Further Refining Risk in Hypertrophic Cardiomyopathy With Late Gadolinium Enhancement by CMR

Kramer, Christopher M.; Neubauer, Stefan

doi:10.1016/j.jacc.2018.05.063

Cited by 9 publications

(4 citation statements)

References 16 publications

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“…We chose the threshold of 15% based on previous findings that demonstrated increase in sudden cardiac death risk with LV scar > 15% of LV mass. 37 As scar burden increases, we observe a higher frequency of T wave inversion across multiple leads; Q amplitude was selected 14% more frequently in patients with LV scar burden >15%, and QRS non-terminal duration was chosen 10% of the time in patients with LV scar burden <15%.…”

Section: Scar Burden Influences Xplainscar Performance and Selected F...mentioning

confidence: 87%

XplainScar: Explainable Artificial Intelligence to Identify and Localize Left Ventricular Scar in Hypertrophic Cardiomyopathy from 12-lead Electrocardiogram

Nezamabadi,

Sivalokanathan,

Lee

et al. 2024

Preprint

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Left ventricular (LV) scar is a risk factor for sudden cardiac death and heart failure in hypertrophic cardiomyopathy (HCM). LV scar is frequent in HCM and evolves over time. Hence there is a need for LV scar detection and longitudinal monitoring. The current gold standard for LV scar detection is late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI), which is limited by high cost and susceptibility to artifacts from implanted defibrillators. We introduce XplainScar, the first explainable machine learning method for LV scar detection and localization in HCM, using 12-lead electrocardiogram (ECG) data, which is not influenced by implanted devices. We use 500 patients from the JH-HCM Registry for model development, and 248 patients from the UCSF-HCM-Registry for validation. XplainScar combines unsupervised and self-supervised ECG representation learning, resulting in high precision (90%), sensitivity (95%), specificity (80%) and F1-score (90%) for scar detection in the basal, mid, and apical LV myocardium, with a processing time of <1 minute per 10 patients. Basal LV scar prediction by XplainScar is dominated by QRS features, and mid/apical LV scar by T wave features. XplainScar generalizes well to the held-out test UCSF data, with 88% precision, 90% sensitivity, 78% specificity, and F1-score of 89%. In summary, XplainScar demonstrates good performance for LV scar detection, and provides ECG signatures of basal, mid, and apical LV scar in HCM.

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Section: Scar Burden Influences Xplainscar Performance and Selected F...mentioning

confidence: 87%

XplainScar: Explainable Artificial Intelligence to Identify and Localize Left Ventricular Scar in Hypertrophic Cardiomyopathy from 12-lead Electrocardiogram

Nezamabadi,

Sivalokanathan,

Lee

et al. 2024

Preprint

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show abstract

“…In patients with HCM, identification of LGE is important for risk stratification and is associated with increased risk for sudden cardiac death or appropriate discharge of implantable cardioverter defibrillator as well as heart failure [ 16 – 18 ]. The fibrotic myocardium in HCM typically is easily identifiable as areas with high signal intensities.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of TI-scout images in the assessment of late gadolinium enhancement in children

Bannan

Aguet

House

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) requires identification of the normal myocardial nulling time using inversion time (TI)-scout imaging sequence. Although TI-scout images are not primarily used for myocardial assessment, they provide information regarding different signal recovery patterns of normal and abnormal myocardium facilitating identification of LGE in instances where standard LGE images alone are not diagnostic. We aimed to assess the diagnostic performance of TI-scout as compared to that of standard LGE images. Methods CMR studies with LGE imaging in 519 patients (345 males, 1–17 years) were reviewed to assess the diagnostic performance of LGE imaging in terms of the location of LGE and the pathologic entities. The diagnostic performance of the TI-scout and standard LGE imaging was classified into four categories: (1) equally diagnostic, (2) TI-scout superior to standard LGE, (3) standard LGE superior to TI-scout, and (4) complementary, by the consensus of the two observers. Results The study cohort consisted of 440 patients with negative LGE and 79 with evidence for LGE. For a negative diagnosis of LGE, TI-scout and standard LGE images were equally diagnostic in 75% of the cases and were complementary in 12%. For patients with LGE, TI-scout images were superior to standard LGE images in 52% of the cases and were complementary in 19%. The diagnostic performance of TI-scout images was superior to that of standard LGE images in all locations. TI-scout images were superior to standard LGE images in 11 of 12 (92%) cases with LGE involving the papillary muscles, in 7 /12 (58%) cases with subendocardial LGE, and in 4/7 (57%) cases with transmural LGE. TI-scout images were particularly useful assessing the presence and extent of LGE in hypertrophic cardiomyopathy (HCM). TI-scout was superior to standard LGE in 6/10 (60%) and was complementary in 3/10 (30%) of the positive cases with HCM. Conclusions TI-scout images enhance the diagnostic performance of LGE imaging in children.

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“…A recent study showed that low fractional anisotropy is associated with increased risk of VAs and can be potentially used as an additional risk factor for VAs in patients with HCM [ 40 ]. The association of T1-mapping and ECV with adverse outcomes in patients with HCM is under investigation [ 41 ], with a recent study showing positive correlation of global native T1 mapping with MACE [ 42 ]. The current National Heart, Lung, and Blood Institute (NHLBI)-Hypertrophic Cardiomyopathy Registry study (HCMR) is evaluating the role of LGE, T1 mapping, ECV, and other CMR parameters together with genetics and serum biomarkers in predicting clinical events in 2755 HCM patients [ 43 ], and outcome results are expected in 1–2 years.…”

Section: Determining the Underlying Etiology Of Arrhythmiamentioning

confidence: 99%

The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

Nikolaidou,

Ormerod,

Ziakas

et al. 2023

Rev. Cardiovasc. Med.

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Cardiac arrhythmias are associated with significant morbidity, mortality and poor quality of life. Cardiovascular magnetic resonance (CMR) imaging, with its unsurpassed capability of non-invasive tissue characterisation, high accuracy, and reproducibility of measurements, plays an integral role in determining the underlying aetiology of cardiac arrhytmias. CMR can reliably diagnose previous myocardial infarction, non-ischemic cardiomyopathy, characterise congenital heart disease and valvular pathologies, and also detect the underlying substrate concealed on conventional investigations in a significant proportion of patients with arrhythmias. Determining the underlying substrate of arrhythmia is of paramount importance for treatment planning and prognosis. However, CMR imaging in patients with irregular heart rates can be problematic. Understanding the different ways to overcome the limitations of CMR in arrhythmia is essential for providing high-quality imaging, comprehensive information, and definitive answers in this diverse group of patients.

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Further Refining Risk in Hypertrophic Cardiomyopathy With Late Gadolinium Enhancement by CMR

Cited by 9 publications

References 16 publications

XplainScar: Explainable Artificial Intelligence to Identify and Localize Left Ventricular Scar in Hypertrophic Cardiomyopathy from 12-lead Electrocardiogram

XplainScar: Explainable Artificial Intelligence to Identify and Localize Left Ventricular Scar in Hypertrophic Cardiomyopathy from 12-lead Electrocardiogram

Usefulness of TI-scout images in the assessment of late gadolinium enhancement in children

The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

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