Population-level emulation enables fast Bayesian calibration of cardiac digital twins

Purpose: Patient-specific cardiac digital twins have the potential to guide individualized therapy, but generating these in a routine clinical workflow remains challenging. This is especially true when the twins must carry quantified uncertainty: Bayesian calibration requires thousands of simulations per patient, and the emulators that reduce this cost are typically trained one patient at a time. We aimed to train a single emulator across a patient cohort, so that a new patient can be calibrated in minutes without new simulations. Methods: We trained a population-level Gaussian process emulator whose inputs included a 12-dimensional latent encoding of the clinical features of each patient, so that a single emulator represents the whole cohort. We compared spending simulation budgets on resampling the real cohort with augmenting the cohort with digital chimeras, synthetic patients interpolated between real patients. Seven parameters of a closed-loop heart and circulation model were calibrated by Markov chain Monte Carlo to ten clinical biomarkers in 26 patients with left bundle branch block, each using an emulator trained without that patient, and the calibrated posteriors were compared against the full simulator. Results: A single emulator, trained without the held-out patient, calibrated the digital twin of each patient in 59.7-63.0 s per patient, versus 15 h with the simulator. Resampling the real cohort was the more efficient training strategy, bringing every output to R2 greater than or equal to 0.9, which augmentation did not achieve for the same simulation budget. For held-out patients, both strategies performed comparably (median leave-one-out normalized root-mean-square error 11.0% vs. 10.7%; p = 0.745), and error rose with distance from the cohort centroid (Spearman rho = +0.406). The calibrated models showed no cohort-wide bias (median standardized residual -0.12 against the clinical targets), and 95% predictive intervals contained 78.5% of targets, with the largest misfit in systolic blood pressure. Conclusion: Removing the need for new simulations for every new patient is a meaningful step toward uncertainty-aware cardiac digital twins that fit within a routine clinical workflow. Because the simulator, surrogate and sampler are interchangeable, the approach used here can be applied to other (cardiac) models and cohorts.