Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling
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 understan...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2018-12-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2018.01832/full |
| _version_ | 1818847542439313408 |
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| author | Gabriel Balaban Brian P. Halliday Caroline Mendonca Costa Wenjia Bai Bradley Porter Bradley Porter Christopher A. Rinaldi Gernot Plank Daniel Rueckert Sanjay K. Prasad Sanjay K. Prasad Martin J. Bishop |
| author_facet | Gabriel Balaban Brian P. Halliday Caroline Mendonca Costa Wenjia Bai Bradley Porter Bradley Porter Christopher A. Rinaldi Gernot Plank Daniel Rueckert Sanjay K. Prasad Sanjay K. Prasad Martin J. Bishop |
| author_sort | Gabriel Balaban |
| collection | DOAJ |
| description | 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 examine variations 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) were measured, 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 depended on 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 NIDCM provide insight into the mechanisms and inducibility of reentry, and their dependence upon the type and density of fibrosis. Transmural activation times, measured at the central extent of the scar, can potentially differentiate microstructures which support reentry. |
| first_indexed | 2024-12-19T06:03:06Z |
| format | Article |
| id | doaj.art-b135712a4b3442d8bf72f2d03031e3a8 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-19T06:03:06Z |
| publishDate | 2018-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-b135712a4b3442d8bf72f2d03031e3a82022-12-21T20:33:15ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2018-12-01910.3389/fphys.2018.01832424341Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational ModelingGabriel Balaban0Brian P. Halliday1Caroline Mendonca Costa2Wenjia Bai3Bradley Porter4Bradley Porter5Christopher A. Rinaldi6Gernot Plank7Daniel Rueckert8Sanjay K. Prasad9Sanjay K. Prasad10Martin J. Bishop11School of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomNational Heart and Lung Institute, Imperial College London, London, United KingdomSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomBiomedical Image Analysis Group, Department of Computing, Imperial College London, London, United KingdomSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomDepartment of Cardiology, Guy's and St. Thomas Hospital Trust, London, United KingdomDepartment of Cardiology, Guy's and St. Thomas Hospital Trust, London, United KingdomInstitute of Biophysics, Medical University of Graz, Graz, AustriaBiomedical Image Analysis Group, Department of Computing, Imperial College London, London, United KingdomNational Heart and Lung Institute, Imperial College London, London, United KingdomCardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United KingdomSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomAims: 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 examine variations 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) were measured, 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 depended on 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 NIDCM provide insight into the mechanisms and inducibility of reentry, and their dependence upon the type and density of fibrosis. Transmural activation times, measured at the central extent of the scar, can potentially differentiate microstructures which support reentry.https://www.frontiersin.org/article/10.3389/fphys.2018.01832/fullnon-ischemic cardiomiopathycomputational modelinglate gadolinium enhanced magnetic resonance imagingdilated cardiaomypothyelectrophysiologyreentry |
| spellingShingle | Gabriel Balaban Brian P. Halliday Caroline Mendonca Costa Wenjia Bai Bradley Porter Bradley Porter Christopher A. Rinaldi Gernot Plank Daniel Rueckert Sanjay K. Prasad Sanjay K. Prasad Martin J. Bishop Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling Frontiers in Physiology non-ischemic cardiomiopathy computational modeling late gadolinium enhanced magnetic resonance imaging dilated cardiaomypothy electrophysiology reentry |
| title | Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling |
| title_full | Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling |
| title_fullStr | Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling |
| title_full_unstemmed | Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling |
| title_short | Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling |
| title_sort | fibrosis microstructure modulates reentry in non ischemic dilated cardiomyopathy insights from imaged guided 2d computational modeling |
| topic | non-ischemic cardiomiopathy computational modeling late gadolinium enhanced magnetic resonance imaging dilated cardiaomypothy electrophysiology reentry |
| url | https://www.frontiersin.org/article/10.3389/fphys.2018.01832/full |
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