Assessing the importance of sex and disease-specific anatomy in electrophysiology and mechanical simulations with a newly developed public virtual cohort of four-chamber heart models.

This work presents a study on how differences in cardiac anatomy attributed to sex and disease can influence cardiac electrophysiology and mechanics using a virtual cohort of four-chamber heart models. Patient anatomy varies across sex and disease. However, capturing this variation in in-silico studies remains poorly accounted for, with studies often using either single representative cases or imbalanced virtual cohorts. Whole-heart electromechanics models incorporate the patient's anatomy, electrophysiology and mechanics across different scales, from molecular, tissue and whole-heart and circulatory system levels. However, cardiac models are typically built from one or a small number of anatomies, with sex rarely reported and the effects of anatomical variability, which include those due to sex or disease, largely unexplored. This limits clinical translation and reduces regulatory credibility. We developed fifty patient-specific anatomical models of 25 male and 25 female hearts in heart failure and control cases. We ran benchmark passive inflation and paced activation simulations with consistent parameters and boundary conditions across cases to isolate the impact of anatomical variations with sex and disease. Heart failure models exhibited increased chamber volumes, larger volume changes during inflation, and delayed activation times relative to controls. These trends were consistent across sexes, although right ventricular activation showed a significant sex-based difference. Variations in anatomy with sex and disease have a significant impact on cardiac simulations, which support the inclusion of multiple heart anatomical models in in-silico trials. The resulting virtual cohort captures key anatomical variability and is publicly available, along with the underlying code (see Data Availability statement).