A UT Austin Biomedical Engineering Graduate student received a prestigious grant from the National Institutes of Health (NIH) for her research on a highly prevalent and fatal cardiovascular disease.

Natalie Simonian is a third-year graduate student working under Michael Sacks in the Willerson Center for Cardiovascular Modeling and Simulation. Simonian is a 2023 NIH National Heart, Lung and Blood Institute F31 Fellowship recipient. The two-year, $78,000+ grant provides funding for research involving cardiovascular diseases.

Simonian’s grant proposal focused on developing predictive, patient-specific simulations of mitral valve repair to improve treatment planning and long-term outcomes for patients with mitral regurgitation.

What is mitral valve regurgitation?

The mitral valve is the largest of four valves in the heart and works to ensure the correct direction of blood flow in the left side of the heart.

Mitral valve regurgitation, also referred to as mitral regurgitation (MR), occurs when the valve can no longer close properly and blood leaks backwards into the left atrium of the heart.

What are mitral valve regurgitation symptoms?

People living with mild mitral regurgitation may not have any symptoms. If the condition worsens, a person may experience palpitations due to atrial fibrillation.

When mitral valve regurgitation becomes severe, a person’s heart may enlarge to maintain forward flow of blood, causing heart failure. This may produce symptoms ranging from shortness of breath during exertion, coughing, congestion around the heart and lungs and swelling of the legs and feet.

How to treat mitral valve regurgitation

The most common method to fix a leaky valve is surgically implanting a ring around the edge of the valve. Unfortunately, this method is unsuccessful in approximately 33% of patients. A recently developed MR treatment option is transcatheter edge-to-edge repair (TEER) using the MitraClip® which closes the valve by pinning the leaflets together with a clip. The procedure is FDA-Approved and a safe option even for patients who cannot handle surgery.

However, the procedure also does not work well for everyone and improved testing to find the most beneficial method is essential—an improvement Simonian is working on bringing to life.

There is an urgent, unmet need for quantitativepatient-specific approaches to MR treatment due to the vast heterogeneity in the MR patient population and given the impact of TEER on mitral valve functionality, the effects of various clip configurations, and the unknown, long-term outcomes of the procedure.

Simonian uses computational repair optimization as a critical step toward this goal.  Previous research in the Willerson Center for Cardiovascular Simulation demonstrated that the MV undergoes substantial changes in multiscale-level growth and remodeling as a direct result of myocardial infarction.

Consequently, a tailored treatment approach is crucial. Her research focuses on using a patient-specific approach to determine how the pre-operative condition of the mitral valve in mitral regurgitation patients can be used to predict long-term TEER outcomes. Additionally, Simonian aims to discover how this relationship can be elucidated using readily available clinical imaging data and innovative MV computational models.

The goal of Simonian’s research is to identify preoperative MV factors that predict postoperative functional decline and create preoperative clinical tools for patient-specific, quantitative prediction and optimization of long-term TEER outcomes.