Myocardial Scar
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2021 ◽  
Vol 8 ◽  
Author(s):  
Xueyao Yang ◽  
Jinfan Tian ◽  
Lijun Zhang ◽  
Wei Dong ◽  
Hongzhi Mi ◽  
...  

Objective: Viability and functional assessments are recommended for indication and intervention for chronic coronary total occlusion (CTO). We aimed to evaluate myocardial viability and left ventricular (LV) functional status by using cardiovascular magnetic resonance (CMR) and to investigate the relationship between them and collaterals in patients with CTO.Materials and Methods: We enrolled 194 patients with one CTO artery as detected by coronary angiography. Patients were scheduled for CMR within 1 week after coronary angiography.Results: A total of 128 CTO territories (66%) showed scar based on late gadolinium enhancement (LGE) imaging. There were 1,112 segments in CTO territory, while only 198 segments (18%) subtended by the CTO artery showed transmural scar (i.e., >50% extent on LGE). Patients with viable myocardium had higher LV ejection fraction (LVEF) (56.7 ± 13.5% vs. 48.3 ± 15.4%, p < 0.001) than those with transmural scar. Angiographically, well-developed collaterals were found in 164 patients (85%). There was no significant correlation between collaterals and the presence of myocardial scar (p = 0.680) or between collaterals and LVEF (p = 0.191). Nevertheless, more segments with transmural scar were observed in patients with poorly-developed collaterals than in those with well-developed collaterals (25 vs. 17%, p = 0.010).Conclusion: Myocardial infarction detected by CMR is widespread among patients with CMO, yet only a bit of transmural myocardial scar was observed within CTO territory. Limited number of segments with transmural scar is associated with preserved LV function. Well-developed collaterals are not related to the prevalence of myocardial scar or systolic functioning, but could be related to reduce number of non-viable segments subtended by the CTO artery.


2021 ◽  
Vol 8 ◽  
Author(s):  
Danzha Zheng ◽  
Yanyun Liu ◽  
Lei Zhang ◽  
Fan Hu ◽  
Xubo Tan ◽  
...  

Background: Phase analysis is a technique used to assess left ventricular mechanical dyssynchrony (LVMD) in nuclear myocardial imaging. Previous studies have found an association between LVMD and myocardial ischemia. We aim to assess the potential diagnostic value of LVMD in terms of myocardial viability, and ability to predict major adverse cardiac events (MACE), using Nitrogen-13 ammonia ECG-gated positron emission tomography (gPET).Methods: Patients with coronary artery disease (CAD) who underwent Nitrogen-13 ammonia and Fluorine-18 FDG myocardial gPET were enrolled, and their gPET imaging data were retrospectively analyzed. Patients were followed up and major adverse cardiac events (MACE) were recorded. The Kruskal-Wallis test and Mann-Whitney U test were performed to compare LVMD parameters among the groups. Binary logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and multiple stepwise analysis curves were applied to identify the relationship between LVMD parameters and myocardial viability. Kaplan–Meier survival curves and the log-rank test were used to look for differences in the incidence of MACE.Results: In total, 79 patients were enrolled and divided into three groups: Group 1 (patients with only viable myocardium, n = 7), Group 2 (patients with more viable myocardium than scar, n = 33), and Group 3 (patients with less viable myocardium than scar, n = 39). All LVMD parameters were significantly different among groups. The median values of systolic phase standard deviation (PSD), systolic phase histogram bandwidth (PHB), diastolic PSD, and diastolic PHB between Group 1 and Group 3, and Group 2 and Group 3 were significantly different. A diastolic PHB of 204.5° was the best cut-off value to predict the presence of myocardial scar. In multiple stepwise analysis models, diastolic PSD, ischemic extent, and New York Heart Association (NYHA) classification were independent predictive factors of viable myocardium and myocardial scar. The incidence of MACE in patients with diastolic PHB > 204.5° was 25.0%, higher than patients with diastolic PHB <204.5° (11.8%), but the difference was not significant.Conclusions: LVMD generated from Nitrogen-13 ammonia ECG-gated myocardial perfusion imaging had added diagnostic value for myocardial viability assessment in CAD patients. LVMD did not show a definite prognostic value.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Wouters ◽  
J Duchenne ◽  
S Bezy ◽  
K Papangelopoulou ◽  
A Puvrez ◽  
...  

Abstract Background Cardiac resynchronization therapy (CRT) is an established therapy for patients suffering from heart failure and left bundle branch block (LBBB) conduction delays. Despite its proven beneficial effects, CRT is associated with a high percentage of non-response. Since CRT has shown to be less effective in patients with ischemic cardiomyopathy, determining the presence of myocardial scar before implantation could help to improve the response-rate. However, the gold standard to assess myocardial scar, magnetic resonance imaging (MRI), cannot be used in every patient, due to already implanted devices and/or reduced renal function. Recently introduced shear wave elastography (SWE) allows the non-invasive assessment of myocardial stiffness. Natural shear waves are excited by mitral valve closure (MVC) and travel through the heart with a speed directly related to tissue stiffness. SWE has previously been proven to be able to detect myocardial scar, however this has never been shown in the presence LBBB. Purpose The aim of this study was to evaluate the capability of SWE as a novel method to determine myocardial scar in patients with conduction delays. Methods We included 24 heart failure patients (age: 68±10; 50% males) with ischemic (n=8) and non-ischemic (n=16) cardiomyopathy. The CRT device was set to AAI mode in order to obtain native ventricular conduction. For patients with ischemic cardiomyopathy, the presence and location of scar was determined by MRI or scintigraphy. All ischemic patients had septal scar only. For SWE, left ventricular parasternal long-axis views were acquired with an experimental high frame rate ultrasound scanner (average frame rate: ±1200 Hz). Shear waves were visualized in M-modes of the septum, colour coded for tissue acceleration. The slope of the shear waves in the M-mode represents their propagation speed (Figure A). Results There was no significant difference between the ischemic and non-ischemic patients in QRS width after CRT (149±31 ms vs 144±26 ms), systolic blood pressure blood pressure (135±11 mmHg vs 135±23 mmHg), diastolic blood pressure (74±9 mmHg vs 70±11 mmHg) and heart rate (58±4 bpm vs 63±9 bpm) (all p>0.05). Ejection fraction (33±8% vs 45±10%), end-diastolic volume (196±34 ml vs 129±64 ml) and global longitudinal strain (−9.8±3.1% vs −14.1±4.1%) differed significantly between the groups (all p<0.05). Shear wave speed after MVC was significantly higher in patients with septal scar compared to non-ischemic patients (8.2±1.9 m/s vs 5.5±1.2 m/s; p<0.01) (Figure B). Conclusion In the presence of scar, we found markedly elevated shear wave propagation speed compared to non-ischemic patients. These results indicate that SWE is able to identify scarred myocardium even in patients with LBBB. We therefore believe that SWE could be a novel easy and non-invasive method to evaluate septal myocardial scarring in patients before CRT implantation. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWO - Research Foundation Flanders


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Silva Garcia ◽  
D Villanueva ◽  
W Delgado ◽  
A Berruezo ◽  
D Soto-Iglesias ◽  
...  

Abstract Background Delayed enhancement gadolinium MRI is a useful technique to identify myocardial scar. The objective of this study is compare the reproducibility of the scar quantification and characterization based on cardiac MRI. Methods 10 patients with ischemic ethology underwent to 1,5T DE-MRI acquisition for myocardial scar analysis. Images were processed using a commercial software (ADAS3D-Galgo Medical) and different parameters from scar tissue (mass of the scar, core of scar and border zone expressed in grams) were analysed. Conducting channels evaluation was obtained by the number of corridors and the mass of the border zone of those corridors. To perform this analysis, 2 experienced and 1 non experienced users segmented DE-MRI acquisition in order to evaluate the inter observer variability. Bland-Altman analysis was employed to evaluate the comparison between the measurements. Results Inter observer agreement between experienced users was high (table). The mean and the standard deviation of the differences between two measurements for the scar mass was −3,9±14,66 gr. Analysing the scar tissue divided in core and border zone, the mass of these volume tissues were very similar (−3,51±4,56gr and −0,4±12,87gr respectively. Regarding conducting channels characteristics, the mean of the differences was 0±2 for the number of channels and 1,71±7,76 gr for the mass on the border zone of the corridors. Comparing the measurements between one of the experienced users and the beginner user, results were similar but significant differences were found on the mass of the core and the number of channels, with a variability of ±2 channels (table). Conclusions Left ventricular scar size and characteristics derived from late gadolinium enhanced post-processed images are highly reproducible between experienced observers. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Scar analysis performed by 3 users


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qian Dong ◽  
Xuesong Wen ◽  
Guanglei Chang ◽  
Rui Xia ◽  
Sihang Wang ◽  
...  

Abstract Objective To investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods Forty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (> 75%) or non-transmural (< 75%) myocardial scars, according to previous study. Results The sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.925. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR < 40.15% had a 170.90-fold higher probability of developing transmural scars compared with patients with STR ≥ 40.15%. Pearson correlation and linear regression analyses showed STR percentage was significantly associated with myocardial scar thickness and size. Conclusion STR < 40.15% at 24 h after PCI may provide meaningful diagnostic information regarding the extent of myocardial scarification in STEMI patients.


2021 ◽  
Vol 8 ◽  
Author(s):  
Umesh C. Sharma ◽  
Kanhao Zhao ◽  
Kyle Mentkowski ◽  
Swati D. Sonkawade ◽  
Badri Karthikeyan ◽  
...  

Contrast-enhanced cardiac magnetic resonance imaging (MRI) is routinely used to determine myocardial scar burden and make therapeutic decisions for coronary revascularization. Currently, there are no optimized deep-learning algorithms for the automated classification of scarred vs. normal myocardium. We report a modified Generative Adversarial Network (GAN) augmentation method to improve the binary classification of myocardial scar using both pre-clinical and clinical approaches. For the initial training of the MobileNetV2 platform, we used the images generated from a high-field (9.4T) cardiac MRI of a mouse model of acute myocardial infarction (MI). Once the system showed 100% accuracy for the classification of acute MI in mice, we tested the translational significance of this approach in 91 patients with an ischemic myocardial scar, and 31 control subjects without evidence of myocardial scarring. To obtain a comparable augmentation dataset, we rotated scar images 8-times and control images 72-times, generating a total of 6,684 scar images and 7,451 control images. In humans, the use of Progressive Growing GAN (PGGAN)-based augmentation showed 93% classification accuracy, which is far superior to conventional automated modules. The use of other attention modules in our CNN further improved the classification accuracy by up to 5%. These data are of high translational significance and warrant larger multicenter studies in the future to validate the clinical implications.


2021 ◽  
Vol 12 ◽  
Author(s):  
Lisa A. Gottlieb ◽  
Fanny Vaillant ◽  
Emma Abell ◽  
Charly Belterman ◽  
Virginie Loyer ◽  
...  

BackgroundPulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure.MethodsRadiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode’s solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes).ResultsIn high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011).ConclusionLocalized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.


2021 ◽  
Vol 8 ◽  
Author(s):  
Alwin B. P. Noordman ◽  
Alexander H. Maass ◽  
Hessel Groenveld ◽  
Bart A. Mulder ◽  
Michiel Rienstra ◽  
...  

Background: Implantable cardioverter-defibrillator (ICD) therapy is associated with several deleterious effects, which can be reduced by antiarrhythmic drugs or catheter ablation. However, it is largely unknown which patients might benefit from these therapies. Therefore, this study aimed to investigate whether myocardial scar characterization improves risk stratification for ventricular arrhythmia (VA) occurrence in patients with ischemic cardiomyopathy and an ICD.Methods: In this study, 82 patients with ischemic cardiomyopathy who received an ICD were enrolled retrospectively. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images were analyzed using an investigational software tool to obtain quantitative data regarding the total scar, core, and border zone (BZ). Data regarding the QRS complex was obtained from electrocardiography (ECG). The primary endpoint was appropriate ICD therapy.Results: During a median follow-up duration of 3.98 years [interquartile range (IQR) 2.89–5.14 years], appropriate therapy occurred in 24 (29.3%) patients. Patients with appropriate ICD therapy had a significantly larger total scar mass [60.0 (IQR 41.2–73.4) vs. 43.3 (IQR 31.2–61.2) g; P = 0.009] and BZ mass [32.9 (IQR 26.9–42.4) vs. 24.5 (IQR 18.8–32.5) g; P = 0.001] than those without appropriate therapy. In multivariable Cox regression analyses, total scar mass [hazard ratio (HR) 1.02 [95% confidence interval (CI) 1.00–1.04]; P = 0.014] and BZ mass (HR 1.04 [95% CI 1.01–1.07]; P = 0.009) independently predicted appropriate ICD therapy. Core mass and the QRS complex, however, were not significantly associated with the primary endpoint.Conclusion: LGE-CMR-based, but not ECG-based myocardial scar characterization improves risk stratification for VA occurrence in patients with ischemic cardiomyopathy who received an ICD.


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