A systems approach to cardiovascular health and disease with a focus on aortic wave dynamics

Cardiovascular diseases (CVDs) have reached an epidemic proportion in the US and worldwide with serious consequences in terms of human suffering and economic impact. More than one third of American adults are suffering from CVDs. The total direct and indirect costs of CVDs are more than $500 billion per year. Therefore, there is an urgent need to develop noninvasive diagnostics methods, to design minimally invasive assist devices, and to develop economical and easy-to-use monitoring systems for cardiovascular diseases. In order to achieve these goals, it is necessary to gain a better understanding of the subsystems that constitute the cardiovascular system. The aorta is one of these subsystems whose role in cardiovascular functioning has been underestimated. Traditionally, the aorta and its branches have been viewed as resistive conduits connected to an active pump (left ventricle of the heart). However, this perception fails to explain many observed physiological results. My goal in this thesis is to demonstrate the subtle but important role of the aorta as a system, with focus on the wave dynamics in the aorta.

The operation of a healthy heart is based on an optimized balance between its pumping characteristics and the hemodynamics of the aorta and vascular branches. The delicate balance between the aorta and heart can be impaired due to aging, smoking, or disease. The heart generates pulsatile flow that produces pressure and flow waves as it enters into the compliant aorta. These aortic waves propagate and reflect from reflection sites (bifurcations and tapering). They can act constructively and assist the blood circulation. However, they may act destructively, promoting diseases or initiating sudden cardiac death. These waves also carry information about the diseases of the heart, vascular disease, and coupling of heart and aorta. In order to elucidate the role of the aorta as a dynamic system, the interplay between the dominant wave dynamic parameters is investigated in this study. These parameters are heart rate, aortic compliance (wave speed), and locations of reflection sites. Both computational and experimental approaches have been used in this research. In some cases, the results are further explained using theoretical models.

The main findings of this study are as follows: (i) developing a physiologically realistic outflow boundary condition for blood flow modeling in a compliant vasculature; (ii) demonstrating that pulse pressure as a single index cannot predict the true level of pulsatile workload on the left ventricle; (iii) proving that there is an optimum heart rate in which the pulsatile workload of the heart is minimized and that the optimum heart rate shifts to a higher value as aortic rigidity increases; (iv) introducing a simple bio-inspired device for correction and optimization of aortic wave reflection that reduces the workload on the heart; (v) deriving a non-dimensional number that can predict the optimum wave dynamic state in a mammalian cardiovascular system; (vi) demonstrating that waves can create a pumping effect in the aorta; (vii) introducing a system parameter and a new medical index, Intrinsic Frequency, that can be used for noninvasive diagnosis of heart and vascular diseases; and (viii) proposing a new medical hypothesis for sudden cardiac death in young athletes.

Probabilistic Imaging and Dynamic Modeling of Earthquake Source Processes

Investigation of large, destructive earthquakes is challenged by their infrequent occurrence and the remote nature of geophysical observations. This thesis sheds light on the source processes of large earthquakes from two perspectives: robust and quantitative observational constraints through Bayesian inference for earthquake source models, and physical insights on the interconnections of seismic and aseismic fault behavior from elastodynamic modeling of earthquake ruptures and aseismic processes.

To constrain the shallow deformation during megathrust events, we develop semi-analytical and numerical Bayesian approaches to explore the maximum resolution of the tsunami data, with a focus on incorporating the uncertainty in the forward modeling. These methodologies are then applied to invert for the coseismic seafloor displacement field in the 2011 Mw 9.0 Tohoku-Oki earthquake using near-field tsunami waveforms and for the coseismic fault slip models in the 2010 Mw 8.8 Maule earthquake with complementary tsunami and geodetic observations. From posterior estimates of model parameters and their uncertainties, we are able to quantitatively constrain the near-trench profiles of seafloor displacement and fault slip. Similar characteristic patterns emerge during both events, featuring the peak of uplift near the edge of the accretionary wedge with a decay toward the trench axis, with implications for fault failure and tsunamigenic mechanisms of megathrust earthquakes.

To understand the behavior of earthquakes at the base of the seismogenic zone on continental strike-slip faults, we simulate the interactions of dynamic earthquake rupture, aseismic slip, and heterogeneity in rate-and-state fault models coupled with shear heating. Our study explains the long-standing enigma of seismic quiescence on major fault segments known to have hosted large earthquakes by deeper penetration of large earthquakes below the seismogenic zone, where mature faults have well-localized creeping extensions. This conclusion is supported by the simulated relationship between seismicity and large earthquakes as well as by observations from recent large events. We also use the modeling to connect the geodetic observables of fault locking with the behavior of seismicity in numerical models, investigating how a combination of interseismic geodetic and seismological estimates could constrain the locked-creeping transition of faults and potentially their co- and post-seismic behavior.