Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling

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Title: Fibrosis Microstructure Modulates Reentry in Non-ischemic Dilated Cardiomyopathy: Insights From Imaged Guided 2D Computational Modeling
Authors: Balaban, G
Halliday, BP
Costa, CM
Bai, W
Porter, B
Rinaldi, CA
Plank, G
Rueckert, D
Prasad, SK
Bishop, MJ
Item Type: Journal Article
Abstract: 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.
Issue Date: 19-Dec-2018
Date of Acceptance: 6-Dec-2018
ISSN: 1664-042X
Publisher: Frontiers Media
Journal / Book Title: Frontiers in Physiology
Volume: 9
Copyright Statement: © 2018 Balaban, Halliday, Mendonca Costa, Bai, Porter, Rinaldi, Plank, Rueckert, Prasad and Bishop. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Sponsor/Funder: Medical Research Council (MRC)
British Heart Foundation
Funder's Grant Number: RTJ12028524-1
Keywords: Science & Technology
Life Sciences & Biomedicine
non-ischemic cardiomiopathy
computational modeling
late gadolinium enhanced magnetic resonance imaging
dilated cardiaomypothy
arrhythmia (any)
ventricular tachycardia (VT)
Publication Status: Published
Open Access location:
Article Number: ARTN 1832
Appears in Collections:Computing
National Heart and Lung Institute
Department of Medicine
Faculty of Medicine

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