The quantitative assessment of epicardial fat distribution on human hearts: Implications for epicardial electrophysiology

Abstract

Epicardial electrophysiological procedures rely on dependable interfacing with the myocardial tissue. For example, epicardial pacing systems must generate sustainable chronic pacing capture, while epicardial ablations must effectively deliver energy to the target hyper-excitable myocytes. The human heart has a significant adipose layer which may impede epicardial procedures. The objective of this study was to quantitatively assess the relative location of epicardial adipose on the human heart, to define locations where epicardial therapies might be performed successfully. We studied perfusion-fixed human hearts (n = 105) in multiple isolated planes including: left ventricular margin, diaphragmatic surface, and anterior right ventricle. Relative adipose distribution was quantitatively assessed via planar images, using a custom-generated image analysis algorithm. In these specimens, 76.7 ± 13.8% of the left ventricular margin, 72.7 ± 11.3% of the diaphragmatic surface, and 92.1 ± 8.7% of the anterior right margin were covered with superficial epicardial adipose layers. Percent adipose coverage significantly increased with age (P < 0.001) and history of coronary artery disease (P < 0.05). No significant relationships were identified between relative percent adipose coverage and gender, body weight or height, BMI, history of hypertension, and/or history of congestive heart failure. Additionally, we describe two-dimensional probability distributions of epicardial adipose coverage for each of the three analysis planes. In this study, we detail the quantitative assessment and probabilistic mapping of the distribution of superficial epicardial adipose on the adult human heart. These findings have implications relative to performing epicardial procedures and/or designing procedures or tools to successfully perform such treatments. Clin. Anat. 31:661-666, 2018. © 2018 Wiley Periodicals, Inc.

Post-Procedure Micro-CT Analyses of Coronary Artery Stenting in Left Main Vessels of Human Hearts

“…Since 1997, the Visible Heart ® Laboratories have performed novel preclinical research on reanimated hearts and have developed an expansive Human Heart Library with >600 perfusion-xed specimens that can be accessed for anatomical research and device investigations 7,8 . We utilize state-of-the-art imaging tools, such as OCT and micro-CT imaging, to expand our ability to develop novel educational experiences and materials.…”

Post-procedure micro-CT analyses of coronary artery stenting in left main vessels of reanimated and perfusion-fixed human hearts

“…For over 25 years, the Visible Heart ® Laboratories have been dedicated to translational research and advancements in cardiac research, devices, and education [ 6 , 7 ]. We routinely perform PCI procedures, including many bifurcations, within reanimated large mammalian hearts [ 8 ].…”