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Klein V, Davids M, Vendramini L, Ferris NG, Schad LR, Sosnovik DE, Nguyen CT, Wald LL, Guérin B. Prediction of experimental cardiac magnetostimulation thresholds using pig-specific body models. Magn Reson Med 2023; 90:1594-1609. [PMID: 37288580 PMCID: PMC10524673 DOI: 10.1002/mrm.29717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Modern high-amplitude gradient systems can be limited by the International Electrotechnical Commission 60601-2-33 cardiac stimulation (CS) limit, which was set in a conservative manner based on electrode experiments and E-field simulations in uniform ellipsoidal body models. Here, we show that coupled electromagnetic-electrophysiological modeling in detailed body and heart models can predict CS thresholds, suggesting that such modeling might lead to more detailed threshold estimates in humans. Specifically, we compare measured and predicted CS thresholds in eight pigs. METHODS We created individualized porcine body models using MRI (Dixon for the whole body, CINE for the heart) that replicate the anatomy and posture of the animals used in our previous experimental CS study. We model the electric fields induced along cardiac Purkinje and ventricular muscle fibers and predict the electrophysiological response of these fibers, yielding CS threshold predictions in absolute units for each animal. Additionally, we assess the total modeling uncertainty through a variability analysis of the 25 main model parameters. RESULTS Predicted and experimental CS thresholds agree within 19% on average (normalized RMS error), which is smaller than the 27% modeling uncertainty. No significant difference was found between the modeling predictions and experiments (p < 0.05, paired t-test). CONCLUSION Predicted thresholds matched the experimental data within the modeling uncertainty, supporting the model validity. We believe that our modeling approach can be applied to study CS thresholds in humans for various gradient coils, body shapes/postures, and waveforms, which is difficult to do experimentally.
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Affiliation(s)
- Valerie Klein
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Mathias Davids
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Livia Vendramini
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Natalie G. Ferris
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Lothar R. Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - David E. Sosnovik
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, USA
| | - Christopher T. Nguyen
- Cardiovascular Innovation Research Center, Heart Vascular & Thoracic Institute, Cleveland Clinic, OH, USA
- Department of Radiology, Imaging Institute, Cleveland Clinic, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Lawrence L. Wald
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Bastien Guérin
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
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Klein V, Coll-Font J, Vendramini L, Straney D, Davids M, Ferris NG, Schad LR, Sosnovik DE, Nguyen CT, Wald LL, Guérin B. Measurement of magnetostimulation thresholds in the porcine heart. Magn Reson Med 2022; 88:2242-2258. [PMID: 35906903 PMCID: PMC9420805 DOI: 10.1002/mrm.29382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Powerful MRI gradient systems can surpass the International Electrotechnical Commission (IEC) 60601-2-33 limit for cardiac stimulation (CS), which was determined by simple electromagnetic simulations and electrode stimulation experiments. Only a few canine studies measured magnetically induced CS thresholds in vivo and extrapolating them to human safety limits can be challenging. METHODS We measured cardiac magnetostimulation thresholds in 10 healthy, anesthetized pigs using capacitors discharged into a flat spiral coil to produce damped sinusoidal waveforms with effective stimulus duration ts,eff = 0.45 ms. Electrocardiography (ECG), blood pressure, and peripheral oximetry signals were recorded to determine threshold coil currents yielding cardiac capture. Dixon and CINE MR volumes from each animal were segmented to generate porcine-specific electromagnetic models to calculate dB/dt and E-field values in the porcine heart at threshold. For comparison, we also simulated maximum dB/dt and E-field values created by three MRI gradient systems in the heart of a human body model. RESULTS The average dB/dt threshold estimated in the porcine heart was 1.66 ± 0.23 kT/s, which is 11-fold greater than the IEC dB/dt limit at ts,eff = 0.45 ms, and 31-fold greater than the maximum value created by the investigated MRI gradients in the human heart. The average E-field threshold estimated in the porcine heart was 92.9 ± 13.5 V/m, which is 6-fold greater than the IEC E-field limit at ts,eff = 0.45 ms and 37-fold greater than the maximum gradient-induced E-field in the human heart. CONCLUSION This first measurement of cardiac magnetostimulation thresholds in pigs indicates that the IEC cardiac safety limit is conservative for the investigated stimulus duration (ts,eff = 0.45 ms).
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Affiliation(s)
- Valerie Klein
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Jaume Coll-Font
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
| | - Livia Vendramini
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Donald Straney
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Mathias Davids
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Natalie G. Ferris
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- Harvard Biophysics Graduate Program, Cambridge, MA, United States
| | - Lothar R. Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - David E. Sosnovik
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Christopher T. Nguyen
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Charlestown, MA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Lawrence L. Wald
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
- Harvard Biophysics Graduate Program, Cambridge, MA, United States
| | - Bastien Guérin
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
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Nakamura K, Neidig LE, Yang X, Weber GJ, El-Nachef D, Tsuchida H, Dupras S, Kalucki FA, Jayabalu A, Futakuchi-Tsuchida A, Nakamura DS, Marchianò S, Bertero A, Robinson MR, Cain K, Whittington D, Tian R, Reinecke H, Pabon L, Knollmann BC, Kattman S, Thies RS, MacLellan WR, Murry CE. Pharmacologic therapy for engraftment arrhythmia induced by transplantation of human cardiomyocytes. Stem Cell Reports 2021; 16:2473-2487. [PMID: 34506727 PMCID: PMC8514851 DOI: 10.1016/j.stemcr.2021.08.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Heart failure remains a significant cause of morbidity and mortality following myocardial infarction. Cardiac remuscularization with transplantation of human pluripotent stem cell-derived cardiomyocytes is a promising preclinical therapy to restore function. Recent large animal data, however, have revealed a significant risk of engraftment arrhythmia (EA). Although transient, the risk posed by EA presents a barrier to clinical translation. We hypothesized that clinically approved antiarrhythmic drugs can prevent EA-related mortality as well as suppress tachycardia and arrhythmia burden. This study uses a porcine model to provide proof-of-concept evidence that a combination of amiodarone and ivabradine can effectively suppress EA. None of the nine treated subjects experienced the primary endpoint of cardiac death, unstable EA, or heart failure compared with five out of eight (62.5%) in the control cohort (hazard ratio = 0.00; 95% confidence interval: 0–0.297; p = 0.002). Pharmacologic treatment of EA may be a viable strategy to improve safety and allow further clinical development of cardiac remuscularization therapy. EA arises after hESC-CM transplantation in infarcted pigs Combination pharmacotherapy prevents EA-related mortality and morbidity Amiodarone and ivabradine significantly suppresses tachycardia and arrythmia burden EA is polymorphic and may be due to interaction with intramural Purkinje fibers
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Affiliation(s)
- Kenta Nakamura
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Lauren E Neidig
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Comparative Medicine, University of Washington, Seattle, WA 98195, USA
| | - Xiulan Yang
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA
| | - Gerhard J Weber
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | | | - Hiroshi Tsuchida
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Sarah Dupras
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Faith A Kalucki
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Anu Jayabalu
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Akiko Futakuchi-Tsuchida
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Daisy S Nakamura
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Silvia Marchianò
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA
| | - Alessandro Bertero
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA
| | - Melissa R Robinson
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Kevin Cain
- Department of Biostatics, University of Washington, Seattle, WA 98195, USA
| | - Dale Whittington
- Department of Medicinal Chemistry, University of Washington, Seattle, WA 98195, USA
| | - Rong Tian
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA 98195, USA; Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Hans Reinecke
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA
| | - Lil Pabon
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - Björn C Knollmann
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Steven Kattman
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - R Scott Thies
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA
| | - W Robb MacLellan
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Charles E Murry
- Institute for Stem Cell and Regenerative Medicine, University of Washington, 850 Republican Street, Brotman Building Room 453, Seattle, WA 98109, USA; Center for Cardiovascular Biology, University of Washington, Seattle, WA 98109, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA; Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA 98195, USA; Sana Biotechnology, Seattle, WA 98102, USA; Department of Bioengineering, University of Washington, Seattle, WA 98195, USA.
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