Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

Winklhofer, Sebastian; Stoeck, Christian T.; Berger, Nicole; Thali, Michael J.; Manka, Robert; Kozerke, Sebastian; Alkadhi, Hatem; Stolzmann, Paul

doi:10.1007/s00330-014-3322-7

Cited by 20 publications

(11 citation statements)

References 34 publications

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“…Nonetheless, part of lateralized gap junctions of remodeled cardiomyocytes in the BZ are thought to be non-functional (Matsushita et al, 1999). Regarding tissue architecture, both DTI (diffusion tensor imaging) (Wu et al, 2006; Winklhofer et al, 2014) and histological preparations (Rutherford et al, 2012; Tschabrunn et al, 2016) have revealed fiber disarray within the BZ that consequently involves alterations in tissue anisotropy. Conversely, a recent study based on very high-resolution DTI observed good preservation of normal fiber orientation patterns in chronically infarcted regions of porcine and human hearts (Pashakhanloo et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia

et al. 2019

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In the chronic stage of myocardial infarction, a significant number of patients develop life-threatening ventricular tachycardias (VT) due to the arrhythmogenic nature of the remodeled myocardium. Radiofrequency ablation (RFA) is a common procedure to isolate reentry pathways across the infarct scar that are responsible for VT. Unfortunately, this strategy show relatively low success rates; up to 50% of patients experience recurrent VT after the procedure. In the last decade, intensive research in the field of computational cardiac electrophysiology (EP) has demonstrated the ability of three-dimensional (3D) cardiac computational models to perform in-silico EP studies. However, the personalization and modeling of certain key components remain challenging, particularly in the case of the infarct border zone (BZ). In this study, we used a clinical dataset from a patient with a history of infarct-related VT to build an image-based 3D ventricular model aimed at computational simulation of cardiac EP, including detailed patient-specific cardiac anatomy and infarct scar geometry. We modeled the BZ in eight different ways by combining the presence or absence of electrical remodeling with four different levels of image-based patchy fibrosis (0, 10, 20, and 30%). A 3D torso model was also constructed to compute the ECG. Patient-specific sinus activation patterns were simulated and validated against the patient's ECG. Subsequently, the pacing protocol used to induce reentrant VTs in the EP laboratory was reproduced in-silico . The clinical VT was induced with different versions of the model and from different pacing points, thus identifying the slow conducting channel responsible for such VT. Finally, the real patient's ECG recorded during VT episodes was used to validate our simulation results and to assess different strategies to model the BZ. Our study showed that reduced conduction velocities and heterogeneity in action potential duration in the BZ are the main factors in promoting reentrant activity. Either electrical remodeling or fibrosis in a degree of at least 30% in the BZ were required to initiate VT. Moreover, this proof-of-concept study confirms the feasibility of developing 3D computational models for cardiac EP able to reproduce cardiac activation in sinus rhythm and during VT, using exclusively non-invasive clinical data.

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Section: Discussionmentioning

confidence: 99%

Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia

et al. 2019

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“…DT-CMR has been applied in MI, with much interest in acute changes and post-infarct ventricular remodelling. Several animal and human studies describe increased MD and decreased FA in the infarct zone (26,(52)(53)(54)(55). This accords with myocyte swelling and necrosis, extracellular matrix expansion and replacement by less organised collagenous fibrosis.…”

Section: Myocardial Infarction (Mi)mentioning

confidence: 68%

Diffusion Tensor Cardiovascular Magnetic Resonance Imaging

Khalique

Ferreira

Scott

et al. 2020

JACC: Cardiovascular Imaging

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Imaging the heart is central to cardiac phenotyping but in clinical practice this has been restricted to macroscopic interrogation. Diffusion tensor cardiovascular magnetic resonance (DT-CMR) is a novel, non-invasive technique which is beginning to unlock details of this microstructure in humans in-vivo. DT-CMR demonstrates the helical cardiomyocyte arrangement that drives rotation and torsion. Sheetlets (functional units of cardiomyocytes, separated by shear layers) have been shown to reorientate between diastole and systole, revealing how microstructural function facilitates cardiac thickening. Measures of tissue diffusion can also be made; fractional anisotropy (a measure of myocyte organisation) and mean diffusivity (a measure of myocyte packing). Abnormal myocyte orientation and sheetlet function has been demonstrated in congenital heart disease, cardiomyopathy and after myocardial infarction. It is too early to predict the clinical importance of DT-CMR, but such unique in-vivo information will likely prove valuable in early diagnosis and risk prediction of cardiac dysfunction and arrhythmias.

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“…Biological factors such as myocardial fibrosis and extracellular volume can influence mean diffusivity (Abdullah et al, 2014; Chen et al, 2003; Winklhofer et al, 2014; Wu et al, 2007). In this study, mean diffusivity values for the LV in term‐born lambs are consistent with previous findings in term‐born lambs at the same age (Abdullah et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Overall, this cardiac microstructure is essential for efficient cardiac output and stable cardiomyocyte ATP consumption (Vendelin, Bovendeerd, Engelbrecht, & Arts, 2002). Importantly, cardiomyocyte microstructure changes throughout development (Abdullah et al, 2016; Notomi et al, 2006), throughout the cardiac cycle (Ferreira et al, 2014), and is altered in diseased hearts (Abdullah et al, 2014; Ferreira et al, 2014; Gotschy et al, 2019; Winklhofer et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Microarchitecture of the hearts in term and former‐preterm lambs using diffusion tensor imaging

Lê

Ferreira

Merchant

et al. 2020

The Anatomical Record

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Diffusion tensor imaging (DTI) is an MRI technique that can be used to map cardiomyocyte tracts and estimate local cardiomyocyte and sheetlet orientation within the heart. DTI measures diffusion distances of water molecules within the myocardium, where water diffusion generally occurs more freely along the long axis of cardiomyocytes and within the extracellular matrix, but is restricted by cell membranes such that transverse diffusion is limited. DTI can be undertaken in fixed hearts and it allows the three‐dimensional mapping of the cardiac microarchitecture, including cardiomyocyte organization, within the whole heart. The objective of this study was to use DTI to compare the cardiac microarchitecture and cardiomyocyte organization in archived fixed left ventricles of lambs that were born either preterm (n = 5) or at term (n = 7), at a postnatal timepoint equivalent to about 6 years of age in children. Although the findings support the feasibility of retrospective DTI scanning of fixed hearts, several hearts were excluded from DTI analysis because of poor scan quality, such as ghosting artifacts. The preliminary findings from viable DTI scans (n = 3/group) suggest that the extracellular compartment is altered and that there is an immature microstructural phenotype early in postnatal life in the LV of lambs born preterm. Our findings support a potential time‐efficient imaging role for DTI in detecting abnormal changes in the microstructure of fixed hearts of former‐preterm neonates, although further investigation into factors that affect scan quality is required.

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Post-mortem cardiac diffusion tensor imaging: detection of myocardial infarction and remodeling of myofiber architecture

Cited by 20 publications

References 34 publications

Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia

Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia

Diffusion Tensor Cardiovascular Magnetic Resonance Imaging

Microarchitecture of the hearts in term and former‐preterm lambs using diffusion tensor imaging

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