Prevalence and functional impact of lipomatous metaplasia in scar tissue following myocardial infarction evaluated by MRI

Lücke, Christian; Schindler, Kathrin; Lehmkuhl, Lukas; Eitel, Ingo; Schuler, Gerhard; Thiele, Holger; Kivelitz, Dietmar; Gutberlet, Matthias

doi:10.1007/s00330-010-1791-x

Cited by 29 publications

(33 citation statements)

References 18 publications

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“…Areas of myocardial FAT-DEP were identified using a post-processing image overlay that highlighted areas between intensity of −180 and 0 Hounsfield units (HU). 3,6,12 Identification of FAT-DEP was confirmed when the intensity met our criteria for an area larger than 1 mm 2 . Sectors with calcification were also identified.…”

Section: Methodsmentioning

confidence: 89%

“…FAT-DEP will negatively affect the remodeling process, leading to depressed regional ventricular mechanics and global ventricular function. 6 FAT-DEP also may have negative effects on electrical conductivities within fibrotic scar tissue that will lead to circuit formations of scar-related VTs; however, the possibility of such effects needs further study.…”

Section: Discussionmentioning

confidence: 99%

“…10 Computed tomography (CT) offers higher spatial resolution and can identify fat tissue based on CT attenuation density values (Hounsfield units, HU). 3–6 In addition, contrast-enhanced computed tomography (CE-CT) can accurately define anatomical structures including chamber boundaries and coronary arteries, which can be integrated into electroanatomic mapping (EAM) systems. The limitations of CT include ionizing radiation, and lower contrast to noise ratio.…”

Section: Introductionmentioning

confidence: 99%

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New insight into scar-related ventricular tachycardia circuits in ischemic cardiomyopathy: Fat deposition after myocardial infarction on computed tomography--A pilot study

Sasaki¹,

Calkins²,

Miller³

et al. 2015

Heart Rhythm

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Background Myocardial fat deposition (FAT-DEP) has been frequently observed in regions of chronic myocardial infarction in patients with ischemic cardiomyopathy (ICM). The role of FAT-DEP within scar-related ventricular tachycardia (VT) circuits has not been investigated. Objective This pilot study aimed to assess the impact of myocardial FAT-DEP on local electrograms and VT circuits in patients with ICM. Methods Contrast-enhanced computed tomography (CE-CT) was performed in 22 patients with ischemic VT. Electroanatomic map (EAM) points were registered to corresponding CE-CT images. Myocardial FAT-DEP were identified and characterized using a post-processing image overlay that highlighted areas below 0 Hounsfield units (HU). The mean attenuation of local myocardial regions corresponding to sampled electrograms was measured on short axis images. The associations of mean attenuation with bipolar and unipolar amplitudes, left ventricular (LV) wall thickness and VT circuit sites were investigated. Results Of 1801 EAM points, 519 (28.8%) were located in regions with FAT-DEP. Significant differences were observed in mean intensity (23.2±35.6 vs. 81.7±21.9 HU, P<0.001), bipolar (0.75±0.83 vs 2.9±2.4 mV, P<0.001) and unipolar (3.1±1.7 vs. 7.4±4.3 mV, P<0.001) amplitudes and LV wall thickness (5.2±1.7 vs. 8.2±2.5 mm, P<0.001) between regions with and without FAT-DEP. Lower HU was strongly associated with lower bipolar and unipolar amplitude (P<0.0001, respectively). Importantly, FAT-DEP was associated with critical VT circuit sites with fractionated or isolated potentials. Conclusions FAT-DEP was associated with electrogram features and VT circuit sites. Further work will be needed to determine whether FAT-DEP plays a causal role in the generation of ischemic scar-related VT circuits.

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Section: Methodsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New insight into scar-related ventricular tachycardia circuits in ischemic cardiomyopathy: Fat deposition after myocardial infarction on computed tomography--A pilot study

Sasaki¹,

Calkins²,

Miller³

et al. 2015

Heart Rhythm

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“…Previous studies reporting on regional myocardial lipomatous metaplasia leading to chemical shift artifacts (29), wall thinning, and/ or wall motion abnormalities in regions of myocardial scar (30) suggested that it might be feasible to depict ischemic scars on cine MR images alone. However, accurate identification of ischemic myocardial scars is possible only when also analyzing corresponding LGE (33).…”

Section: Discussionmentioning

confidence: 99%

Subacute and Chronic Left Ventricular Myocardial Scar: Accuracy of Texture Analysis on Nonenhanced Cine MR Images

et al. 2018

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Purpose To test whether texture analysis (TA) allows for the diagnosis of subacute and chronic myocardial infarction (MI) on noncontrast material-enhanced cine cardiac magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 120 patients who underwent cardiac MR imaging and showed large transmural (volume of enhancement on late gadolinium enhancement [LGE] images >20%, n = 72) or small (enhanced volume 20%, n = 48) subacute or chronic ischemic scars were included. Sixty patients with normal cardiac MR imaging findings served as control subjects. Regions of interest for TA encompassing the left ventricle were drawn by two blinded, independent readers on cine images in end systole by using a freely available software package.Stepwise dimension reduction and texture feature selection based on reproducibility, machine learning, and correlation analyses were performed for selecting features, enabling the diagnosis of MI on nonenhanced cine MR images by using LGE imaging as the standard of reference. Results Five independent texture features allowed for differentiation between ischemic scar and normal myocardium on cine MR images in both subgroups: Teta1, Perc.01, Variance, WavEnHH.s-3, and S(5,5)SumEntrp (in patients with large MI: all P values < .001; in patients with small MI: Teta1 and Perc.01, P < .001; Variance, P = .026; WavEnHH.s-3, P = .007; S[5,5]SumEntrp, P = .045). Multiple logistic regression models revealed that combining the features Teta1 and Perc.01 resulted in the highest accuracy for diagnosing large and small MI on cine MR images, with an area under the curve of 0.93 and 0.92, respectively. Conclusion This proof-of-concept study indicates that TA of nonenhanced cine MR images allows for the diagnosis of subacute and chronic MI with high accuracy. (©) RSNA, 2017 Online supplemental material is available for this article. Purpose:To test whether texture analysis (TA) allows for the diagnosis of subacute and chronic myocardial infarction (MI) on noncontrast material-enhanced cine cardiac magnetic resonance (MR) images. Materials and Methods:In this retrospective, institutional review board-approved study, 120 patients who underwent cardiac MR imaging and showed large transmural (volume of enhancement on late gadolinium enhancement [LGE] images .20%, n = 72) or small (enhanced volume 20%, n = 48) subacute or chronic ischemic scars were included. Sixty patients with normal cardiac MR imaging findings served as control subjects. Regions of interest for TA encompassing the left ventricle were drawn by two blinded, independent readers on cine images in end systole by using a freely available software package. Stepwise dimension reduction and texture feature selection based on reproducibility, machine learning, and correlation analyses were performed for selecting features, enabling the diagnosis of MI on nonenhanced cine MR images by using LGE imaging as the standard of reference. Results:Five independent texture features allowed ...

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“…In a retrospective analysis involving 315 patients with chronic ischemic heart disease using cardiac MRI with steady state free precession (SSFP) sequences LM was identified in 11% of the patients 34 . These findings correlated with findings on cardiac CT and occurred more significantly in patients with older infarcts and hyperlipoproteinemia.…”

Section: Imaging Studiesmentioning

confidence: 99%

Role of adipose tissue in the pathogenesis of cardiac arrhythmias

et al. 2016

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Epicardial adipose tissue is present in normal healthy individuals. It is a unique fat depot that, under physiologic conditions, plays a cardioprotective role. However, excess epicardial adipose tissue has been shown to be associated with prevalence and severity of atrial fibrillation. In arrhythmogenic right ventricular cardiomyopathy and myotonic dystrophy, fibrofatty infiltration of the myocardium is associated with ventricular arrhythmias. In the ovine model of ischemic cardiomyopathy, the presence of intramyocardial adipose or lipomatous metaplasia has been associated with increased propensity to ventricular tachycardia. These observations suggest a role of adipose tissue in the pathogenesis of cardiac arrhythmias. In this article, we review the role of cardiac adipose tissue in various cardiac arrhythmias and discuss the possible pathophysiologic mechanisms.

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Prevalence and functional impact of lipomatous metaplasia in scar tissue following myocardial infarction evaluated by MRI

Abstract: LM is a common finding (11%) in patients with CIHD. LM does not have a significant influence on global cardiac function or ventricular size, but on local function and probably also on the development of left ventricular aneurysms.

Cited by 29 publications

References 18 publications

New insight into scar-related ventricular tachycardia circuits in ischemic cardiomyopathy: Fat deposition after myocardial infarction on computed tomography--A pilot study

New insight into scar-related ventricular tachycardia circuits in ischemic cardiomyopathy: Fat deposition after myocardial infarction on computed tomography--A pilot study

Subacute and Chronic Left Ventricular Myocardial Scar: Accuracy of Texture Analysis on Nonenhanced Cine MR Images

Role of adipose tissue in the pathogenesis of cardiac arrhythmias

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