The role of regional myocardial topography post‐myocardial infarction on infarct extension
| Autor: | Einly Lim, Kok Han Chee, Chen Onn Leong, Yang Faridah Abdul Aziz, Amr Al Abed, Socrates Dokos, Ganiga Srinivasaiah Sridhar, Chin Neng Leong, Yih Miin Liew |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Systole Heart Ventricles Myocardial Infarction Biomedical Engineering Myocardial stiffness Post myocardial infarction Myocardial mechanics Cardiac magnetic resonance imaging Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Molecular Biology medicine.diagnostic_test business.industry Myocardium Applied Mathematics Heart medicine.disease Computational Theory and Mathematics Modeling and Simulation Heart failure cardiovascular system Cardiology Border zone business Infarct zone Software |
| Zdroj: | International Journal for Numerical Methods in Biomedical Engineering. 37 |
| ISSN: | 2040-7947 2040-7939 |
| DOI: | 10.1002/cnm.3501 |
| Popis: | Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ. |
| Databáze: | OpenAIRE |
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