scholarly journals Reconstruction of three-dimensional biventricular activation based on the 12-lead electrocardiogram via patient-specific modelling

EP Europace ◽  
2020 ◽  
Author(s):  
Simone Pezzuto ◽  
Frits W Prinzen ◽  
Mark Potse ◽  
Francesco Maffessanti ◽  
François Regoli ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Three Dimensional ◽  
Specific Model ◽  
Left Ventricular ◽  
Propagation Model ◽  
Electrical Activation ◽  
Patient Specific ◽  
Non Invasive ◽  
Ventricular Activation ◽  
Potential Applications

Abstract Aims Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The nine electrodes of the 12-lead electrocardiogram (ECG) are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modelling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and cardiovascular magnetic resonance (CMR). Methods and results Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126–180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by magnetic resonance (MR) contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/veins (CS) and right ventricular (RV) and left ventricular (LV) endocardium. The QRS complex was correctly reproduced by the model (Pearson’s correlation r = 0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycentre distance 8.2 mm, IQR 8.8 mm). Correlation of simulated with recorded activation time was very good at LV endocardium (r = 0.83) and good at CS (r = 0.68) and RV endocardium (r = 0.58). Conclusion Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modelling and pre-/per-procedural evaluation of ventricular activation.

scholarly journals Three-dimensional left ventricular segmentation from magnetic resonance imaging for patient-specific modelling purposes

EP Europace ◽  
2014 ◽  
Vol 16 (suppl 4) ◽  
pp. iv96-iv101 ◽  
Author(s):  
E. G. Caiani ◽  
A. Colombo ◽  
M. Pepi ◽  
C. Piazzese ◽  
F. Maffessanti ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Patient Specific ◽  
Resonance Imaging

Magnetic Resonance Imaging–Based Three Dimensional Patient-Specific Reconstruction of Uterine Fibromatosis: Impact on Surgery

2017 ◽  
Vol 33 (4) ◽  
pp. 138-144 ◽  
Author(s):  
Andrea Giannini ◽  
Veronica Iodice ◽  
Eugenia Picano ◽  
Eleonora Russo ◽  
Virna Zampa ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Patient Specific ◽  
Resonance Imaging

In vivo application and validation of a novel non-invasive method to estimate the end-systolic elastance

2021 ◽  
Author(s):  
Stamatia Pagoulatou ◽  
Karl-Philipp Rommel ◽  
Karl-Patrik Kresoja ◽  
Maximilian von Roeder ◽  
Philipp Lurz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Function ◽  
Cuff Pressure ◽  
Left Ventricular ◽  
Aortic Flow ◽  
Arterial System ◽  
Patient Specific ◽  
Correct Prediction ◽  
Non Invasive ◽  
Cardiac Model

Accurate assessment of the left ventricular (LV) systolic function is indispensable in the clinic. However, estimation of a precise index of cardiac contractility, i.e., the end-systolic elastance (Ees), is invasive and cannot be established as clinical routine. The aim of this work was to present and validate a methodology that allows for the estimation of Ees from simple and readily available non-invasive measurements. The method is based on a validated model of the cardiovascular system and non-invasive data from arm-cuff pressure and routine echocardiography to render the model patient-specific. Briefly, the algorithm first uses the measured aortic flow as model input and optimizes the properties of the arterial system model in order to achieve correct prediction of the patient's peripheral pressure. In a second step, the personalized arterial system is coupled with the cardiac model (time-varying elastance model) and the LV systolic properties, including Ees, are tuned to predict accurately the aortic flow waveform. The algorithm was validated against invasive measurements of Ees (multiple pressure-volume loop analysis) taken from n=10 heart failure patients with preserved ejection fraction and n=9 patients without heart failure. Invasive measurements of Ees (median 2.4 mmHg/mL, range [1.0, 5.0] mmHg/mL) agreed well with method predictions (nRMSE=9%, ρ=0.89, bias=-0.1 mmHg/mL and limits of agreement [-0.9, 0.6] mmHg/mL). This is a promising first step towards the development of a valuable tool that can be used by clinicians to assess systolic performance of the LV in the critically ill.

Pericardial Effusion Is a Marker of Increased Mortality in Thalassemia Major Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2689-2689
Author(s):  
Antonella Meloni ◽  
Patrizia Toia ◽  
Leonardo Sardella ◽  
Giuseppe Serra ◽  
Roberta Chiari ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pericardial Effusion ◽  
Iron Overload ◽  
Thalassemia Major ◽  
Left Ventricular ◽  
Myocardial Iron ◽  
Cine Ssfp ◽  
Risk Of Death ◽  
Non Invasive ◽  
Increased Risk

Abstract Introduction. In different types of not-hematological diseases the presence of a small pericardial effusion (PE) was associated with worse survival even after adjustment for patient characteristics, suggesting that it is a marker of underlying disease.In thalassemia major (TM) pericardial effusion was shown to be one of the manifestations of heart disease but its potential prognostic importance has never been investigated in the modern era. Cardiovascular Magnetic Resonance (CMR) by cine SSFP sequences was demonstrated to be extremely sensitive to even a small amount of PE. This is the first prospective study evaluating if the presence of pericardial effusion is associated with increased mortality in TM. Methods. 1259 patients (648 females, mean age 31.02 ± 8.64 years) enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) were prospectively followed from their first Magnetic Resonance Imaging (MRI) scan. CMR was used to quantify myocardial iron (MIO) overload by a multislice multiecho T2* approach and to assess biventricular function parameters and to detect PE by cine SSFP sequences. Results. PE was present in 25 (2.0%) patients.Patients with and without PE were comparable for age and ratio of men/women. At the baseline, the percentage of patients with MIO (global heart T2* value < 20 ms) was comparable between patients with and without PE (12.0 % vs 28.7%; P=0.074) and left ventricular and right ventricular ejection fractions were not significantly different between the two groups. Mean follow-up (FU) time was 44.55 ± 20.35 months and there were 15 deaths. Mortality was greater for patients with PE compared to those without an effusion (8.0% vs 1.1%, P=0.034). PE was a significant predictive factor for death (hazard ratio-HR=12.64, 95%CI=2.78-57.42, P=0.001). PE remained a significant prognosticator for death also in a multivariate model including MIO ms (PE: HR=17.36, 95%CI=3.65-82.62, P<0.0001and global heart T2* < 20 ms: HR=3.07, 95%CI=1.07-8.75, P=0.036). Conclusions. PE is quite rare in TM patients and it is not related to myocardial iron overload. An important role in the development of PE could be played by the 'iron-induced' pericardial siderosis but, due to the limitations of the current non-invasive CMR techniques, we were not able to address this issue. PE was found to be a strong predictor for death, independently by the presence of myocardial iron overload. The non-invasive diagnosis of pericardial effusion is important for a more complete definition of the cardiac involvement of TM patients. The increased risk of death associated with PE may be used along with other clinical characteristics when estimating a patient's prognosis and monitoring. Disclosures Pepe: Chiesi: Speakers Bureau; ApoPharma Inc.: Speakers Bureau; Novartis: Speakers Bureau.

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