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Inverse problems in Cardiovascular Mathematics: toward patient‐specific data assimilation and optimization

In the last 25 years, mathematical and numerical modeling of cardiovascular problems has experienced a spectacular progress. Moving progressively from the stage of idealized models supporting traditional in vitro and in vivo approaches – basically with proofs of concept – Cardiovascular Mathematics has been transforming into a unique tool for patient-specific analysis. This has been made possible by the strong integration with imaging devices. Nowadays, the work pipeline starting from a medical image in the Digital Imaging and Communications in Medicine (DICOM) format to retrieve the patient-specific geometry of an artery or the left ventricle to be used as computational domain in a numerical simulation is well established. This has initiated a paradigm shift in the interactions between mathematicians, bioengineers, and medical doctors. The latter are progressively getting used to in silico analysis as an important component of their research [3]. The introduction of numerical procedures as a part of an established clinical routine and more in general of a consolidated support to the decision-making process of physicians still requires some steps both in terms of infrastructures (to bring computational tools to the operating room or the bedside) and methods. In particular, the quality of the numerical results needs to be assessed and certified. The reliability of simulations calls for an accurate quantification and possibly reduction of uncertainty. In this scenario and in view of terrific advancements of measuring techniques, an important research line – quite established in other fields – is data assimilation [4,6,9], that is, the integration of numerical simulations and measurements. We may say that numerical models provide a background knowledge (based on physical principles and constitutive laws, not patient-specific), whereas measures give a foreground (individual) information; accuracy of in silico procedures relies on the correct integration of these two levels of knowledge of the problem [9,10]. As a matter of fact, numerical models depend on parameters and boundary/initial conditions. Their knowledge is in practice usually incomplete, inaccurate, and noisy. In some cases, the sensitivity itself of the final results to these parameters is unclear and needs to be quantified. Such an uncertainty may be significantly reduced by the availability of patient-specific measures; on the other hand, the quality of measures can be strongly enhanced by comparison with mathematical models (after all, noise is in general not educated, it does not know PDEs . ..) [4,5,7,8,9,11]. We think therefore that, in the future, a crucial step for the clinical application of Cardiovascular Mathematics will be the passage from numerical simulation to data assimilation. To be concrete, borrowing a motto by Michel Fortin supporting mesh adaptivity in finite element simulations, stating that a ‘grid should not be considered a data, but an unknown of the problem’, we think that many parameters currently tuned on the basis of nonpatient specific criteria (even in patient-specific geometries) should be considered part of the unknowns to be found by assimilation procedures.