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research-article

Longitudinal Reinforcement of Acute Myocardial Infarcts Improves Function by Transmurally Redistributing Stretch and Stress

[+] Author and Article Information
Ana C. Estrada

Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA 22903
ace3qt@virginia.edu

Kyoko Yoshida

ASME Member, Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA 22903
ky2p@virginia.edu

Samantha A. Clarke

Department of Biomedical Engineering, University of Virginia, Box 800759, Health System, Charlottesville, VA 22903
sac8dr@virginia.edu

Jeffrey W. Holmes

ASME Fellow, Department of Biomedical Engineering, University of Virginia, School of Medicine, University of Virginia; Robert M. Berne Cardiovascular Research Center, University of Virginia; The Center for Engineering in Medicine, University of Virginia; Box 800759, Health System, Charlottesville, VA 22903
holmes@virginia.edu

1Corresponding author.

ASME doi:10.1115/1.4044030 History: Received October 11, 2018; Revised June 04, 2019

Abstract

A wide range of emerging therapies from surgical restraint to biomaterial injection to tissue engineering aim to improve heart function and limit adverse remodeling following myocardial infarction (MI). We previously showed that longitudinal surgical reinforcement of large anterior infarcts in dogs could significantly enhance systolic function without restricting diastolic function, but the underlying mechanisms for this improvement are poorly understood. The goal of this study was to construct a finite-element model that could match our previously published data on changes in regional strains and left ventricular function following longitudinal surgical reinforcement, then use the model to explore potential mechanisms for the improvement in systolic function we observed. The model presented here, implemented in FEBio, matches all the key features of our experiments, including diastolic remodeling strains in the ischemic region, small shifts in the end-diastolic pressure-volume relationship (EDPVR), and large changes in the end-systolic pressure-volume relationship (ESPVR) in response to ischemia and to patch application. Detailed examination of model strains and stresses suggests that longitudinal reinforcement reduces peak diastolic fiber stretch and systolic fiber stress in the remote myocardium and shifts those peaks away from the endocardial surface by reshaping the left ventricle (LV). These finding could help guide the development of novel therapies to improve post-MI function by providing specific design objectives.

Copyright (c) 2019 by ASME
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