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van den Broek HT, Wenker S, van de Leur R, Doevendans PA, Chamuleau SAJ, van Slochteren FJ, van Es R. 3D Myocardial Scar Prediction Model Derived from Multimodality Analysis of Electromechanical Mapping and Magnetic Resonance Imaging. J Cardiovasc Transl Res 2019; 12:517-527. [PMID: 31338795 PMCID: PMC6854049 DOI: 10.1007/s12265-019-09899-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/01/2019] [Indexed: 01/27/2023]
Abstract
Many cardiac catheter interventions require accurate discrimination between healthy and infarcted myocardia. The gold standard for infarct imaging is late gadolinium-enhanced MRI (LGE-MRI), but during cardiac procedures electroanatomical or electromechanical mapping (EAM or EMM, respectively) is usually employed. We aimed to improve the ability of EMM to identify myocardial infarction by combining multiple EMM parameters in a statistical model. From a porcine infarction model, 3D electromechanical maps were 3D registered to LGE-MRI. A multivariable mixed-effects logistic regression model was fitted to predict the presence of infarct based on EMM parameters. Furthermore, we correlated feature-tracking strain parameters to EMM measures of local mechanical deformation. We registered 787 EMM points from 13 animals to the corresponding MRI locations. The mean registration error was 2.5 ± 1.16 mm. Our model showed a strong ability to predict the presence of infarction (C-statistic = 0.85). Strain parameters were only weakly correlated to EMM measures. The model is accurate in discriminating infarcted from healthy myocardium. Unipolar and bipolar voltages were the strongest predictors.
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Affiliation(s)
| | - Steven Wenker
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger van de Leur
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- CMH, Utrecht, Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - René van Es
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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van Slochteren FJ, van Es R, Gyöngyösi M, van der Spoel TIG, Koudstaal S, Leiner T, Doevendans PA, Chamuleau SAJ. Three dimensional fusion of electromechanical mapping and magnetic resonance imaging for real-time navigation of intramyocardial cell injections in a porcine model of chronic myocardial infarction. Int J Cardiovasc Imaging 2016; 32:833-43. [PMID: 26883433 PMCID: PMC4853462 DOI: 10.1007/s10554-016-0852-x] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/07/2016] [Indexed: 11/15/2022]
Abstract
For cardiac regenerative therapy intramyocardial catheter guided cell transplantations are targeted to the infarct border zone (IBZ) i.e. the closest region of viable myocardium in the vicinity of the infarct area. For optimal therapeutic effect this area should be accurately identified. However late gadolinium enhanced magnetic resonance imaging (LGE-MRI) is the gold standard technique to determine the infarct size and location, electromechanical mapping (EMM) is used to guide percutaneous intramyocardial injections to the IBZ. Since EMM has a low spatial resolution, we aim to develop a practical and accurate technique to fuse EMM with LGE-MRI to guide intramyocardial injections. LGE-MRI and EMM were obtained in 17 pigs with chronic myocardial infarction created by balloon occlusion of LCX and LAD coronary arteries. LGE-MRI and EMM datasets were registered using our in-house developed 3D CartBox image registration software toolbox to assess: (1) the feasibility of the 3D CartBox toolbox, (2) the EMM values measured in the areas with a distinct infarct transmurality (IT), and (3) the highest sensitivity and specificity of the EMM to assess IT and define the IBZ. Registration of LGE-MRI and EMM resulted in a mean error of 3.01 ± 1.94 mm between the LGE-MRI mesh and EMM points. The highest sensitivity and specificity were found for UV <9.4 mV and bipolar voltage <1.2 mV to respectively identify IT of ≥5 and ≥97.5 %. The 3D CartBox image registration toolbox enables registration of EMM data on pre-acquired MRI during the EMM guided procedure and allows physicians to easily guide injections to the most optimal injection location for cardiac regenerative therapy and harness the full therapeutic effect of the therapy.
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Affiliation(s)
- F J van Slochteren
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - R van Es
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - M Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - T I G van der Spoel
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
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Mikuz U, Poglajen G, Fister M, Starc V, Wu JC, Hsia H, Haddad F, Vrtovec B. The presence of electromechanical mismatch in nonischemic dilated cardiomyopathy is associated with ventricular repolarization instability. J Card Fail 2014; 20:891-8. [PMID: 25305502 DOI: 10.1016/j.cardfail.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/26/2014] [Revised: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND We analyzed electromechanical mismatch (EMM) and its relationship to ventricular repolarization in patients with nonischemic dilated cardiomyopathy (DCM). METHODS AND RESULTS In 39 DCM patients with left ventricular ejection fraction (LVEF) <40% and New York Heart Association functional class ≥III, electroanatomic mapping was used to quantify areas of EMM. High-resolution electrocardiograph was used to measure heart rate variability (HRV) and QT variability index (QTVI). EMM was present in 22 patients (56%, group 1), whereas 17 patients presented no mismatched segments (44%, group 2). The groups did not differ in age (56 ± 10 years in group 1 vs 57 ± 7 years in group 2; P = .82), sex (male: 82% vs 94%; P = .40), LVEF (27 ± 8% vs 25 ± 6%; P = .18), or N-terminal pro-B-type natriuretic peptide (2,350 pg/mL vs 2,831 pg/mL; P = .32). Although heart rate and HRV were similar in both groups (rate: 80 ± 20 beats/min in group 1 vs 74 ± 19 beats/min in group 2 [P = .47]; standard deviation of normal-to normal RR intervals: 106 ± 79 vs 88 ± 115 [P = .61]), we found significantly higher QTVI values in patients from group 1 (-1.15 ± 0.46 vs -1.62 ± 0.51 in group 2; P = .005). In patients with implantable cardioverter-defibrillators, ventricular arrhythmias recorded ≤1 year before enrollment were more frequent in group 1 than in group 2 (58% vs 13%; P = .02). CONCLUSIONS EMM is present in a majority of patients with DCM and is associated with ventricular repolarization instability.
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Affiliation(s)
- Ursa Mikuz
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Misa Fister
- Department of Intensive Care Medicine, University Medical Center, Ljubljana, Slovenia
| | - Vito Starc
- Institute of Physiology, University of Ljubljana School of Medicine, Ljubljana, Slovenia
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Henry Hsia
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - François Haddad
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center, Ljubljana, Slovenia; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California.
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Zheng Y, Sampaio LC, Li K, Silva GV, Cabreira-Hansen M, Vela D, Segura AM, Bovè C, Perin EC. Safety and feasibility of mapping and stem cell delivery in the presence of an implanted left ventricular assist device: a preclinical investigation in sheep. Tex Heart Inst J 2013; 40:229-234. [PMID: 23914010 PMCID: PMC3709201] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this study was to determine the safety and feasibility of performing transendocardial electromechanical mapping and mesenchymal precursor stem cell injections after left ventricular assist device (LVAD) implantation in a sheep model of acute myocardial infarction. Six sheep were assigned to either an acute or chronic group. Then we created an acute myocardial infarction in each by occluding the distal left anterior descending coronary artery with a balloon for 90 minutes. All the sheep underwent LVAD implantation 30 days later. On the same day, sheep in the acute group underwent transendocardial cell injections and were euthanized. Sheep in the chronic group received cell injections 2 weeks after LVAD implantation and were euthanized 30 days later. The presence of the LVAD or the use of chest-closure wires did not interfere with electromechanical mapping. Furthermore, no adverse events were observed during electromechanical mapping or the stem cell injections. In all sheep, the LVAD flow rate was approximately 4 L/min during mapping and the injections, and no adjustments were required. Histologic analysis confirmed that the mesenchymal precursor stem cells were successfully delivered. No differences were observed between the acute and chronic groups. In conclusion, our study showed that transendocardial electromechanical mapping and stem cell injections are safe and feasible in the presence of an LVAD. Surgically implanted metal devices, including the LVAD, steel chest-closure wire, and skin staples, were compatible with the electromechanical mapping system.
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Affiliation(s)
- Yi Zheng
- The Stem Cell Center and Cardiovascular Pathology Research Department, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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Zheng Y, Fernandes MR, Silva GV, Cardoso CO, Canales J, Gahramenpour A, Baimbridge F, da Graça Cabreira-Hansen M, Perin EC. Histopathological validation of electromechanical mapping in assessing myocardial viability in a porcine model of chronic ischemia. Exp Clin Cardiol 2008; 13:198-203. [PMID: 19343167 PMCID: PMC2663485] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 10/06/2008] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Left ventricular electromechanical mapping (EMM) determines myocardial viability on the basis of endocardial electrograms. The aim of the present study was to validate EMM in differentiating infarcted myocardium from viable myocardium by histopathological analysis. METHODS Sixty days after implanting an ameroid constrictor over the left circumflex artery to create chronic ischemia in 19 pigs, EMM was performed to construct unipolar voltage (UPV), bipolar voltage (BPV) and linear local shortening (LLS) maps. Noninfarcted and infarcted myocardium were identified by histopathology. Threshold determinations comparing noninfarcted tissue with scarred tissue were made by measuring the area under the receiver operating characteristic curves. RESULTS From the 19 hearts, 149 myocardial segments were divided into noninfarcted myocardium (n=128) and transmural infarct (n=21). UPV, BPV and LLS values (4.7+/-1.2 mV, 2.8+/-2.5 mV and 10.0+/-5.1%, respectively) of infarcted segments were significantly lower than those in noninfarcted myocardium (10.9+/-3.4 mV, 4.5+/-2.4 mV and 15.7+/-9.5%, respectively; P<0.01 for each comparison). The threshold values of UPV, BPV and LLS differentiating noninfarcted from infarcted myocardium were 6.2 mV (98% sensitivity, 95% specificity, 97% accuracy), 2.8 mV (80% sensitivity, 72% specificity, 79% accuracy) and 12.3% (68% sensitivity, 67% specificity, 68% accuracy), respectively. The relative dispersion of voltage was lower for UPV versus BPV. CONCLUSION UPV can accurately differentiate infarcted from noninfarcted tissue in the chronic ischemic heart of pigs; however, BPV and LLS results were less accurate.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Emerson C Perin
- Correspondence: Dr Emerson C Perin, Texas Heart Institute, MC 2-255, PO Box 20345, Houston, Texas 77225-0345, USA. Telephone 832-355-9405, fax 832-355-9440, e-mail
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