New Cardiovascular Model Integrating Coronary Circulation in Obstructive and Non-Obstructive Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a complex disease that can be associated with ischemia with no sign of coronary disease. Ischemia seems to result from microcirculatory abnormalities that appear to be modulated by left ventricular outflow tract (LVOT) obstruction. This paper proposes a model-based approach for the analysis of physiological mechanisms that affects coronary circulation in HCM. A novel integrated cardiovascular model, including LVOT obstruction and coronary circulation, was proposed. A sensitivity analysis was applied to identify the most influential parameters on coronary flow both at the macro- and micro- circulatory level. Finally, the proposed model was adapted to two HCM patients (obstructive / non-obstructive) from previous works of the team. Results show that the level of obstruction had a strong influence on coronary flow and the adaptation of the model to HCM patients confirmed the important influence of LVOT obstruction at the microcirculatory level. Despite the difficulty of having direct measures of coronary microcirculation, this works shows that computational models can help in studying the effect of a pathophysiological feature on coronary circulation in the context of HCM.