Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling
Autor: | Balaban, Gabriel, Halliday, Brian P., Mendonca Costa, Caroline, Bai, Wenjia, Porter, Bradley, Rinaldi, Christopher A., Plank, Gernot, Rueckert, Daniel, Prasad, Sanjay K., Bishop, Martin |
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Přispěvatelé: | Medical Research Council (MRC), British Heart Foundation |
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
computational modeling
DYNAMICS reentry Physiology computational modelling BORDER ZONE ACTIVATION arrhyhthmia dilated cardiaomypothy ventricular tachycardia (VT) nonischemic cardiomyopathy arrhythmia (any) cardiovascular diseases Original Research Science & Technology cardiac electrophyiology non-ischemic cardiomiopathy ARRHYTHMIA DEATH electrophysiology dilated cardiomyopathy MYOCARDIAL-INFARCTION CONDUCTION late gadolinium enhanced magnetic resonance imaging HEART Life Sciences & Biomedicine |
Zdroj: | Frontiers in Physiology Balaban, G, Halliday, B P, Mendonca Costa, C, Bai, W, Porter, B, Rinaldi, C A, Plank, G, Rueckert, D, Prasad, S K & Bishop, M 2018, ' Fibrosis Microstructure Modulates Reentry in Non-Ischemic Dilated Cardiomyopathy : Insights from Imaged Guided 2D Computational Modelling ', Frontiers in Physiology . https://doi.org/10.3389/fphys.2018.01832 |
DOI: | 10.3389/fphys.2018.01832 |
Popis: | Aims: Patients who present with non-ischemic dilated cardiomyopathy (NIDCM) and enhancement on late gadolinium magnetic resonance imaging (LGE-CMR), are at high risk of sudden cardiac death (SCD). Further risk stratification of these patients based on LGE-CMR may be improved through better understanding of fibrosis microstructure. Our aim is to examinevariations in fibrosis microstructure based on LGE imaging, and quantify the effect on reentry inducibility and mechanism. Furthermore, we examine the relationship between transmural activation time differences and reentry.Methods and Results: 2D Computational models were created from a single short axis LGE-CMR image, with 401 variations in fibrosis type (interstitial, replacement) and density, as well as presence or absence of reduced conductivity (RC). Transmural activation times (TAT) weremeasured, as well as reentry incidence and mechanism. Reentries were inducible above specific density thresholds (0.8, 0.6 for interstitial, replacement fibrosis). RC reduced these thresholds (0.3, 0.4 for interstitial, replacement fibrosis) and increased reentry incidence (48 no RC vs. 133 with RC). Reentries were classified as rotor, micro-reentry, or macro-reentry and dependedon fibrosis micro-structure. Differences in TAT at coupling intervals 210 and 500ms predicted reentry in the models (sensitivity 89%, specificity 93%). A sensitivity analysis of TAT and reentry incidence showed that these quantities were robust to small changes in the pacing location.Conclusion: Computational models of fibrosis micro-structure underlying areas of LGE in 21 NIDCM provide insight into the mechanisms and inducibility of reentry, and their dependence 22 upon the type and density of fibrosis. Transmural activation times, measured at the central extent 23 of the scar, can potentially differentiate microstructures which support reentry. |
Databáze: | OpenAIRE |
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