Prediction of ventricular arrhythmias using cardiovascular magnetic resonance

Mavrogeni, Sophie; Petrou, Emmanouil; Kolovou, Genovefa; Theodorakis, George; Iliodromitis, Efstathios K.

doi:10.1093/ehjci/jes302

Cited by 46 publications

(30 citation statements)

References 73 publications

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“…There has been a declining use of EP study for prediction of SCD, perhaps due to increasing use of non-invasive markers for SCD risk stratification. 5,[8][9][10][11][12] This declining trend was observed in our cohort as well. Indeed, relevant clinical data, such as symptoms (i.e.…”

Section: Discussionsupporting

confidence: 84%

Diagnostic Electrophysiology Study Has Limited Value in Risk Stratification of Children and Young Adults with and without Congenital Heart Disease

Iyer¹

2016

JICRM

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ABSTRACT. The aim was to determine the utility of electrophysiology (EP) study in children and young adults to risk stratify for sudden cardiac death (SCD). A retrospective cohort study was performed to evaluate the usefulness of EP study in predicting a composite endpoint of SCD or appropriate implantable cardioverter-defibrillator (ICD) discharge in subjects with and without congenital heart disease (CHD). Over the 14-year study period (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009), 169 subjects underwent EP study at a median age of 15.1 years (IQR 12.1-18.7) and median follow-up of 4.7 years (IQR 1.8-8.8). Eighty-five subjects had CHD and 84 subjects did not have CHD. In the With CHD group, 25 of 85 subjects (31%) had positive EP study defined as inducible hemodynamically significant ventricular tachycardia or ventricular fibrillation. An ICD was placed in 18 subjects, with five subjects having subsequent appropriate ICD discharge. Of the 60 out of 85 subjects (69%) with negative EP study, there were two ICDs implanted and no appropriate ICD discharges. Subjects with positive EP study had significantly improved freedom from composite outcome of SCD or ICD discharge (log rank p ¼ 0.002). In the Without CHD group, 25 of 84 subjects (30%) had a positive EP study, and ICDs were implanted in 11 subjects, with one subsequent appropriate ICD discharge. Of the 59 of 84 (70%) subjects with negative EP study, eight had ICDs implanted with two appropriate ICD discharges. There was no significant difference in freedom from composite outcome in subjects with positive and negative EP study. There was no SCD in either group. In our cohort of patients, EP study had limited utility for risk stratification. However, a negative EP study in CHD subjects may suggest a low SCD risk.

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Section: Discussionsupporting

confidence: 84%

Diagnostic Electrophysiology Study Has Limited Value in Risk Stratification of Children and Young Adults with and without Congenital Heart Disease

Iyer¹

2016

JICRM

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“…14 Although LGE is the standard of care for fibrosis imaging, 15 the potential nephrotoxicity 16 of gadolinium in patients with reduced renal function restricts diagnosis to highly invasive, painful, and often inaccurate endomyocardial biopsies, 17 hindering the development of novel therapies. Detection of fibrotic tissue through CEST encoding is a direct detection process, thus obviating the need for chelated gadolinium salts.…”

Section: Discussionmentioning

confidence: 99%

Cardio-Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Reveals Molecular Signatures of Endogenous Fibrosis and Exogenous Contrast Media

Vandsburger

Vandoorne

Oren

et al. 2015

Circ: Cardiovascular Imaging

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Background-Application of emerging molecular MRI techniques, including chemical exchange saturation transfer (CEST)-MRI, to cardiac imaging is desirable; however, conventional methods are poorly suited for cardiac imaging, particularly in small animals with rapid heart rates. We developed a CEST-encoded steady state and retrospectively gated cardiac cine imaging sequence in which the presence of fibrosis or paraCEST contrast agents was directly encoded into the steady-state myocardial signal intensity (cardioCEST). Methods and Results-Development of cardioCEST: A CEST-encoded cardiac cine MRI sequence was implemented on a 9.4T small animal scanner. CardioCEST of fibrosis was serially performed by acquisition of a series of CEST-encoded cine images at multiple offset frequencies in mice (n=7) after surgically induced myocardial infarction. Scar formation was quantified using a spectral modeling approach and confirmed with histological staining. Separately, circulatory redistribution kinetics of the paramagnetic CEST agent Eu-HPDO3A were probed in mice using cardioCEST imaging, revealing rapid myocardial redistribution, and washout within 30 minutes (n=6). Manipulation of vascular tone resulted in heightened peak CEST contrast in the heart, but did not alter redistribution kinetics (n=6). At 28 days after myocardial infarction (n=3), CEST contrast kinetics in infarct zone tissue were altered, demonstrating gradual accumulation of Eu-HPDO3A in the increased extracellular space. Conclusions-cardioCEST MRI enables in vivo imaging of myocardial fibrosis using endogenous contrast mechanisms, and of exogenously delivered paraCEST agents, and can enable multiplexed imaging of multiple molecular targets at highresolution coupled with conventional cardiac MRI scans. (Circ Cardiovasc Imaging. 2015;8:e002180.

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“…Detection of these injured cells is performed by physicians on patient image data set, for example obtained using magnetic resonance imaging [3]. This imaging modality is well adapted to the visualization of soft tissue like the heart.…”

Section: Introductionmentioning

confidence: 99%

Development of a tool-kit for the detection of healthy and injured cardiac tissue based on MR imaging

Westphal

Hilbert²,

Unger

et al. 2017

Current Directions in Biomedical Engineering

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Planning of interventions to treat cardiac arrhythmia requires a 3D patient specific model of the heart. Currently available commercial or free software dedicated to this task have important limitations for routinely use. Automatic algorithms are not robust enough while manual methods are time-consuming. Therefore, the project attempts to develop an optimal software tool. The heart model is generated from preoperative MR data-sets acquired with contrast agent and allows visualisation of damaged cardiac tissue. A requirement in the development of the software tool was the use of semi-automatic functions to be more robust. Once the patient image dataset has been loaded, the user selects a region of interest. Thresholding functions allow selecting the areas of high intensities which correspond to anatomical structures filled with contrast agent, namely cardiac cavities and blood vessels. Thereafter, the targetstructure, for example the left ventricle, is coarsely selected by interactively outlining the gross shape. An active contour function adjusts automatically the initial contour to the image content. The result can still be manually improved using fast interaction tools. Finally, possible scar tissue located in the cavity muscle is automatically detected and visualized on the 3D heart model. The model is exported in format which is compatible with interventional devices at hospital. The evaluation of the software tool included two steps. Firstly, a comparison with two free software tools was performed on two image data sets of variable quality. Secondly, six scientists and physicians tested our tool and filled out a questionnaire. The performance of our software tool was visually judged more satisfactory than the free software, especially on the data set of lower quality. Professionals evaluated positively our functionalities regarding time taken, ease of use and quality of results. Improvements would consist in performing the planning based on different MR modalities.

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Prediction of ventricular arrhythmias using cardiovascular magnetic resonance

Cited by 46 publications

References 73 publications

Diagnostic Electrophysiology Study Has Limited Value in Risk Stratification of Children and Young Adults with and without Congenital Heart Disease

Diagnostic Electrophysiology Study Has Limited Value in Risk Stratification of Children and Young Adults with and without Congenital Heart Disease

Cardio-Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Reveals Molecular Signatures of Endogenous Fibrosis and Exogenous Contrast Media

Development of a tool-kit for the detection of healthy and injured cardiac tissue based on MR imaging

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