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