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.

Tissue engineering active biological machines : bio-inspired design, directed self-assembly, and characterization of muscular pumps simulating the embryonic heart

Biological machines are active devices that are comprised of cells and other biological components. These functional devices are best suited for physiological environments that support cellular function and survival. Biological machines have the potential to revolutionize the engineering of biomedical devices intended for implantation, where the human body can provide the required physiological environment. For engineering such cell-based machines, bio-inspired design can serve as a guiding platform as it provides functionally proven designs that are attainable by living cells. In the present work, a systematic approach was used to tissue engineer one such machine by exclusively using biological building blocks and by employing a bio-inspired design. Valveless impedance pumps were constructed based on the working principles of the embryonic vertebrate heart and by using cells and tissue derived from rats. The function of these tissue-engineered muscular pumps was characterized by exploring their spatiotemporal and flow behavior in order to better understand the capabilities and limitations of cells when used as the engines of biological machines.

Rings faithfully represented on their left socle

In 1964 A. W. Goldie [1] posed the problem of determining all rings with identity and minimal condition on left ideals which are faithfully represented on the right side of their left socle. Goldie showed that such a ring which is indecomposable and in which the left and right principal indecomposable ideals have, respectively, unique left and unique right composition series is a complete blocked triangular matrix ring over a skewfield. The general problem suggested above is very difficult. We obtain results under certain natural restrictions which are much weaker than the restrictive assumptions made by Goldie.

We characterize those rings in which the principal indecomposable left ideals each contain a unique minimal left ideal (Theorem (4.2)). It is sufficient to handle indecomposable rings (Lemma (1.4)). Such a ring is also a blocked triangular matrix ring. There exist r positive integers K₁,..., K_r such that the i,j^th block of a typical matrix is a K_i x K_j matrix with arbitrary entries in a subgroup D_ij of the additive group of a fixed skewfield D. Each D_ii is a sub-skewfield of D and D_ri = D for all i. Conversely, every matrix ring which has this form is indecomposable, faithfully represented on the right side of its left socle, and possesses the property that every principal indecomposable left ideal contains a unique minimal left ideal.

The principal indecomposable left ideals may have unique composition series even though the ring does not have minimal condition on right ideals. We characterize this situation by defining a partial ordering ρ on {i, 2,...,r} where we set iρj if D_ij ≠ 0. Every principal indecomposable left ideal has a unique composition series if and only if the diagram of ρ is an inverted tree and every D_ij is a one-dimensional left vector space over D_ii (Theorem (5.4)).

We show (Theorem (2.2)) that every ring A of the type we are studying is a unique subdirect sum of less complex rings A₁,...,A_s of the same type. Namely, each A_i has only one isomorphism class of minimal left ideals and the minimal left ideals of different A_i are non-isomorphic as left A-modules. We give (Theorem (2.1)) necessary and sufficient conditions for a ring which is a subdirect sum of rings A_i having these properties to be faithfully represented on the right side of its left socle. We show ((4.F), p. 42) that up to technical trivia the rings A_i are matrix rings of the form

[...]. Each Q_j comes from the faithful irreducible matrix representation of a certain skewfield over a fixed skewfield D. The bottom row is filled in by arbitrary elements of D.

In Part V we construct an interesting class of rings faithfully represented on their left socle from a given partial ordering on a finite set, given skewfields, and given additive groups. This class of rings contains the ones in which every principal indecomposable left ideal has a unique minimal left ideal. We identify the uniquely determined subdirect summands mentioned above in terms of the given partial ordering (Proposition (5.2)). We conjecture that this technique serves to construct all the rings which are a unique subdirect sum of rings each having the property that every principal-indecomposable left ideal contains a unique minimal left ideal.

I. The 3.7 Å crystal structure of horse heart ferricytochrome C. II. The application of the Karle-Hauptman tangent formula to protein phasing

I. The 3.7 Å Crystal Structure of Horse Heart Ferricytochrome C.

The crystal structure of horse heart ferricytochrome c has been determined to a resolution of 3.7 Å using the multiple isomorphous replacement technique. Two isomorphous derivatives were used in the analysis, leading to a map with a mean figure of merit of 0.458. The quality of the resulting map was extremely high, even though the derivative data did not appear to be of high quality.

Although it was impossible to fit the known amino acid sequence to the calculated structure in an unambiguous way, many important features of the molecule could still be determined from the 3.7 Å electron density map. Among these was the fact that cytochrome c contains little or no α-helix. The polypeptide chain appears to be wound about the heme group in such a way as to form a loosely packed hydrophobic core in the molecule.

The heme group is located in a cleft on the molecule with one edge exposed to the solvent. The fifth coordinating ligand is His 18 and the sixth coordinating ligand is probably neither His 26 nor His 33.

The high resolution analysis of cytochrome c is now in progress and should be completed within the next year.

II. The Application of the Karle-Hauptman Tangent Formula to Protein Phasing.

The Karle-Hauptman tangent formula has been shown to be applicable to the refinement of previously determined protein phases. Tests were made with both the cytochrome c data from Part I and a theoretical structure based on the myoglobin molecule. The refinement process was found to be highly dependent upon the manner in which the tangent formula was applied. Iterative procedures did not work well, at least at low resolution.

The tangent formula worked very well in selecting the true phase from the two possible phase choices resulting from a single isomorphous replacement phase analysis. The only restriction on this application is that the heavy atoms form a non-centric cluster in the unit cell.

Pages 156 through 284 in this Thesis consist of previously published papers relating to the above two sections. References to these papers can be found on page 155.