1
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Marhabaie S, Delcey M, El Hamrani D, Vaillant F, Ginefri JC, Ozenne V, Abell E, Poirier-Quinot M, Quesson B. Remotely detuned receiver coil for high-resolution interventional cardiac magnetic resonance imaging. Front Cardiovasc Med 2023; 10:1249572. [PMID: 38028485 PMCID: PMC10643167 DOI: 10.3389/fcvm.2023.1249572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Interventional cardiac MRI in the context of the treatment of cardiac arrhythmia requires submillimeter image resolution to precisely characterize the cardiac substrate and guide the catheter-based ablation procedure in real-time. Conventional MRI receiver coils positioned on the thorax provide insufficient signal-to-noise ratio (SNR) and spatial selectivity to satisfy these constraints. Methods A small circular MRI receiver coil was developed and evaluated under different experimental conditions, including high-resolution MRI anatomical and thermometric imaging at 1.5 T. From the perspective of developing a therapeutic MR-compatible catheter equipped with a receiver coil, we also propose alternative remote active detuning techniques of the receiver coil using one or two cables. Theoretical details are presented, as well as simulations and experimental validation. Results Anatomical images of the left ventricle at 170 µm in-plane resolution are provided on ex vivo beating heart from swine using a 2 cm circular receiver coil. Taking advantage of the increase of SNR at its vicinity (up to 35 fold compared to conventional receiver coils), real-time MR-temperature imaging can reach an uncertainty below 0.1°C at the submillimetric spatial resolution. Remote active detuning using two cables has similar decoupling efficiency to conventional on-site decoupling, at the cost of an acceptable decrease in the resulting SNR. Discussion This study shows the potential of small dimension surface coils for minimally invasive therapy of cardiac arrhythmia intraoperatively guided by MRI. The proposed remote decoupling approaches may simplify the construction process and reduce the cost of such single-use devices.
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Affiliation(s)
- Sina Marhabaie
- Laboratoire D'Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CNRS, Inserm, Orsay, France
| | - Marylène Delcey
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
- Siemens Healthineers, Saint-Denis, France
| | | | - Fanny Vaillant
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Jean-Christophe Ginefri
- Laboratoire D'Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CNRS, Inserm, Orsay, France
| | - Valéry Ozenne
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, IHU Liryc, Bordeaux, France
| | - Emma Abell
- Univ. Bordeaux, INSERM, CRCTB, U 1045, IHU Liryc, Bordeaux, France
| | - Marie Poirier-Quinot
- Laboratoire D'Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CNRS, Inserm, Orsay, France
| | - Bruno Quesson
- Univ. Bordeaux, CNRS, CRMSB, UMR 5536, IHU Liryc, Bordeaux, France
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2
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Bear LR, Bergquist JA, Abell E, Cochet H, MacLeod RS, Dubois R, Serinagaoglu Y. Investigation into the importance of using natural PVCs and pathological models for potential-based ECGI validation. Front Physiol 2023; 14:1198002. [PMID: 37275229 PMCID: PMC10232953 DOI: 10.3389/fphys.2023.1198002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction: Premature ventricular contractions (PVCs) are one of the most commonly targeted pathologies for ECGI validation, often through ventricular stimulation to mimic the ectopic beat. However, it remains unclear if such stimulated beats faithfully reproduce spontaneously occurring PVCs, particularly in the case of the R-on-T phenomenon. The objective of this study was to determine the differences in ECGI accuracy when reconstructing spontaneous PVCs as compared to ventricular-stimulated beats and to explore the impact of pathophysiological perturbation on this reconstruction accuracy. Methods: Langendorff-perfused pig hearts (n = 3) were suspended in a human torso-shaped tank, and local hyperkalemia was induced through perfusion of a high-K+ solution (8 mM) into the LAD. Recordings were taken simultaneously from the heart and tank surfaces during ventricular pacing and during spontaneous PVCs (including R-on-T), both at baseline and high K+. Epicardial potentials were reconstructed from torso potentials using ECGI. Results: Spontaneously occurring PVCs were better reconstructed than stimulated beats at baseline in terms of electrogram morphology [correlation coefficient (CC) = 0.74 ± 0.05 vs. CC = 0.60 ± 0.10], potential maps (CC = 0.61 ± 0.06 vs. CC = 0.51 ± 0.12), and activation time maps (CC = 0.86 ± 0.07 vs. 0.76 ± 0.10), though there was no difference in the localization error (LE) of epicardial origin (LE = 14 ± 6 vs. 15 ± 11 mm). High K+ perfusion reduced the accuracy of ECGI reconstructions in terms of electrogram morphology (CC = 0.68 ± 0.10) and AT maps (CC = 0.70 ± 0.12 and 0.59 ± 0.23) for isolated PVCs and paced beats, respectively. LE trended worse, but the change was not significant (LE = 17 ± 9 and 20 ± 12 mm). Spontaneous PVCs were less well when the R-on-T phenomenon occurred and the activation wavefronts encountered a line of block. Conclusion: This study demonstrates the differences in ECGI accuracy between spontaneous PVCs and ventricular-paced beats. We also observed a reduction in this accuracy near regions of electrically inactive tissue. These results highlight the need for more physiologically realistic experimental models when evaluating the accuracy of ECGI methods. In particular, reconstruction accuracy needs to be further evaluated in the presence of R-on-T or isolated PVCs, particularly when encountering obstacles (functional or anatomical) which cause line of block and re-entry.
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Affiliation(s)
- Laura R. Bear
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Jake A. Bergquist
- Scientific Computing and Imaging Institute, University of Utah, Salt LakeCity, UT, United States
- Norra Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah, Salt LakeCity, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt LakeCity, UT, United States
| | - Emma Abell
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Bordeaux University Hospital (CHU), Pessac, France
| | - Rob S. MacLeod
- Scientific Computing and Imaging Institute, University of Utah, Salt LakeCity, UT, United States
- Norra Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), University of Utah, Salt LakeCity, UT, United States
- Department of Biomedical Engineering, University of Utah, Salt LakeCity, UT, United States
| | - Remi Dubois
- IHU-Liryc, Heart Rhythm Disease Institute, Foundation Bordeaux Université, Bordeaux, France
- University Bordeaux, CRCTB, Bordeaux, France
- INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Yesim Serinagaoglu
- Electrical-Electronics Engineering Department, Middle East Technical University, Ankara, Türkiye
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3
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Lamonzie E, Vaillant F, Abell E, Charron S, El Hamrani D, Quesson B, Brette F. Assessment of Cardiac Toxicity of Manganese Chloride for Cardiovascular Magnetic Resonance. Front Physiol 2022; 13:952043. [PMID: 35874541 PMCID: PMC9302587 DOI: 10.3389/fphys.2022.952043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
MRI is widely used in cardiology to characterize the structure and function of the heart. Currently, gadolinium-based contrast agents are widely used to improve sensitivity and specificity of diagnostic images. Recently, Manganese, a calcium analogue, has emerged as a complementary contrast agent with the potential to reveal remaining viable cells within altered tissue. Imaging applications may be limited by substantial toxicity of manganese. Indeed, cardiac safety of manganese is not yet comprehensively assessed. In this study we investigated the effect of MnCl2 (1–100 µM) on cardiac function. Hemodynamic function was determined ex vivo using an isolated working rat heart preparation. HL-1 cardiac myocytes were used to investigate cell viability (calcein AM) and calcium cycling (Cal-520 a.m.). Rat ventricular cardiomyocytes were dissociated by enzymatic digestion. Action potentials and calcium currents were recorded using the patch clamp technique. MRI experiments were performed at 1.5T on formalin-fixed rat hearts, previously perfused with MnCl2. MnCl2 perfusion from 1 up to 100 µM in isolated working hearts did not alter left ventricular hemodynamic parameters. Contractility and relaxation index were not altered up to 50 µM MnCl2. In HL-1 cardiac myocytes, incubation with increasing concentrations of MnCl2 did not impact cell viability. The amplitude of the calcium transients were significantly reduced at 50 and 100 µM MnCl2. In freshly isolated ventricular myocytes, action potential duration at 20, 50 and 90% of repolarization were not modified up to 10 µM of MnCl2. L-type calcium current amplitude was significantly decreased by 50 and 100 µM of MnCl2. MRI on heart perfused with 25 and 100 µM of MnCl2 showed a dose dependent decrease in the T1 relaxation time. In conclusion, our results show that low concentrations of MnCl2 (up to 25 µM) can be used as a contrast agent in MRI, without significant impact on cardiac hemodynamic or electrophysiology parameters.
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Affiliation(s)
- Elodie Lamonzie
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Fanny Vaillant
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Emma Abell
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | | | - Dounia El Hamrani
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Bruno Quesson
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Fabien Brette
- Univ, Bordeaux, CRCTB, Inserm, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France
- *Correspondence: Fabien Brette,
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4
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Robert J, Bessiere F, Cao E, Loyer V, Abell E, Vaillant F, Quesson B, Catheline S, Lafon C. Spectral Analysis of Tissue Displacement for Cardiac Activation Mapping: Ex Vivo Working Heart and In Vivo Study. IEEE Trans Ultrason Ferroelectr Freq Control 2022; 69:942-956. [PMID: 34941506 DOI: 10.1109/tuffc.2021.3137989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Characterizing myocardial activation is of major interest for understanding the underlying mechanism of cardiac arrhythmias. Electromechanical wave imaging (EWI) is an ultrafast ultrasound-based method used to map the propagation of the local contraction triggered by electrical activation of the heart. This study introduces a novel way to characterize cardiac activation based on the time evolution of the instantaneous frequency content of the cardiac tissue displacement curves. The first validation of this method was performed on an ex vivo dataset of 36 acquisitions acquired from two working heart models in paced rhythms. It was shown that the activation mapping described by spectral analysis of interframe displacement is similar to the standard EWI method based on zero-crossing of interframe strain. An average median error of 3.3 ms was found in the ex vivo dataset between the activation maps obtained with the two methods. The feasibility of mapping cardiac activation by EWI was then investigated on two open-chest pigs during sinus and paced rhythms in a pilot trial of cardiac mapping with an intracardiac probe. Seventy-five acquisitions were performed with reasonable stability and analyzed with the novel algorithm to map cardiac contraction propagation in the left ventricle (LV). Sixty-one qualitatively continuous isochrones were successfully computed based on this method. The region of contraction onset was coherently described while pacing in the imaging plane. These findings highlight the potential of implementing EWI acquisition on intracardiac probes and emphasize the benefit of performing short time-frequency analysis of displacement data to characterize cardiac activation in vivo.
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5
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Cluitmans MJM, Bear LR, Nguyên UC, van Rees B, Stoks J, Ter Bekke RMA, Mihl C, Heijman J, Lau KD, Vigmond E, Bayer J, Belterman CNW, Abell E, Labrousse L, Rogier J, Bernus O, Haïssaguerre M, Hassink RJ, Dubois R, Coronel R, Volders PGA. Noninvasive detection of spatiotemporal activation-repolarization interactions that prime idiopathic ventricular fibrillation. Sci Transl Med 2021; 13:eabi9317. [PMID: 34788076 DOI: 10.1126/scitranslmed.abi9317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Matthijs J M Cluitmans
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Philips Research, 5656 AE Eindhoven, Netherlands
| | | | - Uyên C Nguyên
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Bianca van Rees
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Job Stoks
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Rachel M A Ter Bekke
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Casper Mihl
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands.,Department of Radiology, Maastricht University Medical Centre, 6200 MD Maastricht, Netherlands
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
| | - Kevin D Lau
- Philips Research, 5656 AE Eindhoven, Netherlands
| | | | | | - Charly N W Belterman
- Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | | | - Louis Labrousse
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Julien Rogier
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Olivier Bernus
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France
| | - Michel Haïssaguerre
- IHU LIRYC, 33600 Pessac, France.,University of Bordeaux, 33000 Bordeaux, France.,Hôpital Haut Lévêque, University Hospital of Bordeaux, 33604 Bordeaux, France
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands
| | | | - Ruben Coronel
- IHU LIRYC, 33600 Pessac, France.,Department of Experimental Cardiology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, Netherlands
| | - Paul G A Volders
- Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, Netherlands
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6
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Gottlieb LA, Vaillant F, Abell E, Belterman C, Loyer V, El Hamrani D, Naulin J, Constantin M, Quesson B, Boukens BJ, Coronel R, Dekker LRC. Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure. Front Physiol 2021; 12:709844. [PMID: 34512384 PMCID: PMC8424033 DOI: 10.3389/fphys.2021.709844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Pulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure. Methods Radiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode's solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes). Results In high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011). Conclusion Localized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.
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Affiliation(s)
- Lisa A Gottlieb
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.,AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Fanny Vaillant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Charly Belterman
- AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Virginie Loyer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Dounia El Hamrani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Jérôme Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Marion Constantin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Bastiaan J Boukens
- AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands.,AUMC, Academic Medical Center, Department of Medical Biology, Amsterdam, Netherlands
| | - Ruben Coronel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.,AUMC, Academic Medical Center, Department of Experimental Cardiology, Amsterdam, Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, Netherlands.,Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
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7
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Gottlieb LA, Vaillant F, Abell E, Belterman C, El-Hamrani D, Naulin J, Lamy J, Kachenoura N, Quesson B, Coronel R, Dekker L. B-011-04 ABLATION SCAR IN A SINGLE PULMONARY VEIN CAUSES PROARRHYTHMIC MECHANICAL DESTABILIZATION IN HEALTHY SHEEP ATRIA. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Caluori G, Vaillant F, Abell E, Ichou F, Loyer V, Häberlin A, Ploux S, Mahamat HA, Dubois R, Guillot B, Diolez P, Meillet V, Hatem S, Krisai P, Kamakura T, Hocini M, Bernus O, Dos Santos P, Jais P, Pasdois P. B-PO02-032 SUCCINATE ACCUMULATION IN ATRIAL CARDIOMYOCYTES INCREASES MITOCHONDRIAL REVERSE ELECTRON FLUX, OXIDATIVE STRESS, AND MIGHT PARTICIPATE TO AF STABILIZATION IN THE SHEEP. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Gottlieb LA, Vaillant F, Abell E, Belterman C, El-Hamrani D, Naulin J, Lamy J, Kachenoura N, Quesson B, Coronel R, Dekker L. B-PO01-013 ABLATION SCAR IN A SINGLE PULMONARY VEIN CAUSES PROARRHYTHMIC MECHANICAL DESTABILIZATION IN HEALTHY SHEEP ATRIA. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Jurak P, Bear LR, Nguyên UC, Viscor I, Andrla P, Plesinger F, Halamek J, Vondra V, Abell E, Cluitmans MJM, Dubois R, Curila K, Leinveber P, Prinzen FW. 3-Dimensional ventricular electrical activation pattern assessed from a novel high-frequency electrocardiographic imaging technique: principles and clinical importance. Sci Rep 2021; 11:11469. [PMID: 34075135 PMCID: PMC8169848 DOI: 10.1038/s41598-021-90963-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
The study introduces and validates a novel high-frequency (100–400 Hz bandwidth, 2 kHz sampling frequency) electrocardiographic imaging (HFECGI) technique that measures intramural ventricular electrical activation. Ex-vivo experiments and clinical measurements were employed. Ex-vivo, two pig hearts were suspended in a human-torso shaped tank using surface tank electrodes, epicardial electrode sock, and plunge electrodes. We compared conventional epicardial electrocardiographic imaging (ECGI) with intramural activation by HFECGI and verified with sock and plunge electrodes. Clinical importance of HFECGI measurements was performed on 14 patients with variable conduction abnormalities. From 3 × 4 needle and 108 sock electrodes, 256 torso or 184 body surface electrodes records, transmural activation times, sock epicardial activation times, ECGI-derived activation times, and high-frequency activation times were computed. The ex-vivo transmural measurements showed that HFECGI measures intramural electrical activation, and ECGI-HFECGI activation times differences indicate endo-to-epi or epi-to-endo conduction direction. HFECGI-derived volumetric dyssynchrony was significantly lower than epicardial ECGI dyssynchrony. HFECGI dyssynchrony was able to distinguish between intraventricular conduction disturbance and bundle branch block patients.
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Affiliation(s)
- Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic.
| | - Laura R Bear
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ivo Viscor
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Petr Andrla
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Emma Abell
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rémi Dubois
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Karol Curila
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Gottlieb LA, Vaillant F, Abell E, El-Hamrani D, Naulin J, Lamy J, Kachenoura K, Quesson B, Coronel R, Dekker LRC. Ablation scar in a single pulmonary vein causes proarrhythmic mechanical destabilization in healthy sheep atria. Europace 2021. [DOI: 10.1093/europace/euab116.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Catharina Hospital, Eindhoven Medtronic (unrestricted research grant)
Background
Ablative pulmonary vein isolation (PVI) prevents AF in 60% of AF patients. The absence of an antiarrhythmic effect of PVI is poorly understood. Atrial and PV stretch is proarrhythmic but the mechanical effect of PV ablation scar on AF arrhythmogenesis is unknown. We hypothesize that single ablation scars are potentially proarrhythmic because they create heterogeneous stretch.
Purpose
To evaluate the mechanical effect of a purposely incomplete PVI ablation scar on left atrial (LA) electrophysiology.
Methods
Functional cardiac MRIs in vivo in sheep (n = 11) before and 3-months after incomplete PVI by radiofrequency in the right PV (RPV) were analyzed with a feature-tracking algorithm to obtain local strain in the LA. The ablated hearts were explanted and perfused with 1:5 blood:Krebs solution in a dual-chamber working-heart set-up. Diagnostic multi-electrode endocardial catheters were positioned in the RPV and left PV (LPV). Premature stimulation was performed in each PV in low (∼12mmHg) and high (∼25mmHg) LA pressure. Twelve control hearts without ablation scar underwent similar ex vivo investigation.
Results
The maximum longitudinal strain of the myocardial wall between the RPV and LPV increased
from 20.2 ± 6.2% to 33.5 ± 16.0% (before vs. after ablation, respectively; p = 0.032), whereas the maximum radial strain of the LA septum close to the RPV decreased from 45.6 ± 9.7% to 35.8 ± 7.3% (before vs. after ablation, respectively; p = 0.035). Sustained AF (>30s) was more often induced during stimulation in hearts with ablation scar than in control (25.0% and 11.5% of induction attempts (n = 76 and n = 87) in ablated and control hearts, respectively; p = 0.025). In ablated hearts, an increase in LA pressure augmented AF inducibility (12.8% vs. 37.8% of induction attempts (n = 39 vs. n = 37), low vs. high LA pressure, respectively; p = 0.023), whereas this was not the case in control hearts (4.4% vs. 19.0% of induction attempts (n = 45 vs. n = 42), low vs. high LA pressure; p = 0.289). The number of spontaneous premature atrial complexes (PACs) not leading to AF were similar in ablated and control hearts (0 ± 0 vs. 0 ± 2 total PACs within 20ms of refractory period during premature stimulation protocol, respectively; p = 0.411). The diastolic stimulation threshold of RPV was higher in the ablated than in control hearts (90 ± 63 vs. 79 ± 31mA, respectively; p = 0.049). The refractory period was similar in the ablated and control hearts (237 ± 62 vs. 235 ± 55ms, respectively; p = 0.873).
Conclusion
Local ablation scar caused regionally disparate bio-mechanical changes in proximity to ablative energy delivery and increased inducibility of sustained AF especially during increased LA stretch. This was associated with decreased tissue excitability without changes in refractoriness. A single incomplete PVI ablation scar therefore is proarrhythmic. Development of ablation lesion sets that homogenize atrial mechanics and electrophysiology may improve AF ablation success.
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Affiliation(s)
- LA Gottlieb
- Academic Medical Center, Experimental Cardiology, Amsterdam, Netherlands (The)
| | | | | | | | | | - J Lamy
- Yale University, Department of Radiology and Biomedical Imaging, New Haven, United States of America
| | - K Kachenoura
- Sorbonne University, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Paris, France
| | | | - R Coronel
- Academic Medical Center, Experimental Cardiology, Amsterdam, Netherlands (The)
| | - LRC Dekker
- Catharina Hospital, Department of Cardiology, Eindhoven, Netherlands (The)
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12
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Bear LR, Cluitmans M, Abell E, Rogier J, Labrousse L, Cheng LK, LeGrice I, Lever N, Sands GB, Smaill B, Haïssaguerre M, Bernus O, Coronel R, Dubois R. Electrocardiographic Imaging of Repolarization Abnormalities. J Am Heart Assoc 2021; 10:e020153. [PMID: 33880931 PMCID: PMC8200734 DOI: 10.1161/jaha.120.020153] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Dispersion and gradients in repolarization have been associated with life‐threatening arrhythmias, but are difficult to quantify precisely from surface electrocardiography. The objective of this study was to evaluate electrocardiographic imaging (ECGI) to noninvasively detect repolarization‐based abnormalities. Methods and Results Ex vivo data were obtained from Langendorff‐perfused pig hearts (n=8) and a human donor heart. Unipolar electrograms were recorded simultaneously during sinus rhythm from an epicardial sock and the torso‐shaped tank within which the heart was suspended. Regional repolarization heterogeneities were introduced through perfusion of dofetilide and pinacidil into separate perfusion beds. In vivo data included torso and epicardial potentials recorded simultaneously in anesthetized, closed‐chest pigs (n=5), during sinus rhythm, and ventricular pacing. For both data sets, ECGI accurately reconstructed T‐wave electrogram morphologies when compared with those recorded by the sock (ex vivo: correlation coefficient, 0.85 [0.52–0.96], in vivo: correlation coefficient, 0.86 [0.52–0.96]) and repolarization time maps (ex‐vivo: correlation coefficient, 0.73 [0.63–0.83], in vivo: correlation coefficient, 0.76 [0.67–0.82]). ECGI‐reconstructed repolarization time distributions were strongly correlated to those measured by the sock (both data sets, R2 ≥0.92). Although the position of the gradient was slightly shifted by 8.3 (0–13.9) mm, the mean, max, and SD between ECGI and recorded gradient values were highly correlated (R2=0.87, 0.75, and 0.86 respectively). There was no significant difference in ECGI accuracy between ex vivo and in vivo data. Conclusions ECGI reliably and accurately maps potentially critical repolarization abnormalities. This noninvasive approach allows imaging and quantifying individual parameters of abnormal repolarization‐based substrates in patients with arrhythmogenesis, to improve diagnosis and risk stratification.
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Affiliation(s)
- Laura R Bear
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Matthijs Cluitmans
- CARIM School for Cardiovascular Diseases Maastricht UMC Maastricht Netherlands
| | - Emma Abell
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | | | - Louis Labrousse
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Cardiac Surgery CHU Pessac France
| | - Leo K Cheng
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Ian LeGrice
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Nigel Lever
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Gregory B Sands
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Bruce Smaill
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Michel Haïssaguerre
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France.,Department of Cardiac Electrophysiology and Stimulation Bordeaux University Hospital (CHU) Pessac France
| | - Olivier Bernus
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Ruben Coronel
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Experimental Cardiology Academic Medical Center Amsterdam the Netherlands
| | - Rémi Dubois
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
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13
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Langfield P, Feng Y, Bear LR, Duchateau J, Sebastian R, Abell E, Dubois R, Labrousse L, Rogier J, Hocini M, Haissaguerre M, Vigmond E. A novel method to correct repolarization time estimation from unipolar electrograms distorted by standard filtering. Med Image Anal 2021; 72:102075. [PMID: 34020081 DOI: 10.1016/j.media.2021.102075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Reliable patient-specific ventricular repolarization times (RTs) can identify regions of functional block or afterdepolarizations, indicating arrhythmogenic cardiac tissue and the risk of sudden cardiac death. Unipolar electrograms (UEs) record electric potentials, and the Wyatt method has been shown to be accurate for estimating RT from a UE. High-pass filtering is an important step in processing UEs, however, it is known to distort the T-wave phase of the UE, which may compromise the accuracy of the Wyatt method. The aim of this study was to examine the effects of high-pass filtering, and improve RT estimates derived from filtered UEs. We first generated a comprehensive set of UEs, corresponding to early and late activation and repolarization, that were then high-pass filtered with settings that mimicked the CARTO filter. We trained a deep neural network (DNN) to output a probabilistic estimation of RT and a measure of confidence, using the filtered synthetic UEs and their true RTs. Unfiltered ex-vivo human UEs were also filtered and the trained DNN used to estimate RT. Even a modest 2 Hz high-pass filter imposes a significant error on RT estimation using the Wyatt method. The DNN outperformed the Wyatt method in 62.75% of cases, and produced a significantly lower absolute error (p=8.99E-13), with a median of 16.91 ms, on 102 ex-vivo UEs. We also applied the DNN to patient UEs from CARTO, from which an RT map was computed. In conclusion, DNNs trained on synthetic UEs improve the RT estimation from filtered UEs, which leads to more reliable repolarization maps that help to identify patient-specific repolarization abnormalities.
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Affiliation(s)
- Peter Langfield
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Univ. Bordeaux, IMB UMR 5251, Talence F-33400, France.
| | - Yingjing Feng
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Univ. Bordeaux, IMB UMR 5251, Talence F-33400, France.
| | - Laura R Bear
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Rafael Sebastian
- CoMMLab, Dept. Computer Sciences, Universitat de Valencia, Valencia, Spain
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Remi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Louis Labrousse
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Julien Rogier
- Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Meleze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Cardiac Stimulation Team, Pessac, France
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Univ. Bordeaux, IMB UMR 5251, Talence F-33400, France
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14
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Cluitmans M, Bear L, Nguyen U, Van Rees B, Stoks J, Ter Bekke R, Mihl C, Bayer J, Vigmond E, Belterman C, Abell E, Dubois R, Coronel R, Volders P. A novel trigger-substrate mechanism based on clinically concealed repolarization abnormalities underlies idiopathic ventricular fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sudden cardiac arrest (SCA) is most often due to ventricular fibrillation (VF). When no cause is found during diagnostic follow-up, fibrillation is classified as idiopathic (iVF). We hypothesize that a critical functional substrate-trigger interaction underlies iVF.
Purpose
To study electrophysiological triggers and substrate for iVF in a clinical cohort; and seek mechanistic explanations in explanted pig hearts and computer models mimicking trigger-substrate interactions.
Methods
Repolarization time (RT) isochrones on the epicardium were studied with electrocardiographic imaging (ECGI) in patients with iVF, patients with frequent monomorphic premature ventricular complexes (fmPVC) but no structural disease or SCA, and controls without cardiovascular disease.
RT gradients were created in explanted, Langendorff-perfused pig hearts by local infusion of dofetilide (“dof”, 250 nM, delaying RT) and pinacidil (“pin”, 30 μM, shortening RT) in adjacent regions of the heart. Arrhythmia inducibility was tested by programmed stimulation (8 atrial stimuli [S1] followed by one ventricular stimulus [S2] paced at regions of early or late RT).
A computational ventricular monodomain model was used to study the location-dependency of trigger-substrate interaction; RT gradients were created by local changes in potassium channel conductance.
Results
Although QTc values were similar, iVF survivors (n=11) displayed significantly steeper RT gradients than controls (n=10) or fmPVC individuals (n=7): 269±111 vs 179±40 vs 171±76 ms/cm respectively (panel A). Unipolar electrograms (EGMs) at the gradients displayed a change in polarity of the local T wave (B). In iVF, PVCs originated more often from regions with early RT than in fmPVC individuals (yellow circles in A; 64% vs 14%).
In the explanted hearts (C), drug infusion resulted in similar RT gradients and polarity changes of EGM T waves (D-E). VF inducibility by pacing of the early RT region (D) increased significantly with steeper RT gradients (baseline: 3/6 hearts inducible, dof+pin: 3/3). Pacing of late RT regions (E) did not induce arrhythmias in baseline (0/6) nor with RT gradients (0/3). For similar pacing intervals at the early RT region, the 12-lead ECG R-on-T morphology was similar but VF only occurred in the presence of RT gradients (F).
In the computer model, the number of inducible pacing intervals critically depended on the stimulus location (G).
Conclusion
Combined, these results demonstrate that R-on-T superposition per se is insufficient to explain arrhythmogenesis. Rather, not only the temporal coupling interval but also the spatial origin of PVCs in relationship to the degree of local repolarization abnormalities are critical elements. In iVF, a substrate of RT gradients (panel H1) with triggers from early RT regions (H2) precipitate reentry (H3). Noninvasive ECGI can uncover these substrate and trigger characteristics in (at least a subset of) iVF survivors.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Scientific Research Veni grant TTW 16772, French National Research Agency (ANR-10-IAHU04-LIRYC)
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Affiliation(s)
- M Cluitmans
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - L Bear
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - U Nguyen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - B Van Rees
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - J Stoks
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - R Ter Bekke
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - C Mihl
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - J Bayer
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - E Vigmond
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - C Belterman
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - E Abell
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - R Dubois
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - R Coronel
- University of Bordeaux, IHU LIRYC, Bordeaux, France
| | - P Volders
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
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15
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Rivaud MR, Bayer JD, Cluitmans M, van der Waal J, Bear LR, Boukens BJ, Belterman C, Gottlieb L, Vaillant F, Abell E, Dubois R, Meijborg VMF, Coronel R. Critical repolarization gradients determine the induction of reentry-based torsades de pointes arrhythmia in models of long QT syndrome. Heart Rhythm 2020; 18:278-287. [PMID: 33031961 DOI: 10.1016/j.hrthm.2020.09.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Torsades de pointes arrhythmia is a potentially lethal polymorphic ventricular tachyarrhythmia (pVT) in the setting of long QT syndrome. Arrhythmia susceptibility is influenced by risk factors modifying repolarization. OBJECTIVE The purpose of this article was to characterize repolarization duration and heterogeneity in relation to pVT inducibility and maintenance. METHODS Sotalol was infused regionally or globally in isolated Langendorff blood-perfused pig hearts (N = 7) to create repolarization time (RT) heterogeneities. Programmed stimulation and epicardial activation and repolarization mapping were performed. The role of RT (heterogeneities) was studied in more detail using a computer model of the human heart. RESULTS pVTs (n = 11) were inducible at a critical combination of RT and RT heterogeneities. The pVT cycle lengths were similar in the short and long RT regions. Short-lasting pVTs were maintained by focal activity while longer-lasting pVTs by reentry wandering along the interface between the 2 regions. Local restitution curves from the long and short RT regions crossed. This was associated with T-wave inversion at coupling intervals at either side of the crossing point. These experimental observations were confirmed by the computer simulations. CONCLUSION pVTs are inducible within a critical range of RT and RT heterogeneities and are maintained by reentry wandering along the repolarization gradient. Double potentials localize at the core of the reentrant circuit and reflect phase singularities. RT gradient and T waves invert with short-coupled premature beats in the long RT region as a result of the crossing of the restitution curves allowing reentry initiation.
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Affiliation(s)
- Mathilde R Rivaud
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands.
| | - Jason D Bayer
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France; Institut de Mathématiques de Bordeaux, UMR5251, Centre National De La Recherche Scientifique, Bordeaux, France
| | - Matthijs Cluitmans
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands; CARIM School for Cardiovascular Disease, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeanne van der Waal
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Laura R Bear
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Bastiaan J Boukens
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands; Department of Medical Biology, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Charly Belterman
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Lisa Gottlieb
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Fanny Vaillant
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Emma Abell
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Remi Dubois
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Veronique M F Meijborg
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - Ruben Coronel
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, Amsterdam, The Netherlands; Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
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16
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Douard M, Vaillant F, Abell E, White E, Dos Santos P, Brette F. Acute hexosamine pathway activation induces cardiac arrhythmia. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Meo M, Bonizzi P, Bear LR, Cluitmans M, Abell E, Haïssaguerre M, Bernus O, Dubois R. Body Surface Mapping of Ventricular Repolarization Heterogeneity: An Ex-vivo Multiparameter Study. Front Physiol 2020; 11:933. [PMID: 32903614 PMCID: PMC7438571 DOI: 10.3389/fphys.2020.00933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Increased heterogeneity of ventricular repolarization is associated with life-threatening arrhythmia and sudden cardiac death (SCD). T-wave analysis through body surface potential mapping (BSPM) is a promising tool for risk stratification, but the clinical effectiveness of current electrocardiographic indices is still unclear, with limited experimental validation. This study aims to investigate performance of non-invasive state-of-the-art and novel T-wave markers for repolarization dispersion in an ex vivo model. Methods Langendorff-perfused pig hearts (N = 7) were suspended in a human-shaped 256-electrode torso tank. Tank potentials were recorded during sinus rhythm before and after introducing repolarization inhomogeneities through local perfusion with dofetilide and/or pinacidil. Drug-induced repolarization gradients were investigated from BSPMs at different experiment phases. Dispersion of electrical recovery was quantified by duration parameters, i.e., the time interval between the peak and the offset of T-wave (TPEAK-TEND) and QT interval, and variability over time and electrodes was also assessed. The degree of T-wave symmetry to the peak was quantified by the ratio between the terminal and initial portions of T-wave area (Asy). Morphological variability between left and right BSPM electrodes was measured by dynamic time warping (DTW). Finally, T-wave organization was assessed by the complexity of repolarization index (CR), i.e., the amount of energy non-preserved by the dominant eigenvector computed by principal component analysis (PCA), and the error between each multilead T-wave and its 3D PCA approximation (NMSE). Body surface indices were compared with global measures of epicardial dispersion of repolarization, and with local gradients between adjacent ventricular sites. Results After drug intervention, both regional and global repolarization heterogeneity were significantly enhanced. On the body surface, TPEAK-TEND was significantly prolonged and less stable in time in all experiments, while QT interval showed higher variability across the interventions in terms of duration and spatial dispersion. The rising slope of the repolarization profile was steeper, and T-waves were more asymmetric than at baseline. Interventricular shape dissimilarity was enhanced by repolarization gradients according to DTW. Organized T-wave patterns were associated with abnormal repolarization, and they were properly described by the first principal components. Conclusion Repolarization heterogeneity significantly affects T-wave properties, and can be non-invasively captured by BSPM-based metrics.
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Affiliation(s)
- Marianna Meo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Laura R Bear
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emma Abell
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Michel Haïssaguerre
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Olivier Bernus
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Rémi Dubois
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
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18
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Douard M, Vaillant F, Abell E, Dos Santos P, Brette F. Hexosamine Pathway Induces Cardiac Arrhythmia via Modulation of Sustained Potassium Currentmodulation of Sustained Potassium Current. Biophys J 2020. [DOI: 10.1016/j.bpj.2019.11.1992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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19
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Bessière F, Zorgani A, Robert J, Daunizeau L, Cao E, Vaillant F, Abell E, Quesson B, Catheline S, Chevalier P, Lafon C. High Frame Rate Ultrasound for Electromechanical Wave Imaging to Differentiate Endocardial From Epicardial Myocardial Activation. Ultrasound Med Biol 2020; 46:405-414. [PMID: 31767455 DOI: 10.1016/j.ultrasmedbio.2019.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
Differentiation between epicardial and endocardial ventricular activation remains a challenge despite the latest technologies available. The aim of the present study was to develop a new tool method, based on electromechanical wave imaging (EWI), to improve arrhythmogenic substrate activation analysis. Experiments were conducted on left ventricles (LVs) of four isolated working mode swine hearts. The protocol aimed at demonstrating that different patterns of mechanical activation could be observed whether the ventricle was in sinus rhythm, paced from the epicardium or from the endocardium. A total of 72 EWI acquisitions were recorded on the anterior, lateral and posterior segments of the LV. A total of 54 loop records were blindly assigned to two readers. EWI sequences interpretations were correct in 89% of cases. The overall agreement rate between the two readers was 83%. When in a paced ventricle, the origin of the wave front was focal and originated from the endocardium or the epicardium. In sinus rhythm, wave front was global and activated within the entire endocardium toward the epicardium at a speed of 1.7 ± 0.28 m·s-1. Wave front speeds were respectively measured when the endocardium or the epicardium were paced at a speed of 1.1 ± 0.35 m·s-1 versus 1.3 ± 0.34 m·s-1 (p = NS). EWI activation mapping allows activation localization within the LV wall and calculation of the wave front propagation speed through the muscle. In the future, this technology could help localize activation within the LV thickness during complex ablation procedures.
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Affiliation(s)
- Francis Bessière
- Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France.
| | - Ali Zorgani
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Jade Robert
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Loïc Daunizeau
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Elodie Cao
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Fanny Vaillant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000 Bordeaux, France
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000 Bordeaux, France
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000 Bordeaux, France
| | - Stéphane Catheline
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Philippe Chevalier
- Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France
| | - Cyril Lafon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France; Université de Lyon, Lyon, France
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20
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Bear LR, Bouhamama O, Cluitmans M, Duchateau J, Walton RD, Abell E, Belterman C, Haissaguerre M, Bernus O, Coronel R, Dubois R. Advantages and pitfalls of noninvasive electrocardiographic imaging. J Electrocardiol 2019; 57S:S15-S20. [PMID: 31477238 DOI: 10.1016/j.jelectrocard.2019.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND With increasing clinical use of Electrocardiographic Imaging (ECGI), it is imperative to understand the limits of this technique. The objective of this study is to evaluate a potential-based ECGI approach for activation and repolarization mapping in sinus rhythm. METHOD Langendorff-perfused pig hearts were suspended in a human-shaped torso tank. Electrograms were recorded with a 108-electrode sock and ECGs with 256 electrodes embedded in the tank surface. Left bundle branch block (LBBB) was developed in 4 hearts through ablation, and repolarization abnormalities in another 4 hearts through regional perfusion of dofetilide and pinacidil. Electrograms were noninvasively reconstructed and reconstructed activation and repolarization features were compared to those recorded. RESULTS Visual consistency between ECGI and recorded activation and repolarization maps was high. While reconstructed repolarization times showed significantly more error than activation times quantitatively, patterns were reconstructed with a similar level of accuracy. The number of epicardial breakthrough sites was underestimated by ECGI and these were misplaced (>20 mm) in location. Likewise, ECGI reconstructed activation maps demonstrated artificial lines of block resulting from a W-shaped QRS waveform that were not present in recorded maps. Nevertheless, ECGI allowed identification of regions of abnormal repolarization reasonably accurately in terms of size, location and timing. CONCLUSIONS This study validates a potential-based ECGI approach to noninvasively image activation and recovery in sinus rhythm. Despite inaccuracies in epicardial breakthroughs and lines of conduction block, other important clinical features such as regions of abnormal repolarization can be accurately derived making ECGI a valuable clinical tool.
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Affiliation(s)
- Laura R Bear
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.
| | - Oumayma Bouhamama
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INRIA Bordeaux Sud-Ouest, Carmen team, Bordeaux, France
| | - Matthijs Cluitmans
- CARIM School for Cardiovascular Diseases, Maastricht UMC, Maastricht, Netherlands
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France
| | - Richard D Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France
| | - Charly Belterman
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Department of Experimental Cardiology, Academic Medical Center, the Netherlands
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France
| | - Ruben Coronel
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Department of Experimental Cardiology, Academic Medical Center, the Netherlands
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France
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21
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Bessiere F, Zorgani A, Daunizeau L, Cao E, Vaillant F, Abell E, Quesson B, Catheline S, Chevalier P, Lafon C. High frame rate ultrasounds for electromechanical wave imaging to characterize and differentiate endocardial from epicardial activation of ventricular arrhythmia: A proof of concept study. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Bear LR, Dogrusoz YS, Svehlikova J, Coll-Font J, Good W, van Dam E, Macleod R, Abell E, Walton R, Coronel R, Haissaguerre M, Dubois R. Effects of ECG Signal Processing on the Inverse Problem of Electrocardiography. Comput Cardiol (2010) 2019; 45. [PMID: 30899762 DOI: 10.22489/cinc.2018.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The inverse problem of electrocardiography is ill-posed. Errors in the model such as signal noise can impact the accuracy of reconstructed cardiac electrical activity. It is currently not known how sensitive the inverse problem is to signal processing techniques. To evaluate this, experimental data from a Langendorff-perfused pig heart (n=1) suspended in a human-shaped torso-tank was used. Different signal processing methods were applied to torso potentials recorded from 128 electrodes embedded in the tank surface. Processing methods were divided into three categories i) high-frequency noise removal ii) baseline drift removal and iii) signal averaging, culminating in n=72 different signal sets. For each signal set, the inverse problem was solved and reconstructed signals were compared to those directly recorded by the sock around the heart. ECG signal processing methods had a dramatic effect on reconstruction accuracy. In particular, removal of baseline drift significantly impacts the magnitude of reconstructed electrograms, while the presence of high-frequency noise impacts the activation time derived from these signals (p<0.05).
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Affiliation(s)
- Laura R Bear
- IHU-LIRYC, Université de Bordeaux, Bordeaux, France
| | | | - J Svehlikova
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - J Coll-Font
- Computational Radiology Department at Boston Children's Hospital, Boston (MA), USA
| | - W Good
- Dept. of Bioengineering and SCI Institute, University of Utah, Salt Lake City (UT), USA
| | - E van Dam
- Peacs BV, Nieuwerbrug aan den Rijn, The Netherlands
| | - R Macleod
- Dept. of Bioengineering and SCI Institute, University of Utah, Salt Lake City (UT), USA
| | - E Abell
- IHU-LIRYC, Université de Bordeaux, Bordeaux, France
| | - R Walton
- IHU-LIRYC, Université de Bordeaux, Bordeaux, France
| | - R Coronel
- IHU-LIRYC, Université de Bordeaux, Bordeaux, France.,Dept. Exp. Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - R Dubois
- IHU-LIRYC, Université de Bordeaux, Bordeaux, France
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23
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Bear LR, Walton RD, Abell E, Coudière Y, Haissaguerre M, Bernus O, Dubois R. Optical Imaging of Ventricular Action Potentials in a Torso Tank: A New Platform for Non-Invasive Electrocardiographic Imaging Validation. Front Physiol 2019; 10:146. [PMID: 30863318 PMCID: PMC6399141 DOI: 10.3389/fphys.2019.00146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Non-invasive electrocardiographic imaging (ECGI) is a promising tool to provide high-resolution panoramic imaging of cardiac electrical activity noninvasively from body surface potential measurements. Current experimental methods for ECGI validation are limited to comparison with unipolar electrograms and the relatively low spatial resolution of cardiac mapping arrays. We aim to develop a novel experimental set up combining a human shaped torso tank with high-resolution optical mapping allowing the validation of ECGI reconstructions. Methods: Langendorff-perfused pig hearts (n = 3) were suspended in a human torso-shaped tank, with the left anterior descending artery (LAD) cannulated on a separate perfusion. Electrical signals were recorded from an 108-electrode epicardial sock and 128 electrodes embedded in the tank surface. Simultaneously, optical mapping of the heart was performed through the anterior surface of the tank. Recordings were made in sinus rhythm and ventricular pacing (n = 55), with activation and repolarization heterogeneities induced by perfusion of hot and cold solutions as well as Sotalol through the LAD. Fluoroscopy provided 3D cardiac and electrode geometries in the tank that were transformed to the 2D optical mapping window using an optimization algorithm. Epicardial unipolar electrograms were reconstructed from torso potentials using ECGI and validated using optical activation and repolarization maps. Results: The transformation and alignment of the 3D geometries onto the 2D optical mapping window was good with an average correlation of 0.87 ± 0.10 and error of 7.7 ± 3.1 ms with activation derived from the sock. The difference in repolarization times were more substantial (error = 17.4 ± 3.7 ms) although the sock and optical repolarization patterns themselves were very similar (correlation = 0.83 ± 0.13). Validation of ECGI reconstructions revealed ECGI accurately captures the pattern of activation (correlation = 0.79 ± 0.11) and identified regions of late and/or early repolarization during different perfusions through LAD. ECGI also correctly demonstrated gradients in both activation and repolarization, although in some cases these were under or over-estimated or shifted slightly in space. Conclusion: A novel experimental setup has been developed, combining a human-shaped torso tank with optical mapping, which can be effectively used in the validation of ECGI techniques; including the reconstruction of activation and repolarization patterns and gradients.
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Affiliation(s)
- Laura R Bear
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Richard D Walton
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Emma Abell
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Yves Coudière
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,CARMEN Research Team, INRIA, Talence, France.,CNRS, IMB, UMR 5251, Talence, France
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Olivier Bernus
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Rémi Dubois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,Univ. Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
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24
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Greillier P, Ankou B, Bour P, Zorgani A, Abell E, Lacoste R, Bessière F, Pernot M, Catheline S, Quesson B, Chevalier P, Lafon C. Myocardial Thermal Ablation with a Transesophageal High-Intensity Focused Ultrasound Probe: Experiments on Beating Heart Models. Ultrasound Med Biol 2018; 44:2625-2636. [PMID: 30205993 DOI: 10.1016/j.ultrasmedbio.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
Described here is a study of transesophageal thermal ablation of isolated and perfused beating hearts and non-human primates. An endoscope integrating a transesophageal echocardiography probe and a high-intensity focused ultrasound transducer was built and tested on five Langendorff-isolated hearts and three 30-kg baboons. B-Mode ultrasound, passive elastography and magnetic resonance imaging were performed to monitor thermal lesions. In isolated hearts, continuous and gated sonication parameters were evaluated with acoustic intensities of 9-12 W/cm2. Sonication parameters of gated exposures with 12 W/cm2 acoustic intensity for 5 min consistently produced visible lesions in the ventricles of isolated hearts. In animals, left atria and ventricles were exposed to repeated continuous sonications (4-15 times for 16 s) at an acoustic intensity at the surface of the transducer of 9 W/cm2. Clinical states of the baboons during and after the treatment were good. One suspected lesion in the left ventricle could be evidenced by elastography, but was not confirmed by magnetic resonance imaging. The transesophageal procedure therefore has the potential to create thermal lesions in beating hearts and its safety in clinical practice seems promising. However, further technical exploration of the energy deposition in the target would be necessary before the next pre-clinical experiments.
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Affiliation(s)
| | - Bénédicte Ankou
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | | | - Ali Zorgani
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
| | | | | | - Francis Bessière
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France; Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Mathieu Pernot
- Institut Langevin, Ondes et Images, ESPCI ParisTech, CNRS UMR 7587, Paris, France
| | | | | | - Philippe Chevalier
- Hospices Civils de Lyon, Hôpital Cardiovasculaire Louis Pradel, Lyon, France
| | - Cyril Lafon
- Universite Lyon, INSERM, UMR1032, LabTAU, Lyon, France
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25
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Coste F, Guibert C, Magat J, Abell E, Vaillant F, Dubois M, Courtois A, Diolez P, Quesson B, Marthan R, Savineau JP, Muller B, Freund-Michel V. Chronic hypoxia aggravates monocrotaline-induced pulmonary arterial hypertension: a rodent relevant model to the human severe form of the disease. Respir Res 2017; 18:47. [PMID: 28288643 PMCID: PMC5348907 DOI: 10.1186/s12931-017-0533-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/08/2017] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe form of pulmonary hypertension that combines multiple alterations of pulmonary arteries, including, in particular, thrombotic and plexiform lesions. Multiple-pathological-insult animal models, developed to more closely mimic this human severe PAH form, often require complex and/or long experimental procedures while not displaying the entire panel of characteristic lesions observed in the human disease. In this study, we further characterized a rat model of severe PAH generated by combining a single injection of monocrotaline with 4 weeks exposure to chronic hypoxia. This model displays increased pulmonary arterial pressure, right heart altered function and remodeling, pulmonary arterial inflammation, hyperresponsiveness and remodeling. In particular, severe pulmonary arteriopathy was observed, with thrombotic, neointimal and plexiform-like lesions similar to those observed in human severe PAH. This model, based on the combination of two conventional procedures, may therefore be valuable to further understand the pathophysiology of severe PAH and identify new potential therapeutic targets in this disease.
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Affiliation(s)
- Florence Coste
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France. .,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France. .,CHU de Bordeaux, F-33000, Bordeaux, France.
| | - Christelle Guibert
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
| | - Julie Magat
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600, Pessac, Bordeaux, France
| | - Emma Abell
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600, Pessac, Bordeaux, France
| | - Fanny Vaillant
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600, Pessac, Bordeaux, France
| | - Mathilde Dubois
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
| | - Arnaud Courtois
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
| | - Philippe Diolez
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600, Pessac, Bordeaux, France
| | - Bruno Quesson
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F-33600, Pessac, Bordeaux, France
| | - Roger Marthan
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,CHU de Bordeaux, F-33000, Bordeaux, France
| | - Jean-Pierre Savineau
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
| | - Bernard Muller
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
| | - Véronique Freund-Michel
- INSERM, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux U1045, F-33000, Bordeaux, France
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26
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Vaillant F, Abell E, Constantin M, Pasdois P, Arsac L, Desplantez T, Deschodt-Arsac V, Dos Santos P. 0307 : Acute activation of the hexosamine biosynthetic pathway promotes electrical instability. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Liu Y, Mangini J, Saad R, Silverman AR, Abell E, Tung MY, Graner SR, Silverman JF. Diagnostic value of microtubule-associated protein-2 in Merkel cell carcinoma. Appl Immunohistochem Mol Morphol 2004; 11:326-9. [PMID: 14663358 DOI: 10.1097/00129039-200312000-00008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous carcinoma with neuroendocrine differentiation and a propensity for early spread to regional lymph nodes. Since surgical resection is the mainstay of treatment of MCC, differentiation of MCC from malignant lymphoma, metastatic small cell carcinoma, basal cell carcinoma, and malignant melanoma is very important and is sometimes challenging with routine histologic examination. Immunohistochemical studies may be required to differentiate MCC from other primary and metastatic skin neoplasms. Previously, the authors reported that microtubule-associated protein-2 (MAP-2) is a sensitive and specific marker for pulmonary neoplasms with neuroendocrine differentiation. Because MCC is also a neuroendocrine carcinoma, the authors hypothesized that MAP-2 may be expressed in MCC and therefore may be a useful marker in establishing an accurate diagnosis. MAP-2 staining was demonstrated in all 14 MCCs with diffuse (10 cases) to focal (4 cases) patterns of immunoreactivity. No MAP-2 immunoreactivity was observed in any lymphoma (14 cases), basal cell carcinoma (20 cases), or squamous cell carcinoma (14 cases). CK20 reactivity was present in 12 of 14 cases with focal (2 cases) to diffuse (10 cases) staining having the characteristic perinuclear dot-like pattern. NSE was positive in 13 of 14 cases, SYN was positive in all 14 cases, CHR was positive in 8 of 14 cases, CK7 was positive in 4 of 14 cases, and CD99 was focally positive in 2 cases and diffusely positive in 3 cases. MAP-2 showed a diffuse or focal staining of MCC with a +1 to +4 intensity in most cases. MAP-2 was positive in two cases of MCC that were negative for CK20 and CHR and negative or only slightly positive for SYN and NSE. Therefore, MAP-2 may be a valuable ancillary study in skin tumors suspicious for neuroendocrine origin with faint or negative staining with the antibodies traditionally used for diagnosing MCC. The authors believe this is the first study to demonstrate the utility of MAP-2 in the immunohistochemical workup of MCC. The authors recommend that MAP-2 be added to immunohistochemical panels to confirm the diagnosis of MCC.
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Affiliation(s)
- Yulin Liu
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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28
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Abstract
Previous studies have suggested the importance of CD8+ cytotoxic T-cells of hosts against neoplasms. Earlier studies and our previous investigation showed that a majority of tumor infiltrating T-cells in human basal cell carcinomas (BCCs) belonged to CD4+ T-cells. CD8+ cells were also present in the peritumor areas of human BCCs, but in smaller numbers. Published evidence indicates the importance of cytotoxic T-cells in antitumor immunity. Cytotoxic T-cells have been identified by using monoclonal antibodies against various cytotoxic T-cell components. In this study, we used monoclonal antibodies to perforin to evaluate the role of cytotoxic T-cells in the host response against basal cell carcinomas. Perforin-expressing T-cells could be identified in the infiltrate of BCCs in frozen tissue sections, and also in antigen-retrieved paraffin-embedded sections of BCCs, and the presence of perforin-expressing T-cells correlated with the infiltration of CD8+ T-cells. These results suggest that cytotoxic T-cells play a role in host defense against human BCCs.
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Affiliation(s)
- J S Deng
- Department of Dermatology, University of Pittsburgh School of Medicine, Department of Veterans Affairs Medical Center, Pennsylvania 15240, USA
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29
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Deng JS, Saito R, Abell E, Silverman A, Falo L, Tharp M. Prognostic value of mast cells, T cells and cytotoxic T cells in melanomas. J Dermatol Sci 1998. [DOI: 10.1016/s0923-1811(98)83652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Affiliation(s)
- D S Wong
- University of California, San Diego, Medical Center, USA
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31
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Affiliation(s)
- M P Seraly
- Department of Dermatology, University of Pittsburgh Medical Center, PA 15213
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32
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Abstract
A periodic eruption of porokeratosis developed in a 31-year-old black woman with chronic idiopathic hepatitis requiring liver transplantation. The clinicopathologic features were chiefly those of linear and punctate porokeratosis but overlapped those of porokeratosis plantaris, palmaris et disseminata and hyperkeratotic or verrucous porokeratosis. Typical cornoid lamellae were visible on histologic examination. Outbreaks of the lesions occurred during exacerbations of the liver disease. The skin condition rapidly improved after operation, with concomitant improvement in liver function.
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Affiliation(s)
- S J Hunt
- Department of Dermatology, University of Pittsburgh, Pennsylvania
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33
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Abstract
An adnexal tumor with features of both clear cell hidradenoma and mucinous syringometaplasia is reported. The lesion occurred as a solitary, asymptomatic, slow growing nodule of 6-months duration on the anterior neck of a 55-year-old woman. Serous fluid could be expressed from a central skin opening. Histologically, there was a squamous-lined invagination with foci of mucin-laden cells. A ductal component with a variable admixture of mucinous cells merged with a nearby clear cell hidradenoma. Because clinicopathologic similarities exist between mucinous syringometaplasia and clear cell hidradenoma with mucinous change, thorough sectioning of mucinous syringometaplasia-like lesions is necessary to exclude an associated sweat gland neoplasm.
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Affiliation(s)
- S J Hunt
- Department of Dermatology, University of Pittsburgh
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34
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Affiliation(s)
- L M Benedict
- Department of Dermatology, University of Pittsburgh, PA 15213
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35
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Abstract
An unusual adnexal tumor on the scalp of a 59-year-old woman with hereditary trichoepithelioma is reported. After the initial removal, the tumor recurred twice during a 4-year period. Mohs micrographic surgery resulted in full excision of the lesion. Two years later there was no evidence of recurrence. Histologic examination of the tumor showed it to merge with adjacent areas of classic trichoepithelioma. The tumor showed cytologic atypia, mitotic figures, necrosis, deep infiltration, and features of pilar differentiation including clear cells, reminiscent of cells of the follicular outer root sheath, and focal shadow-cell formation. The differential diagnosis of this malignant follicular neoplasm included pilomatrix carcinoma and basal-cell carcinoma with matrical differentiation. The unique clinicopathologic features, however, raised consideration of a "malignant trichoepithelioma."
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Affiliation(s)
- S J Hunt
- Department of Dermatology, University of Pittsburgh, Pennsylvania
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36
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Abstract
A 57-year-old woman with a 6-year history of a dermatitis that evolved into typical necrolytic migratory erythema is reported. Four biopsy specimens were obtained in 5 years. The early lesions revealed superficial perivascular inflammation in the dermis, minor epidermal spongiosis, and scattered dyskeratotic cells in the upper epidermis. The differential diagnosis of this pattern of dyskeratotic dermatitis, particularly in a chronic eruption, should include consideration of hyperglucagonemia and the possibility of an associated pancreatic islet cell tumor.
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Affiliation(s)
- S J Hunt
- Department of Dermatology, University of Pittsburgh, PA 15221
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37
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Abstract
As the width of surgical margins declines, histologic evaluation of the margins is needed to assess the completeness of excision of a malignant melanoma. We studied 221 specimens in 59 patients and compared the interpretations of frozen and paraffin sections from the same block. Frozen sections had a sensitivity of 100% in detecting melanoma when present and a specificity of 90%.
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Affiliation(s)
- J A Zitelli
- Department of Medicine, Montefiore Hospital, University Health Center of Pittsburgh, PA
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38
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Elenitsas R, Abell E, Lee YY, Huang J, Deng JS. Comparison of IgG subclass autoantibodies in patients with systemic lupus erythematosus and subacute cutaneous lupus erythematosus. J Dermatol Sci 1990; 1:207-15. [PMID: 2085508 DOI: 10.1016/0923-1811(90)90133-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Circulating antinuclear antibodies and in vivo bound immunoglobulins at the dermal-epidermal junction are frequently seen in patients with lupus erythematosus. The present study was designed to examine the distribution of the IgG subclasses of in vivo skin bound IgG and circulating antinuclear antibodies (ANA) in patients with systemic lupus erythematosus (SLE) or subacute cutaneous lupus erythematosus (SCLE). Immunofluorescence studies on skin biopsies showed IgG1 to be the predominant IgG subclass in SCLE patients, present in 20 of 21 (95%) of the specimens. IgG2 was present in 4 patients (19%), IgG3 in 1 (5%), and IgG4 in 7 (33%). The frequencies of IgG2, IgG3, and IgG4 skin staining were significantly higher in the seven SLE patients who were studied: IgG1 in 7/7 (100%), IgG2 in 7/7 (100%) and IgG4 in 6/7 (86%). Immunoblot analysis for the IgG subclasses was performed on serum of 29 patients with SCLE who had antibodies to SSA/Ro antigen. Twenty-seven (93%) of these patients were positive for IgG1 anti-SSA/Ro antibody, while the frequencies for IgG2, IgG3, and IgG4 anti-SSA/Ro were very low. These studies indicate that there is a difference in the IgG subclass antibody response in patients with SLE and SCLE. The presence of more than one subclass antibody may be indicative of systemic disease.
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Affiliation(s)
- R Elenitsas
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania
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39
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Charley MR, Tharp M, Locker J, Deng JS, Goslen JB, Mauro T, McCoy P, Abell E, Jegasothy B. Establishment of a human cutaneous T-cell lymphoma in C.B-17 SCID mice. J Invest Dermatol 1990; 94:381-4. [PMID: 2307857 DOI: 10.1111/1523-1747.ep12874500] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Investigation into the immunobiology of cutaneous T-cell lymphomas (CTCL) would be facilitated by the development of a suitable experimental system. The recent use of mice with severe combined immune deficiency (SCID) as a vehicle to study the human immune system prompted us to try to establish CTCL in SCID mice. We found that a CD4+ lymphocytic infiltrate characteristic of CTCL was maintained within patient skin grafts in place on natural killer cell depleted SCID mice for the month of observation. CTCL cells were not found outside the human skin graft. This chimeric model using SCID mice and patient lesional skin should provide a useful tool to characterize CTCL/skin microenvironmental interactions and to test new therapeutic approaches.
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Affiliation(s)
- M R Charley
- Department of Dermatology, University of Pittsburgh Medical School, Pennsylvania
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40
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Bari MM, Shulkin DJ, Abell E. Ulcerative syphilis in acquired immunodeficiency syndrome: a case of precocious tertiary syphilis in a patient infected with human immunodeficiency virus. J Am Acad Dermatol 1989; 21:1310-2. [PMID: 2584468 DOI: 10.1016/s0190-9622(89)80316-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M M Bari
- Department of Dermatology, University of Pittsburgh School of Medicine, PA
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41
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Lee JY, Abell E, Shevechik GJ. Solitary spindle cell tumor with myoid differentiation of the lymph node. Arch Pathol Lab Med 1989; 113:547-50. [PMID: 2712680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Spindle cell tumors arising in the lymph nodes are very rare. We report the light microscopic, histochemical, immunohistochemical, and ultrastructural findings of an unusual solitary spindle cell tumor in a peripheral lymph node of a 45-year-old woman. Microscopically, the tumor was characterized by interlacing fascicles of uniform spindle cells with nuclear palisading and formation of Verocay bodies. Numerous erythrocytes were found interstitially. There were no mitotic figures or significant nuclear atypia. The ultrastructural findings of abundant myofilaments with dense bodies indicated myoid differentiation. The clinical and pathologic findings favored this being a benign tumor and could represent a unique example of "intranodal myofibroblastoma." The differential diagnosis includes neurilemoma, leiomyoma, and, more importantly, leiomyosarcoma, Kaposi's sarcoma, and other metastatic spindle cell tumors.
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Affiliation(s)
- J Y Lee
- Departments of Pathology, University of Pittsburgh, Pa
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42
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Brooks WS, Lee YY, Abell E, Deng JS. Comparison of IgG subclasses and complement binding activity of autoantibodies from patients with bullous pemphigoid and pemphigus. J Clin Lab Anal 1989; 3:307-11. [PMID: 2681622 DOI: 10.1002/jcla.1860030509] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Bullous pemphigoid and pemphigus are autoimmune disorders of skin of unknown etiology and are characterized by the presence of immunoreactants in the skin and circulating autoantibodies to skin components. The distribution of IgG subclass antibodies to intercellular substance (ICS) of pemphigus and basement membrane zone substance (BMZ) of bullous pemphigoid was analyzed by using monoclonal antibodies to human IgG subclasses. IgG4 type anti-BMZ antibody was found in the majority of patients with bullous pemphigoid (88% in skin and 96% in serum). One third to one half of bullous pemphigoid patients had IgG1 and IgG2 anti-BMZ antibodies. The majority of bullous pemphigoid skin (92%) had complement in skin, however only one third of their sera had complement binding activity in vitro. IgG1 anti-ICS antibody was the predominant one in patients with pemphigus (86% in skin and 80% in circulation). IgG4 anti-ICS antibody was seen in two thirds of specimens from pemphigus patients. IgG3 subclass antibody was more frequently seen in pemphigus than in bullous pemphigoid patients. Two-thirds of pemphigus sera were capable of activating complement in vitro. The complement binding activity was directly associated with IgG1 and/or IgG3 subclass antibodies. The possible mechanisms for the restricted IgG4 subclass antibodies in bullous pemphigoid and pemphigus are discussed.
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Affiliation(s)
- W S Brooks
- Department of Dermatology, University of Pittsburgh School of Medicine, Pennsylvania
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43
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Hambley R, Hebda PA, Abell E, Cohen BA, Jegasothy BV. Wound healing of skin incisions produced by ultrasonically vibrating knife, scalpel, electrosurgery, and carbon dioxide laser. J Dermatol Surg Oncol 1988; 14:1213-7. [PMID: 3141490 DOI: 10.1111/j.1524-4725.1988.tb03478.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An ultrasonically vibrating knife has been developed for producing surgical incisions with reduced hemorrhage. Tissue injury and wound healing of porcine cutaneous incisions produced by this instrument, conventional scalpel, electrosurgery, and CO2 laser were compared regarding clinical, histopathologic, and tensile strength differences. Scalpel incisions had the least tissue injury and fastest healing, but the ultrasonically vibrating knife produced less tissue injury and faster healing than electrosurgery or CO2 laser.
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Affiliation(s)
- R Hambley
- Department of Dermatology, University of Pittsburgh, Pennsylvania
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44
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Affiliation(s)
- E Abell
- Department of Dermatology, University of Pittsburgh, School of Medicine, Pennsylvania
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45
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Affiliation(s)
- D Shulkin
- Department of Medicine and Dermatology, School of Medicine, University of Pittsburgh, Pennsylvania
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46
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Abstract
We report the histologic and ultrastructural findings of a solitary, unusual cutaneous tumor in a 69-year-old woman. The tumor is characterized by many mature ganglion cells in the papillary dermis and fascicles of unmyelinated axons in the lower dermis. The lesion is ganglioneuromatous but differs from the other ganglioneuromas histologically in that the ganglion cells do not intermingle with the neuromatous elements. It may represent a combined heterotopia of ganglion cells and hamartomatous neuroma. The histologic differential diagnosis and the possible pathogenesis are discussed.
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Affiliation(s)
- J Y Lee
- Department of Pathology, Presbyterian-University Hospital, Pittsburgh, PA 15213
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47
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Derkay C, Hirsch BE, Abell E. Pathologic quiz case 2. Plaque stage of mycosis fungoides. Arch Otolaryngol Head Neck Surg 1987; 113:332-3, 335-6. [PMID: 3814383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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48
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Abstract
Physical examination by a single clinician showed that 17 of 51 asymptomatic homosexual men and 19 of 26 men with persistent lymphadenopathy had linear telangiectasias in a broad, crescent distribution across the chest. The telangiectasias were commonly associated with erythema in the same distribution. Of the 36 men with telangiectasias, 25 were positive for serum antibody to the human immunodeficiency virus (HIV), whereas only 15 of 41 men without telangiectasias were seropositive (p = 0.001). Biopsy studies of supraclavicular skin from 6 of the men with HIV antibody and telangiectasias showed a characteristic pattern of dilated blood vessels with a perivascular small-cell infiltrate; no endothelial proliferation was noted. This histopathologic pattern was not consistently observed in HIV-seronegative men regardless of whether they had telangiectasias. These data show that telangiectasias of the upper chest are a relatively common finding in homosexual men and that they are significantly, although not exclusively, associated with HIV infection.
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49
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Abstract
Intrathoracic involvement with cutaneous T-cell lymphoma (CTCL) was documented in eight patients with mycosis fungoides and two patients with Sĕzary syndrome. The radiographic findings consisted of multiple bilateral parenchymal nodular densities (five patients), patchy areas of consolidation (two patients), diffuse reticulonodular or interstitial infiltration (two patients), and pleural effusion without underlying parenchymal disease (one patient). Dyspnea on exertion and nonproductive cough were the most frequent presenting symptoms, and physical examination of the lungs was usually normal. In one patient a partial Pancoast's syndrome developed from a pulmonary apical mass. Results of blood gas studies and pulmonary function tests indicated an alveolar-capillary block in gas diffusion. Although the antemortem diagnosis was often suggested on cytopathologic preparations or on tissue obtained by transbronchial or percutaneous needle aspiration biopsy, a definitive diagnosis of CTCL usually required an open-lung biopsy. The response of pulmonary infiltrates to various systemic chemotherapeutic agents was variable, and the mean survival after initiation of drug therapy was 9.5 months. The findings suggest that combined modality therapy should be considered for patients with extracutaneous CTCL.
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50
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Abstract
Twelve patients with early mycosis fungoides were enrolled in a randomized, double-blind, placebo-controlled study. Isolated plaques were injected three times a week with recombinant alpha 2-interferon in nine patients and with the vehicle in three patients. Two additional plaques were evaluated in each patient; one was left untreated, and another was treated topically with either placebo ointment or betamethasone ointment. Biopsies were taken from an untreated, representative plaque prior to treatment and from all test sites following treatment for light microscopy and T lymphocyte subsets. Three of the nine lesions injected with interferon cleared, and all showed improvement. Thirteen of eighteen noninjected lesions improved in patients who received interferon, showing a systemic effect. In the control group, none of the injected lesions improved and only two of the noninjected lesions showed any change. Histopathologic changes confirmed the clinical impression. This study shows that intralesional interferon may be given safely and has a beneficial effect, both locally and systemically.
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