[Applause]
how many of you have recently been on a
modern jet commercial jet like a Boeing
Dreamliner or a Airbus did you know that
these Jets have been entirely designed
using computer simulations we trust
these airplanes with our lives but when
it comes to our own human health things
are actually quite different computer
simulations have rarely been used in
medicine in medicine we have a different
approach
it’s called trial and error trial and
error to make a decision for
life-threatening diseases today I want
to talk to you about how we in my lab
and my collaborators want to change that
we want to bring computer simulation to
the clinical practice so decision
precise decisions can be made about
treatments in our case for heart disease
I am a professor of biomedical
engineering and medicine although
actually I have neither engineering
degree nor MD I’m actually a physicist
by education but in my lab we build what
we called personalized virtual heart
those are computer models of the
patient’s hearts so we construct them
from the MRI scans of the patient now we
work mostly with patients who have life
threatening disorders in their heart
rhythms they are called arrhythmias so
we build these virtual hearts with the
MRI scans and also with the knowledge
that we have of the biology and the
physics of the electricity in the heart
and then we use those to predict what
would be the best treatment for a given
disorder in the patient now you may ask
under what circumstance one would use a
virtual heart to make a decision about
the patient well imagine the following
situation um somebody has a heart attack
they survive it however during the
crisis part of the heart muscle has died
because it has been deprived of oxygen
so there is scar in the heart and the
scar interferes with the electrical
function of the heart of with the
heartbeat and the patient can suddenly
die unexpectedly and suddenly for
patients like this the cardiologist will
implant a defibrillator in the patient’s
chest these a device is very much like
the external defibrillators that you
have seen in ambulances or emergency
rooms they shock the heart back into
rhythm and save the patient’s life now
how would a doctor make a decision
whether to implant the device it’s not a
simple task the procedure is invasive
but most importantly it carries numerous
risks for the patient’s risk of
infections risks of unexpected very
painful shocks that can occur at any
time because of that the decision has to
be carefully made how is this decision
made currently well in the clinic the
doctor uses one clinical measurement to
make this important decision it is
called ejection fraction ejection
fraction is the amount of blood that’s
pumped out of the heart with every
heartbeat so when this number is below
35% then the patient is considered at
risk of dying and the defibrillator will
be implanted well turns out this is a
very inaccurate predictor of arrhythmia
why because ejection fraction
is a number that describes blood flow it
has nothing to do with the electricity
of the heart it’s like you have an
electrical problem at home
but you call you call the plumber to fix
it so that’s the same situation because
of that many patients will get devices
that they do not need as a matter of
fact for one person’s life saved by a
defibrillator 20 patients will receive
unnecessary devices which is even worse
that inaccurate criterion misses many
patients that are at risk of sudden
cardiac death and indeed they will go to
die sometimes in the prime of their life
so the situation is actually
unacceptable and a change needs to be
made in my lab we are using these
personalized virtual hearts to try to
make a better prediction whether a
patient will die suddenly of cardiac
death and needs a defibrillator to
protect them so we use the virtual
hearts we developed from the MRI scans
and then we use them to figure out in
depth what is the specific rhythm
disorder in that patient so we can
devise the best treatment we are able to
do that because we can poke and prod and
stress out that virtual organ that
otherwise you cannot do in a
flesh-and-blood heart that allows us to
do this so we had a clinical study and
we used our approach that we call VAR
p–
virtual heart arrhythmia risk predictor
to assess whether a group of patients
have certain probability of cardiac
death and need defibrillators so what
you see here now is 32 virtual hearts
those are the models of
patience heart they have the scarring
because they all have survived the heart
attack that’s the green and and yellow
so they look kind of simple maybe to you
but each of these hearts is comprised of
about 10 million virtual cells in each
of these cells has electrical signals
and thought they all communicate
together to determine the function of
the organ so how do we know whether
these virtual hearts will develop an
arrhythmia well if an arrhythmia is
exists in the patient’s heart it looks
like a tornado an electrical storm so
using our virtual hearts we predicted
that 22 of these hearts will have an
arrhythmia so the cells in these cards
communicate it together and came up with
the disturbance of the rhythm and in 10
of them we predicted they will not have
although by the clinical criterion they
all got defibrillators implanted so we
believe that with using this approach we
can decrease the number of unnecessary
implantation of devices and save human
life we completed that study with the
number of patients that we had enrolled
in it and then we finished indeed
statistical analysis turned out we were
way better than anything out there
better the dejection fraction better
than any other clinical assessment that
has been attempted so this was the first
big victory for our virtual heart
approach I must say it has not been an
easy road to get to this point science
you may know is quite messy but the
attempt to bring computational science
together with medicine this is a tricky
and long road and we have met so much
disbelief so much rejection
in this path I remember when I was a
young professor and pretty much
everything that we submitted for
publication got rejected because we were
building the first virtual heart nobody
believed that it will be first possible
and number two that it would be useful
so we created the Wall of shame in my
lab and we would paste every rejected
paper every rejected grant every
rejected abstract it was pretty full and
we would look at that and instead of
discouraging it us it actually it
greatly inspired us to fight back to dig
in in what we believed to get on that
path that we to that vision that we had
and here we are
so if our approach indeed turns out to
is to be better predictor of sudden
cardiac that in a large group of patient
patients of course then this would be an
amazing triumph of what we are trying to
do and again it is the importance is
what it will bring to the patient
prevention sudden cardiac death and the
decrease of an unnecessary implantations
you may ask what other things are you
gonna do with these virtual hearts well
we are currently working on a very cool
approach to pure itness now curing
correctness goes way beyond the
implantable defibrillator the implant
implantable defibrillator is a
prevention device it’s not a cure but to
cure an arrhythmia the physician has to
find which parts of the heart are
actually the rogue ones the ones that
generate electrical signal that cause
disturbance in the heart to do that they
it’s really difficult task they have to
find where they are and then they go and
burn them out so they stop disturbing
the rhythm this has to be done carefully
because you don’t want to burn too much
of the heart so the way it is done
currently in the clinic
a catheter is threaded to the patient’s
heart and then painstakingly navigated
actually I’m gonna go back to the
personal hearth in pen stating he
navigated to that point that they
believe might be actually interrogation
of the electrical signals takes a long
long time to find these spots and it can
last up to 12 hours it is actually
carries numerous dangers and
complications for the patients and on
top of that it’s not accurate as a
result of that the patient will receive
many unnecessary burns so we are now
using our virtual heart technology to
help the physician make the decision
where are these spots and to burn them
so we are using the virtual heart
approach exactly examining the specific
arrhythmia of the patient and then the
simulations determine which is the
smallest burn and and also the least
number of burns that need to be done in
the patient to terminate all arrhythmias
at once and so we do these calculations
and we provide that to the clinicians
and we are now in the clinic sitting
there it’s a glass between us and the
patient the patient’s right there and we
sit there and we watch the physician
navigate the catheter to a model
predicted target in the patient’s heart
and we sit with these headphones and the
physician talks to us and asks us
questions and we provide clarifications
it is nerve-racking it is so scary but
it is also immensely thrilling and
fulfilling to be sitting there watching
this because we are not these people
from the engineering school that are
just running supercool models of the
heart know we these people who are also
in the cleaning watching how your model
might make a difference in the patient
heart and that is an incredible it
period so should our virtual heart
approach become a routine clinical test
or routine clinical use that would be
absolutely amazing merger of
computational simulations with clinical
medicine something that we have set out
to achieve this route for me as a
personal experience have been amazing I
always knew I was gonna be a scientist
so I grew up in a science family I was
raised that way
my academic parents put me on an
elevator to a science career and there I
was I became a scientist but that
elevator took me to a truly unexpected
place I would have never imagined I
would get to a floor where I will be
working directly with physicians making
the decisions how to deliver the best
care for the patient I would never have
imagined that it is truly incredible to
be able to step out of the elevator and
to find the place where complex theory
computer simulations in clinical
practice merge together like me you may
not know where your elevators are going
to take you to but take a chance press a
button get out of the elevator and find
out
[Applause]
how many of you have recently been on a
modern jet commercial jet like a Boeing
Dreamliner or a Airbus did you know that
these Jets have been entirely designed
using computer simulations we trust
these airplanes with our lives but when
it comes to our own human health things
are actually quite different computer
simulations have rarely been used in
medicine in medicine we have a different
approach
it’s called trial and error trial and
error to make a decision for
life-threatening diseases today I want
to talk to you about how we in my lab
and my collaborators want to change that
we want to bring computer simulation to
the clinical practice so decision
precise decisions can be made about
treatments in our case for heart disease
I am a professor of biomedical
engineering and medicine although
actually I have neither engineering
degree nor MD I’m actually a physicist
by education but in my lab we build what
we called personalized virtual heart
those are computer models of the
patient’s hearts so we construct them
from the MRI scans of the patient now we
work mostly with patients who have life
threatening disorders in their heart
rhythms they are called arrhythmias so
we build these virtual hearts with the
MRI scans and also with the knowledge
that we have of the biology and the
physics of the electricity in the heart
and then we use those to predict what
would be the best treatment for a given
disorder in the patient now you may ask
under what circumstance one would use a
virtual heart to make a decision about
the patient well imagine the following
situation um somebody has a heart attack
they survive it however during the
crisis part of the heart muscle has died
because it has been deprived of oxygen
so there is scar in the heart and the
scar interferes with the electrical
function of the heart of with the
heartbeat and the patient can suddenly
die unexpectedly and suddenly for
patients like this the cardiologist will
implant a defibrillator in the patient’s
chest these a device is very much like
the external defibrillators that you
have seen in ambulances or emergency
rooms they shock the heart back into
rhythm and save the patient’s life now
how would a doctor make a decision
whether to implant the device it’s not a
simple task the procedure is invasive
but most importantly it carries numerous
risks for the patient’s risk of
infections risks of unexpected very
painful shocks that can occur at any
time because of that the decision has to
be carefully made how is this decision
made currently well in the clinic the
doctor uses one clinical measurement to
make this important decision it is
called ejection fraction ejection
fraction is the amount of blood that’s
pumped out of the heart with every
heartbeat so when this number is below
35% then the patient is considered at
risk of dying and the defibrillator will
be implanted well turns out this is a
very inaccurate predictor of arrhythmia
why because ejection fraction
is a number that describes blood flow it
has nothing to do with the electricity
of the heart it’s like you have an
electrical problem at home
but you call you call the plumber to fix
it so that’s the same situation because
of that many patients will get devices
that they do not need as a matter of
fact for one person’s life saved by a
defibrillator 20 patients will receive
unnecessary devices which is even worse
that inaccurate criterion misses many
patients that are at risk of sudden
cardiac death and indeed they will go to
die sometimes in the prime of their life
so the situation is actually
unacceptable and a change needs to be
made in my lab we are using these
personalized virtual hearts to try to
make a better prediction whether a
patient will die suddenly of cardiac
death and needs a defibrillator to
protect them so we use the virtual
hearts we developed from the MRI scans
and then we use them to figure out in
depth what is the specific rhythm
disorder in that patient so we can
devise the best treatment we are able to
do that because we can poke and prod and
stress out that virtual organ that
otherwise you cannot do in a
flesh-and-blood heart that allows us to
do this so we had a clinical study and
we used our approach that we call VAR
p–
virtual heart arrhythmia risk predictor
to assess whether a group of patients
have certain probability of cardiac
death and need defibrillators so what
you see here now is 32 virtual hearts
those are the models of
patience heart they have the scarring
because they all have survived the heart
attack that’s the green and and yellow
so they look kind of simple maybe to you
but each of these hearts is comprised of
about 10 million virtual cells in each
of these cells has electrical signals
and thought they all communicate
together to determine the function of
the organ so how do we know whether
these virtual hearts will develop an
arrhythmia well if an arrhythmia is
exists in the patient’s heart it looks
like a tornado an electrical storm so
using our virtual hearts we predicted
that 22 of these hearts will have an
arrhythmia so the cells in these cards
communicate it together and came up with
the disturbance of the rhythm and in 10
of them we predicted they will not have
although by the clinical criterion they
all got defibrillators implanted so we
believe that with using this approach we
can decrease the number of unnecessary
implantation of devices and save human
life we completed that study with the
number of patients that we had enrolled
in it and then we finished indeed
statistical analysis turned out we were
way better than anything out there
better the dejection fraction better
than any other clinical assessment that
has been attempted so this was the first
big victory for our virtual heart
approach I must say it has not been an
easy road to get to this point science
you may know is quite messy but the
attempt to bring computational science
together with medicine this is a tricky
and long road and we have met so much
disbelief so much rejection
in this path I remember when I was a
young professor and pretty much
everything that we submitted for
publication got rejected because we were
building the first virtual heart nobody
believed that it will be first possible
and number two that it would be useful
so we created the Wall of shame in my
lab and we would paste every rejected
paper every rejected grant every
rejected abstract it was pretty full and
we would look at that and instead of
discouraging it us it actually it
greatly inspired us to fight back to dig
in in what we believed to get on that
path that we to that vision that we had
and here we are
so if our approach indeed turns out to
is to be better predictor of sudden
cardiac that in a large group of patient
patients of course then this would be an
amazing triumph of what we are trying to
do and again it is the importance is
what it will bring to the patient
prevention sudden cardiac death and the
decrease of an unnecessary implantations
you may ask what other things are you
gonna do with these virtual hearts well
we are currently working on a very cool
approach to pure itness now curing
correctness goes way beyond the
implantable defibrillator the implant
implantable defibrillator is a
prevention device it’s not a cure but to
cure an arrhythmia the physician has to
find which parts of the heart are
actually the rogue ones the ones that
generate electrical signal that cause
disturbance in the heart to do that they
it’s really difficult task they have to
find where they are and then they go and
burn them out so they stop disturbing
the rhythm this has to be done carefully
because you don’t want to burn too much
of the heart so the way it is done
currently in the clinic
a catheter is threaded to the patient’s
heart and then painstakingly navigated
actually I’m gonna go back to the
personal hearth in pen stating he
navigated to that point that they
believe might be actually interrogation
of the electrical signals takes a long
long time to find these spots and it can
last up to 12 hours it is actually
carries numerous dangers and
complications for the patients and on
top of that it’s not accurate as a
result of that the patient will receive
many unnecessary burns so we are now
using our virtual heart technology to
help the physician make the decision
where are these spots and to burn them
so we are using the virtual heart
approach exactly examining the specific
arrhythmia of the patient and then the
simulations determine which is the
smallest burn and and also the least
number of burns that need to be done in
the patient to terminate all arrhythmias
at once and so we do these calculations
and we provide that to the clinicians
and we are now in the clinic sitting
there it’s a glass between us and the
patient the patient’s right there and we
sit there and we watch the physician
navigate the catheter to a model
predicted target in the patient’s heart
and we sit with these headphones and the
physician talks to us and asks us
questions and we provide clarifications
it is nerve-racking it is so scary but
it is also immensely thrilling and
fulfilling to be sitting there watching
this because we are not these people
from the engineering school that are
just running supercool models of the
heart know we these people who are also
in the cleaning watching how your model
might make a difference in the patient
heart and that is an incredible it
period so should our virtual heart
approach become a routine clinical test
or routine clinical use that would be
absolutely amazing merger of
computational simulations with clinical
medicine something that we have set out
to achieve this route for me as a
personal experience have been amazing I
always knew I was gonna be a scientist
so I grew up in a science family I was
raised that way
my academic parents put me on an
elevator to a science career and there I
was I became a scientist but that
elevator took me to a truly unexpected
place I would have never imagined I
would get to a floor where I will be
working directly with physicians making
the decisions how to deliver the best
care for the patient I would never have
imagined that it is truly incredible to
be able to step out of the elevator and
to find the place where complex theory
computer simulations in clinical
practice merge together like me you may
not know where your elevators are going
to take you to but take a chance press a
button get out of the elevator and find
out
[Applause]
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