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Kwon DH, Huang S, Turkmani M, Salam D, Al-Dieri D, Ming Wang TK, Kapadia SR, Krishnaswamy A, Gillinov M, Svensson LG, Grimm RA, Tang WW, Chen D, Nguyen CT, Wang X. Cardiac MRI-Enriched Phenomapping Classification and Differential Treatment Outcomes in Patients With Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2024; 17:e016006. [PMID: 38626097 PMCID: PMC11020053 DOI: 10.1161/circimaging.123.016006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/09/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Significant controversy continues to confound patient selection and referral for revascularization and mitral valve intervention in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance (CMR) enables comprehensive phenotyping with gold-standard tissue characterization and volumetric/functional measures. Therefore, we sought to determine the impact of CMR-enriched phenomapping patients with ICM to identify differential outcomes following surgical revascularization and surgical mitral valve intervention (sMVi). METHODS Consecutive patients with ICM referred for CMR between 2002 and 2017 were evaluated. Latent class analysis was performed to identify phenotypes enriched by comprehensive CMR assessment. The primary end point was death, heart transplant, or left ventricular assist device implantation. A multivariable Cox survival model was developed to determine the association of phenogroups with overall survival. Subgroup analysis was performed to assess the presence of differential response to post-magnetic resonance imaging procedural interventions. RESULTS A total of 787 patients were evaluated (63.0±11.2 years, 24.8% women), with 464 primary events. Subsequent surgical revascularization and sMVi occurred in 380 (48.3%) and 157 (19.9%) patients, respectively. Latent class analysis identified 3 distinct clusters of patients, which demonstrated significant differences in overall outcome (P<0.001). Latent class analysis identified differential survival benefit of revascularization in patients as well as patients who underwent revascularization with sMVi, based on phenogroup classification, with phenogroup 3 deriving the most survival benefit from revascularization and revascularization with sMVi (hazard ratio, 0.61 [0.43-0.88]; P=0.0081). CONCLUSIONS CMR-enriched unsupervised phenomapping identified distinct phenogroups, which were associated with significant differential survival benefit following surgical revascularization and sMVi in patients with ICM. Phenomapping provides a novel approach for patient selection, which may enable personalized therapeutic decision-making for patients with ICM.
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Affiliation(s)
- Deborah H. Kwon
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Shuaiqi Huang
- Quantitative Health Sciences (S.H., X.W.), Cleveland Clinic, OH
| | - Mustafa Turkmani
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Donna Salam
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Danah Al-Dieri
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Tom Kai Ming Wang
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Amar Krishnaswamy
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Marc Gillinov
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Lars G. Svensson
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Richard A. Grimm
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - W.H. Wilson Tang
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - David Chen
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
| | - Christopher T. Nguyen
- Heart, Vascular and Thoracic Institute (D.H.K., M.T., D.S., D.A.-D., T.K.M.W., S.R.K., A.K., M.G., L.G.S., R.A.G., W.H.W.T., D.C., C.T.N.), Cleveland Clinic, OH
- Department of Radiology, (D.H.K., T.K.M.W., R.A.G., C.T.N.), Cleveland Clinic, OH
| | - Xiaofeng Wang
- Quantitative Health Sciences (S.H., X.W.), Cleveland Clinic, OH
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Imbrie-Moore AM, Zhu Y, Bandy-Vizcaino T, Park MH, Wilkerson RJ, Woo YJ. Ex Vivo Model of Ischemic Mitral Regurgitation and Analysis of Adjunctive Papillary Muscle Repair. Ann Biomed Eng 2021; 49:3412-3424. [PMID: 34734363 DOI: 10.1007/s10439-021-02879-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/15/2021] [Indexed: 01/24/2023]
Abstract
Ischemic mitral regurgitation (IMR) is particularly challenging to repair with lasting durability due to the complex valvular and subvalvular pathologies resulting from left ventricular dysfunction. Ex vivo simulation is uniquely suited to quantitatively analyze the repair biomechanics, but advancements are needed to model the nuanced IMR disease state. Here we present a novel IMR model featuring a dilation device with precise dilatation control that preserves annular elasticity to enable accurate ex vivo analysis of surgical repair. Coupled with augmented papillary muscle head positioning, the enhanced heart simulator system successfully modeled IMR pre- and post-surgical intervention and enabled the analysis of adjunctive subvalvular papillary muscle repair to alleviate regurgitation recurrence. The model resulted in an increase in regurgitant fraction: 11.6 ± 1.7% to 36.1 ± 4.4% (p < 0.001). Adjunctive papillary muscle head fusion was analyzed relative to a simple restrictive ring annuloplasty repair and, while both repairs successfully eliminated regurgitation initially, the addition of the adjunctive subvalvular repair reduced regurgitation recurrence: 30.4 ± 5.7% vs. 12.5 ± 2.6% (p = 0.002). Ultimately, this system demonstrates the success of adjunctive papillary muscle head fusion in repairing IMR as well as provides a platform to optimize surgical techniques for increased repair durability.
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Affiliation(s)
- Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.,Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.,Department of Bioengineering, Stanford University, Stanford, CA, USA
| | | | - Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA.,Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Robert J Wilkerson
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Falk Cardiovascular Research Building CV-235, 300 Pasteur Drive, Stanford, CA, 94305-5407, USA. .,Department of Bioengineering, Stanford University, Stanford, CA, USA.
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