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The cardiac physiome - a new paradigm

ESC congress 2010

An ambitious project has been spreading among European cardiologists, cardiovascular scientists, and bio-engineers: the cardiac physiome. With an extreme simplification, the idea is to build up a cardiac model capable of integrating knowledge derived from studies in diverse fields and levels of complexity: protein synthesis and structure, genomics and proteomics, cell metabolism and metabolomics, biophysics of channels and contractile machinery, in vitro histo-anatomical and in vivo imaging information on micro- and macro-organization of cardiac tissues. The motivations were multiple, among which the desire to harmonize experimental insights and to overcome the limitations associated with classical (‘wet’) research techniques.
Arrhythmias and Device Therapy

Nic Smith (Oxford) reviewed goals, methods and perspectives of the cardiac physiome. His overview described the strategy used to capture information from “dry” and “wet” experiments in literature in order to harmonize and integrate available models describing, for example, cardiomyocyte behavior (action potential properties, calcium handling and excitation contraction coupling) in different species and experimental settings. He showed practical applications in cardiac resynchronization therapy in patients, in particular the perspective of a better comprehension of mechanisms underlying responder vs. non-responder phenotype.

Peter Kohl from Oxford was able to take the audience through the philosophical motivation behind the need for such an approach. His sophisticated but immediate conceptual view of classical reductionist versus integrating approaches, the evolution of questions and answers benefiting from the mutual interaction of these two “worlds” gave the audience the impression of feeling “at home” in a field that is still alien for many of us.

Axel Pries (Berlin) illustrated the advancement in the comprehension of vascular plasticity and signals controlling angio-adaptation in the heart. In particular, he showed the relevance of modeling for “creating new questions” that were not envisaged based on anatomical or functional studies, such as the “shunt problem”. Heterogeneity and remodeling in the vascular architecture of the heart represent an effective adaptive response to variations in perfusion demand due to different pathophysiological conditions.

Finally, Maxime Sermesant from Sophia Antipolis translated some of the previous concepts to the clinical arena, by showing examples of personalized, patient specific and predictive electrophysiological modeling and simulation in the setting of CRT and arrhythmias.




The cardiac physiome - a new paradigm
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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