Although previous experience, co-morbidities and the risk of potentially fatal complications play a role in clinical decision-making, patient-specific modelling may become a daily approach for the selection and optimisation of device-based treatment for heart failure patients. Willingness to adopt such a combined approach may be the way forward for further progress.