Interview with Roy Kerckhoffs By: Maddy Davison Cardiac Mechanics Research Group, UC San Diego Interview held

via email October 30, 2013 - November 4, 2013

Introduction: Roy Kerckhoffs works in the Cardiac Mechanics Research Group at UC SD. He is currently working on the personalization of medical procedures to indi vidual patients. The goal is to eventually be able to use computer models of pat ients' hearts to predict outcomes of therapies or surgeries. Maddy Davison: Your name, position, organization/laboratory/hospital. Roy Kerckhoffs: Roy Kerckhoffs, PhD, assistant research scientist, University of California San Diego, Department of Bioengineering. I work in the Cardiac Mecha nics Research Group (www.cmrg.ucsd.edu). MD: How did you come to research the cardiovascular system? RK: In 1993 I was doing an internship at Medtronic (an American medical devices company) in Kerkrade in the south of the Netherlands, during my studies for a Ba chelor's in mechanical engineering (at the "Hogeschool Heerlen", which somehow t ranslates to "College Heerlen", Heerlen is the town). The department at Medtroni c I worked at manufactured catheters to treat coronary stenosis. I very much lik ed the combination of working with a combination of knowledge of human physiolog y and mechanics. I mentioned that to my advisor at the time and he pointed out t hat there was a department of biomechanics at the Eindhoven University of Techno logy in the Netherlands that I should look into. After my graduation for a BS in mechanical engineering I went to that university. I graduated for an MS in mech anical engineering in 1998 in which I investigated methods to measure deformatio n in muscle. My MS advisors were scientists that worked in cardiovascular resear ch and that's how I got into my PhD studies in which my research encompassed the design and use of a cardiac electromechanics computer model. After my graduatio n in 2003 I moved to UCSD to the current group for postdoctoral research. My pla n was to go back to the Netherlands after a while, but I liked it so much here ( not only the research but also San Diego), that I decided to stay. MD: Can you tell me a little about your current work and its implications? RK: The main focus of my research now is the design and application of patient-s pecific models of cardiac electromechanics. With all the latest advancements in medical technology and computer power we think that we could use computer models of patients' hearts to predict outcomes of therapies or surgeries. So, instead of performing a therapy or surgery just like that, we could perform the therapy or surgery in the computer model first, to see if it would actually have a posit ive effect on the patient. Or even better: use the computer model to optimize th e therapy. So we have recruited 9 patients by now from the San Diego VA hospital (who of course agreed to the study, which is called after signed informed conse nt), for whom we have measured all kinds of things so we can create the models. We measure cardiac geometry with CT or MRI, cardiac deformations, cavity volumes and cardiac output with echocardiography, electrical depolarization on the insi

de of the heart walls with a catheter (called electro-anatomical mapping) and ca vity (left and right ventricles) pressures. From this we create a computer model that will simulate the electrical depolarization and contraction of the heart. These patients are getting a pacemaker for a therapy called Cardiac Resynchroniz ation Therapy (CRT), because their left and right ventricles are not contracting synchronously. The pacemaker (with a lead going into the right and left ventric le) aims to restore the synchronous contraction. Because this therapy does not w ork for everyone (for about 30 to 40% of the patients), this type of therapy is ideal for our research on patient-specific modeling, because we could also try t o find out why it doesn't work for these patients. I think that patient-specific modeling is the future of medicine where computer models will predict the effec ts and optimize therapies before you perform the actual procedures. We and other labs already have some good encouraging results. Patient-specific modeling can be done for all kinds of parts of the body. MD: We are interested in what your life is like as a researcher/clinician on a d ay to day basis. Is there something that you would like to share with the genera l public or community that cares about prevention, therapies and cures for the d isease? RK: As a researcher you also need to provide your own funding, so I do a lot of grant writing. I have a due date for a grant proposal tomorrow and am also worki ng on a corporate grant proposal for Samsung. I guide students and postdocs who carry out the cardiac simulations. I still do a little of computer modeling myse lf too: I proposed a hypothesis a while ago about how the heart changes it's geo metry over time when it gets diseased. So I set up these simulations and evaluat e the results. Another big part of the job is to write scientific publications, in which you show your results of the research to the scientific and public comm unity. And of course, I also read others' results which helps to advance our mod els and knowledge. My main drive comes from curiosity about how nature functions . As a kid I already read a lot of popular science magazines and books. That par t of this research may lead to improvements in patient care is of course a nice additional component of it. MD: As part of the 11th grade project, we are creating an art piece in studio ar t that I hope can serve to represent a piece of your work. Is there an image or idea that represents what you do that I can work towards to represent the impor tant things that you do? RK: We have a gallery of images on our website (go to www.cmrg.ucsd.edu and clic k on Gallery on the left). This particular one (http://cmrg.ucsd.edu/Gallery?web nail=Fig%20D&action=show) shows the visualization of fiber orientation in the he art (which is very specific). This was measured in the heart of a diseased patie nt who donated his or her heart for research. It was measured with a MRI scanner and the technique is called diffusion tensor MRI (magnetic resonance imaging). The MRI scanner measures how water diffuses through the tissue and it turns out that water moves faster along fibers than perpendicular to them and this is how you then meausre the fiber orientation in the heart. We need this information be cause the fibers determine how the electrical depolarization wave travels throug h the heart and how it contracts.