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The study of myocardial ischemia-reperfusion treatment through computational modelling
Wan Naimah Wan Ab Naim1, Mohd Jamil Mohamed Mokhtarudin2, Bee Ting Chan3
1Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600 Pekan, Pahang, Malaysia.
Insights
Reperfusion therapy for myocardial infarction can cause injury due to excessive oxygen. Lowering initial oxygen concentration during reperfusion may prevent this, reducing heart damage.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Computational Modeling
Background:
- Reperfusion is standard for myocardial infarction but can induce injury.
- Mechanisms and risk factors for reperfusion injury are not fully understood.
Purpose of the Study:
- Investigate ischemia-reperfusion injury mechanisms using a 3D oxygen diffusion model.
- Identify myocardial damage regions by coupling electrical and oxygen models.
Main Methods:
- Developed a three-dimensional (3D) oxygen diffusion model.
- Coupled an electrical model with the oxygen model.
- Analyzed oxygen levels and electrical conductivity in ischemic myocardium.
Main Results:
- Oxygen levels exceeded optimal levels (>1.0) in the ischemic area during early reperfusion.
- Prolonged ischemia worsened oxygen excess; prolonged reperfusion caused continuous excess.
- Recommended initial oxygen concentration <0.8 to prevent early oxygen upsurge.
- Myocardial injury risk correlated with impaired electrical conductivity in the ischemic vicinity.
Conclusions:
- Excessive oxygen accumulation during reperfusion can cause myocardial injury.
- Optimizing initial oxygen concentration is crucial for preventing reperfusion injury.
- Reperfusion remains beneficial for reducing infarct size despite risks.
Abstract:
Reperfusion of the blood flow to ischemic myocardium is the standard treatment for patients suffering myocardial infarction. However, the reperfusion itself can also induce myocardial injury, in which the actual mechanism and its risk factors remain unclear. This work aims to study the mechanism of ischemia-reperfusion treatment using a three-dimensional (3D) oxygen diffusion model. An electrical model is then coupled to an oxygen model to identify the possible region of myocardial damage. Our findings show that the value of oxygen exceeds its optimum (>1.0) at the ischemic area during early reperfusion period. This complication was exacerbated in a longer ischemic period. While a longer reperfusion time causes a continuous excessive oxygen supply to the ischemic area throughout the reperfusion time. This work also suggests the use of less than 0.8 of initial oxygen concentration in the reperfusion treatment to prevent undesired upsurge at the early reperfusion period and further myocardial injury. We also found the region at risk for myocardial injury is confined in the ischemic vicinity revealed by its electrical conductivity impairment. Although there is a risk that reperfusion leads to myocardial injury for excessive oxygen accumulation, the reperfusion treatment is helpful in reducing the infarct size.
