Three-dimensional cardiac fibre disorganization as a novel parameter for ventricular arrhythmia stratification after myocardial infarction

Daniel G. León, Mariña López-Yunta, José Manuel Alfonso-Almazán, Manuel Marina-Breysse, Jorge G. Quintanilla, Javier Sánchez-González, Carlos Galán-Arriola, Francisco Castro-Núñez, Juan José González-Ferrer, Borja Ibáñez, Julián Pérez-Villacastín, Nicasio Pérez-Castellano, Valentín Fuster, José Jalife, Mariano Vázquez, Jazmín Aguado-Sierra, David Filgueiras-Rama

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Aims: Myocardial infarction (MI) alters cardiac fibre organization with unknown consequences on ventricular arrhythmia. We used diffusion tensor imaging (DTI) of three-dimensional (3D) cardiac fibres and scar reconstructions to identify the main parameters associated with ventricular arrhythmia inducibility and ventricular tachycardia (VT) features after MI. Methods and results: Twelve pigs with established MI and three controls underwent invasive electrophysiological characterization of ventricular arrhythmia inducibility and VT features. Animal-specific 3D scar and myocardial fibre distribution were obtained from ex vivo high-resolution contrast-enhanced T1 mapping and DTI sequences. Diffusion tensor imaging-derived parameters significantly different between healthy and scarring myocardium, scar volumes, and left ventricular ejection fraction (LVEF) were included for arrhythmia risk stratification and correlation analyses with VT features. Ventricular fibrillation (VF) was the only inducible arrhythmia in 4 out of 12 infarcted pigs and all controls. Ventricular tachycardia was also inducible in the remaining eight pigs during programmed ventricular stimulation. A DTI-based 3D fibre disorganization index (FDI) showed higher disorganization within dense scar regions of VF-only inducible pigs compared with VT inducible animals (FDI: 0.36; 0.36-0.37 vs. 0.32; 0.26-0.33, respectively, P = 0.0485). Ventricular fibrillation induction required lower programmed stimulation aggressiveness in VF-only inducible pigs than VT inducible and control animals. Neither LVEF nor scar volumes differentiated between VF and VT inducible animals. Re-entrant VT circuits were localized within areas of highly disorganized fibres. Moreover, the FDI within heterogeneous scar regions was associated with the median VT cycle length per animal (R2 = 0.5320). Conclusion: The amount of scar-related cardiac fibre disorganization in DTI sequences is a promising approach for ventricular arrhythmia stratification after MI.

Original languageEnglish
Article numbereuy306
Pages (from-to)822-832
Number of pages11
JournalEuropace
Volume21
Issue number5
DOIs
StatePublished - 1 May 2019

Keywords

  • Arrhythmia stratification
  • Cardiac fibres
  • Diffusion tensor imaging
  • Magnetic resonance imaging
  • Myocardial infarction

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