Constitutive discovery in the living human heart.

Constitutive models of myocardial mechanics form a cornerstone of personalized cardiac simulations and cardiac digital twins. Researchers traditionally prescribe these models a priori and calibrate them from ex vivo tissue experiments, even though tissue excision alters loading conditions, removes residual stresses, and eliminates important physiological interactions. Multimodal cardiac MRI now provides subject-specific ventricular geometry, deformation, and myocardial microstructure, yet current inverse approaches still rely on predefined constitutive laws. Here we present the first framework to discover constitutive models of passive myocardial mechanics directly from in vivo cardiac imaging data by embedding a constitutive artificial neural network within a nonlinear finite element model of ventricular filling. Using multimodal cardiac MRI that combines ventricular geometry, deformation, and microstructure from a representative healthy individual, the framework identifies sparse, mechanically admissible strain-energy functions without prescribing their form a priori. The best-performing model contains only two fiber- and two sheet-invariant terms, achieves a mean displacement error of 1.62 mm, and reduces the error of the widely used Guccione and Holzapfel models by 34.14% and 26.01%. The discovered models indicate that fiber- and sheet-related anisotropic mechanisms dominate the passive mechanical response during physiological ventricular filling. More broadly, this work establishes a non-invasive strategy for subject-specific constitutive discovery from cardiac imaging data and lays the foundation for personalized cardiac simulations and cardiac digital twins.