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Backhaus SJ, Nasopoulou A, Lange T, Schulz A, Evertz R, Kowallick JT, Hasenfuß G, Lamata P, Schuster A. Left Atrial Roof Enlargement Is a Distinct Feature of Heart Failure With Preserved Ejection Fraction. Circ Cardiovasc Imaging 2024; 17:e016424. [PMID: 39012942 PMCID: PMC11251503 DOI: 10.1161/circimaging.123.016424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND It remains unknown to what extent intrinsic atrial cardiomyopathy or left ventricular diastolic dysfunction drive atrial remodeling and functional failure in heart failure with preserved ejection fraction (HFpEF). Computational 3-dimensional (3D) models fitted to cardiovascular magnetic resonance allow state-of-the-art anatomic and functional assessment, and we hypothesized to identify a phenotype linked to HFpEF. METHODS Patients with exertional dyspnea and diastolic dysfunction on echocardiography (E/e', >8) were prospectively recruited and classified as HFpEF or noncardiac dyspnea based on right heart catheterization. All patients underwent rest and exercise-stress right heart catheterization and cardiovascular magnetic resonance. Computational 3D anatomic left atrial (LA) models were generated based on short-axis cine sequences. A fully automated pipeline was developed to segment cardiovascular magnetic resonance images and build 3D statistical models of LA shape and find the 3D patterns discriminant between HFpEF and noncardiac dyspnea. In addition, atrial morphology and function were quantified by conventional volumetric analyses and deformation imaging. A clinical follow-up was conducted after 24 months for the evaluation of cardiovascular hospitalization. RESULTS Beyond atrial size, the 3D LA models revealed roof dilation as the main feature found in masked HFpEF (diagnosed during exercise-stress only) preceding a pattern shift to overall atrial size in overt HFpEF (diagnosed at rest). Characteristics of the 3D model were integrated into the LA HFpEF shape score, a biomarker to characterize the gradual remodeling between noncardiac dyspnea and HFpEF. The LA HFpEF shape score was able to discriminate HFpEF (n=34) to noncardiac dyspnea (n=34; area under the curve, 0.81) and was associated with a risk for atrial fibrillation occurrence (hazard ratio, 1.02 [95% CI, 1.01-1.04]; P=0.003), as well as cardiovascular hospitalization (hazard ratio, 1.02 [95% CI, 1.00-1.04]; P=0.043). CONCLUSIONS LA roof dilation is an early remodeling pattern in masked HFpEF advancing to overall LA enlargement in overt HFpEF. These distinct features predict the occurrence of atrial fibrillation and cardiovascular hospitalization. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany (S.J.B.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany (S.J.B.)
| | - Anastasia Nasopoulou
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (A.N., P.L.)
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Johannes T. Kowallick
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
- FORUM Radiology, Rosdorf, Germany (J.T.K.)
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
| | - Pablo Lamata
- Department of Biomedical Engineering, Division of Imaging Sciences and Biomedical Engineering, King’s College London, United Kingdom (A.N., P.L.)
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany (T.L., A. Schulz, R.E., G.H., A. Schuster)
- DZHK, Partner Site Lower Saxony, Germany (T.L., A. Schulz, R.E., J.T.K., G.H., A. Schuster)
- FORUM Cardiology, Rosdorf, Germany (A. Schuster)
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (A. Schuster)
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Riaz Gondal MU, Atta Mehdi H, Khenhrani RR, Kumari N, Ali MF, Kumar S, Faraz M, Malik J. Role of Machine Learning and Artificial Intelligence in Arrhythmias and Electrophysiology. Cardiol Rev 2024:00045415-990000000-00270. [PMID: 38761137 DOI: 10.1097/crd.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Machine learning (ML), a subset of artificial intelligence (AI) centered on machines learning from extensive datasets, stands at the forefront of a technological revolution shaping various facets of society. Cardiovascular medicine has emerged as a key domain for ML applications, with considerable efforts to integrate these innovations into routine clinical practice. Within cardiac electrophysiology, ML applications, especially in the automated interpretation of electrocardiograms, have garnered substantial attention in existing literature. However, less recognized are the diverse applications of ML in cardiac electrophysiology and arrhythmias, spanning basic science research on arrhythmia mechanisms, both experimental and computational, as well as contributions to enhanced techniques for mapping cardiac electrical function and translational research related to arrhythmia management. This comprehensive review delves into various ML applications within the scope of this journal, organized into 3 parts. The first section provides a fundamental understanding of general ML principles and methodologies, serving as a foundational resource for readers interested in exploring ML applications in arrhythmia research. The second part offers an in-depth review of studies in arrhythmia and electrophysiology that leverage ML methodologies, showcasing the broad potential of ML approaches. Each subject is thoroughly outlined, accompanied by a review of notable ML research advancements. Finally, the review delves into the primary challenges and future perspectives surrounding ML-driven cardiac electrophysiology and arrhythmias research.
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Affiliation(s)
| | - Hassan Atta Mehdi
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Raja Ram Khenhrani
- Department of Medicine, Internal Medicine Fellow, Shaheed Mohtarma Benazir Bhutto Medical College and Lyari General Hospital, Karachi, Pakistan
| | - Neha Kumari
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Muhammad Faizan Ali
- Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Sooraj Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan; and
| | - Maria Faraz
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Rawalpindi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Rawalpindi, Pakistan
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Li J, Chen K, He L, Luo F, Wang X, Hu Y, Zhao J, Zhu K, Chen X, Zhang Y, Tao H, Dong J. Data-driven classification of left atrial morphology and its predictive impact on atrial fibrillation catheter ablation. J Cardiovasc Electrophysiol 2024; 35:811-820. [PMID: 38424601 DOI: 10.1111/jce.16228] [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: 01/06/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Various left atrial (LA) anatomical structures are correlated with postablative recurrence for atrial fibrillation (AF) patients. Comprehensively integrating anatomical structures, digitizing them, and implementing in-depth analysis, which may supply new insights, are needed. Thus, we aim to establish an interpretable model to identify AF patients' phenotypes according to LA anatomical morphology, using machine learning techniques. METHODS AND RESULTS Five hundred and nine AF patients underwent first ablation treatment in three centers were included and were followed-up for postablative recurrent atrial arrhythmias. Data from 369 patients were regarded as training set, while data from another 140 patients, collected from different centers, were used as validation set. We manually measured 57 morphological parameters on enhanced computed tomography with three-dimensional reconstruction technique and implemented unsupervised learning accordingly. Three morphological groups were identified, with distinct prognosis according to Kaplan-Meier estimator (p < .001). Multivariable Cox model revealed that morphological grouping were independent predictors of 1-year recurrence (Group 1: HR = 3.00, 95% CI: 1.51-5.95, p = .002; Group 2: HR = 4.68, 95% CI: 2.40-9.11, p < .001; Group 3 as reference). Furthermore, external validation consistently demonstrated our findings. CONCLUSIONS Our study illustrated the feasibility of employing unsupervised learning for the classification of LA morphology. By utilizing morphological grouping, we can effectively identify individuals at different risks of postablative recurrence and thereby assist in clinical decision-making.
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Affiliation(s)
- Jiaju Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Chen
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fangyuan Luo
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
- Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Xianqing Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yucai Hu
- Department of Cardiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiangtao Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kui Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaowei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuekun Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hailong Tao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Bhalodia R, Elhabian S, Adams J, Tao W, Kavan L, Whitaker R. DeepSSM: A blueprint for image-to-shape deep learning models. Med Image Anal 2024; 91:103034. [PMID: 37984127 PMCID: PMC11087075 DOI: 10.1016/j.media.2023.103034] [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: 10/14/2021] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
Statistical shape modeling (SSM) characterizes anatomical variations in a population of shapes generated from medical images. Statistical analysis of shapes requires consistent shape representation across samples in shape cohort. Establishing this representation entails a processing pipeline that includes anatomy segmentation, image re-sampling, shape-based registration, and non-linear, iterative optimization. These shape representations are then used to extract low-dimensional shape descriptors that are anatomically relevant to facilitate subsequent statistical analyses in different applications. However, the current process of obtaining these shape descriptors from imaging data relies on human and computational resources, requiring domain expertise for segmenting anatomies of interest. Moreover, this same taxing pipeline needs to be repeated to infer shape descriptors for new image data using a pre-trained/existing shape model. Here, we propose DeepSSM, a deep learning-based framework for learning the functional mapping from images to low-dimensional shape descriptors and their associated shape representations, thereby inferring statistical representation of anatomy directly from 3D images. Once trained using an existing shape model, DeepSSM circumvents the heavy and manual pre-processing and segmentation required by classical models and significantly improves the computational time, making it a viable solution for fully end-to-end shape modeling applications. In addition, we introduce a model-based data-augmentation strategy to address data scarcity, a typical scenario in shape modeling applications. Finally, this paper presents and analyzes two different architectural variants of DeepSSM with different loss functions using three medical datasets and their downstream clinical application. Experiments showcase that DeepSSM performs comparably or better to the state-of-the-art SSM both quantitatively and on application-driven downstream tasks. Therefore, DeepSSM aims to provide a comprehensive blueprint for deep learning-based image-to-shape models.
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Affiliation(s)
- Riddhish Bhalodia
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA.
| | - Shireen Elhabian
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA
| | - Jadie Adams
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA
| | - Wenzheng Tao
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA
| | - Ladislav Kavan
- School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA
| | - Ross Whitaker
- Scientific Computing and Imaging Institute, 72 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA; School of Computing, 50 Central Campus Dr, University of Utah, Salt Lake City, UT 84112, USA
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Hermida U, Stojanovski D, Raman B, Ariga R, Young AA, Carapella V, Carr-White G, Lukaschuk E, Piechnik SK, Kramer CM, Desai MY, Weintraub WS, Neubauer S, Watkins H, Lamata P. Left ventricular anatomy in obstructive hypertrophic cardiomyopathy: beyond basal septal hypertrophy. Eur Heart J Cardiovasc Imaging 2023; 24:807-818. [PMID: 36441173 PMCID: PMC10229266 DOI: 10.1093/ehjci/jeac233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by dynamic obstruction of the left ventricular (LV) outflow tract (LVOT). Although this may be mediated by interplay between the hypertrophied septal wall, systolic anterior motion of the mitral valve, and papillary muscle abnormalities, the mechanistic role of LV shape is still not fully understood. This study sought to identify the LV end-diastolic morphology underpinning oHCM. METHODS AND RESULTS Cardiovascular magnetic resonance images from 2398 HCM individuals were obtained as part of the NHLBI HCM Registry. Three-dimensional LV models were constructed and used, together with a principal component analysis, to build a statistical shape model capturing shape variations. A set of linear discriminant axes were built to define and quantify (Z-scores) the characteristic LV morphology associated with LVOT obstruction (LVOTO) under different physiological conditions and the relationship between LV phenotype and genotype. The LV remodelling pattern in oHCM consisted not only of basal septal hypertrophy but a combination with LV lengthening, apical dilatation, and LVOT inward remodelling. Salient differences were observed between obstructive cases at rest and stress. Genotype negative cases showed a tendency towards more obstructive phenotypes both at rest and stress. CONCLUSIONS LV anatomy underpinning oHCM consists of basal septal hypertrophy, apical dilatation, LV lengthening, and LVOT inward remodelling. Differences between oHCM cases at rest and stress, as well as the relationship between LV phenotype and genotype, suggest different mechanisms for LVOTO. Proposed Z-scores render an opportunity of redefining management strategies based on the relationship between LV anatomy and LVOTO.
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Affiliation(s)
- Uxio Hermida
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - David Stojanovski
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rina Ariga
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alistair A Young
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Valentina Carapella
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
| | - Gerry Carr-White
- Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Elena Lukaschuk
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stefan K Piechnik
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher M Kramer
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, OH, USA
| | - William S Weintraub
- MedStar Health Research Institute, Georgetown University, Washington, DC, USA
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hugh Watkins
- NIHR Oxford Biomedical Research Centre, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King’s College London, 5th Floor Becket House, Lambeth Palace Road, London SE1 7EU, UK
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Ogbomo-Harmitt S, Muffoletto M, Zeidan A, Qureshi A, King AP, Aslanidi O. Exploring interpretability in deep learning prediction of successful ablation therapy for atrial fibrillation. Front Physiol 2023; 14:1054401. [PMID: 36998987 PMCID: PMC10043207 DOI: 10.3389/fphys.2023.1054401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Radiofrequency catheter ablation (RFCA) therapy is the first-line treatment for atrial fibrillation (AF), the most common type of cardiac arrhythmia globally. However, the procedure currently has low success rates in dealing with persistent AF, with a reoccurrence rate of ∼50% post-ablation. Therefore, deep learning (DL) has increasingly been applied to improve RFCA treatment for AF. However, for a clinician to trust the prediction of a DL model, its decision process needs to be interpretable and have biomedical relevance.Aim: This study explores interpretability in DL prediction of successful RFCA therapy for AF and evaluates if pro-arrhythmogenic regions in the left atrium (LA) were used in its decision process.Methods: AF and its termination by RFCA have been simulated in MRI-derived 2D LA tissue models with segmented fibrotic regions (n = 187). Three ablation strategies were applied for each LA model: pulmonary vein isolation (PVI), fibrosis-based ablation (FIBRO) and a rotor-based ablation (ROTOR). The DL model was trained to predict the success of each RFCA strategy for each LA model. Three feature attribution (FA) map methods were then used to investigate interpretability of the DL model: GradCAM, Occlusions and LIME.Results: The developed DL model had an AUC (area under the receiver operating characteristic curve) of 0.78 ± 0.04 for predicting the success of the PVI strategy, 0.92 ± 0.02 for FIBRO and 0.77 ± 0.02 for ROTOR. GradCAM had the highest percentage of informative regions in the FA maps (62% for FIBRO and 71% for ROTOR) that coincided with the successful RFCA lesions known from the 2D LA simulations, but unseen by the DL model. Moreover, GradCAM had the smallest coincidence of informative regions of the FA maps with non-arrhythmogenic regions (25% for FIBRO and 27% for ROTOR).Conclusion: The most informative regions of the FA maps coincided with pro-arrhythmogenic regions, suggesting that the DL model leveraged structural features of MRI images to identify such regions and make its prediction. In the future, this technique could provide a clinician with a trustworthy decision support tool.
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Jiang J, Deng H, Liao H, Fang X, Zhan X, Wei W, Wu S, Xue Y. An Artificial Intelligence-Enabled ECG Algorithm for Predicting the Risk of Recurrence in Patients with Paroxysmal Atrial Fibrillation after Catheter Ablation. J Clin Med 2023; 12:jcm12051933. [PMID: 36902719 PMCID: PMC10003633 DOI: 10.3390/jcm12051933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Catheter ablation (CA) is an important treatment strategy to reduce the burden and complications of atrial fibrillation (AF). This study aims to predict the risk of recurrence in patients with paroxysmal AF (pAF) after CA by an artificial intelligence (AI)-enabled electrocardiography (ECG) algorithm. Methods and Results: 1618 ≥ 18 years old patients with pAF who underwent CA in Guangdong Provincial People's Hospital from 1 January 2012 to 31 May 2019 were enrolled in this study. All patients underwent pulmonary vein isolation (PVI) by experienced operators. Baseline clinical features were recorded in detail before the operation and standard follow-up (≥12 months) was conducted. The convolutional neural network (CNN) was trained and validated by 12-lead ECGs within 30 days before CA to predict the risk of recurrence. A receiver operating characteristic curve (ROC) was created for the testing and validation sets, and the predictive performance of AI-enabled ECG was assessed by the area under the curve (AUC). After training and internal validation, the AUC of the AI algorithm was 0.84 (95% CI: 0.78-0.89), with a sensitivity, specificity, accuracy, precision and balanced F Score (F1 score) of 72.3%, 95.0%, 92.0%, 69.1% and 0.707, respectively. Compared with current prognostic models (APPLE, BASE-AF2, CAAP-AF, DR-FLASH and MB-LATER), the performance of the AI algorithm was better (p < 0.01). Conclusions: The AI-enabled ECG algorithm seemed to be an effective method to predict the risk of recurrence in patients with pAF after CA. This is of great clinical significance in decision-making for personalized ablation strategies and postoperative treatment plans in patients with pAF.
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Gunturiz-Beltrán C, Nuñez-Garcia M, Althoff TF, Borràs R, Figueras I Ventura RM, Garre P, Caixal G, Prat-González S, Perea RJ, Benito EM, Tolosana JM, Arbelo E, Roca-Luque I, Brugada J, Sitges M, Mont L, Guasch E. Progressive and Simultaneous Right and Left Atrial Remodeling Uncovered by a Comprehensive Magnetic Resonance Assessment in Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026028. [PMID: 36216438 DOI: 10.1161/jaha.122.026028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Left atrial structural remodeling contributes to the arrhythmogenic substrate of atrial fibrillation (AF), but the role of the right atrium (RA) remains unknown. Our aims were to comprehensively characterize right atrial structural remodeling in AF and identify right atrial parameters predicting recurrences after ablation. Methods and Results A 3.0 T late gadolinium enhanced-cardiac magnetic resonance was obtained in 109 individuals (9 healthy volunteers, 100 patients with AF undergoing ablation). Right and left atrial volume, surface, and sphericity were quantified. Right atrial global and regional fibrosis burden was assessed with validated thresholds. Patients with AF were systematically followed after ablation for recurrences. Progressive right atrial dilation and an increase in sphericity were observed from healthy volunteers to patients with paroxysmal and persistent AF; fibrosis was similar among the groups. The correlation between parameters recapitulating right atrial remodeling was mild. Subsequently, remodeling in both atria was compared. The RA was larger than the left atrium (LA) in all groups. Fibrosis burden was higher in the LA than in the RA of patients with AF, whereas sphericity was higher in the LA of patients with persistent AF only. Fibrosis, volume, and surface of the RA and LA, but not sphericity, were strongly correlated. Tricuspid regurgitation predicted right atrial volume and shape, whereas diabetes was associated with right atrial fibrosis burden; sex and persistent AF also predicted right atrial volume. Fibrosis in the RA was mostly located in the inferior vena cava-RA junction. Only right atrial sphericity is significantly associated with AF recurrences after ablation (hazard ratio, 1.12 [95% CI, 1.01-1.25]). Conclusions AF progression associates with right atrial remodeling in parallel with the LA. Right atrial sphericity yields prognostic significance after ablation.
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Affiliation(s)
- Clara Gunturiz-Beltrán
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Marta Nuñez-Garcia
- Electrophysiology and Heart Modeling Institute (IHU LIRYC) Pessac France.,Université de Bordeaux Bordeaux France
| | - Till F Althoff
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Department of Cardiology and Angiology, Charite ́ University Medicine Berlin, Charite ́ Campus Mitte Berlin Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin Berlin Germany
| | - Roger Borràs
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Salud Mental Instituto de Salud Carlos III Madrid Spain
| | | | - Paz Garre
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Gala Caixal
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Susanna Prat-González
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Rosario J Perea
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Eva Maria Benito
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain
| | - Jose Maria Tolosana
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Elena Arbelo
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Josep Brugada
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Marta Sitges
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Lluís Mont
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
| | - Eduard Guasch
- Arrhythmia Section, Institut Clínic Cardiovascular Hospital Clínic, Universitat de Barcelona Barcelona Catalonia Spain.,Institut d'Investigacions Biomédiques August Pi i Sunyer Barcelona Catalonia Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Instituto de Salud Carlos III Madrid Spain
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9
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Corral Acero J, Schuster A, Zacur E, Lange T, Stiermaier T, Backhaus SJ, Thiele H, Bueno-Orovio A, Lamata P, Eitel I, Grau V. Understanding and Improving Risk Assessment After Myocardial Infarction Using Automated Left Ventricular Shape Analysis. JACC Cardiovasc Imaging 2022; 15:1563-1574. [PMID: 35033494 PMCID: PMC9444994 DOI: 10.1016/j.jcmg.2021.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) and end-systolic volume (ESV) remain the main imaging biomarkers for post-acute myocardial infarction (AMI) risk stratification. However, they are limited to global systolic function and fail to capture functional and anatomical regional abnormalities, hindering their performance in risk stratification. OBJECTIVES This study aimed to identify novel 3-dimensional (3D) imaging end-systolic (ES) shape and contraction descriptors toward risk-related features and superior prognosis in AMI. METHODS A multicenter cohort of AMI survivors (n = 1,021; median age 63 years; 74.5% male) who underwent cardiac magnetic resonance (CMR) at a median of 3 days after infarction were considered for this study. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE; n = 73), consisting of all-cause death, reinfarction, and new congestive heart failure. A fully automated pipeline was developed to segment CMR images, build 3D statistical models of shape and contraction in AMI, and find the 3D patterns related to MACE occurrence. RESULTS The novel ES shape markers proved to be superior to ESV (median cross-validated area under the receiver-operating characteristic curve 0.681 [IQR: 0.679-0.684] vs 0.600 [IQR: 0.598-0.602]; P < 0.001); and 3D contraction to LVEF (0.716 [IQR: 0.714-0.718] vs 0.681 [IQR: 0.679-0.684]; P < 0.001) in MACE occurrence prediction. They also contributed to a significant improvement in a multivariable setting including CMR markers, cardiovascular risk factors, and basic patient characteristics (0.747 [IQR: 0.745-0.749]; P < 0.001). Based on these novel 3D descriptors, 3 impairments caused by AMI were identified: global, anterior, and basal, the latter being the most complementary signature to already known predictors. CONCLUSIONS The quantification of 3D differences in ES shape and contraction, enabled by a fully automated pipeline, improves post-AMI risk prediction and identifies shape and contraction patterns related to MACE occurrence.
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Affiliation(s)
- Jorge Corral Acero
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Göttingen, Germany
| | - Ernesto Zacur
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II, Cardiology, Angiology, and Intensive Care Medicine, Lübeck, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; German Centre for Cardiovascular Research, Lübeck, Germany
| | - Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Centre for Cardiovascular Research, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine and Cardiology, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | | | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II, Cardiology, Angiology, and Intensive Care Medicine, Lübeck, Germany; University Hospital Schleswig-Holstein, Lübeck, Germany; German Centre for Cardiovascular Research, Lübeck, Germany
| | - Vicente Grau
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
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10
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Mîra A, Lamata P, Pushparajah K, Abraham G, Mauger CA, McCulloch AD, Omens JH, Bissell MM, Blair Z, Huffaker T, Tandon A, Engelhardt S, Koehler S, Pickardt T, Beerbaum P, Sarikouch S, Latus H, Greil G, Young AA, Hussain T. Le Cœur en Sabot: shape associations with adverse events in repaired tetralogy of Fallot. J Cardiovasc Magn Reson 2022; 24:46. [PMID: 35922806 PMCID: PMC9351245 DOI: 10.1186/s12968-022-00877-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patterns associated with adverse events in patients with rToF using shape and function analysis. METHODS Biventricular shape and function were studied in 192 patients with rToF (median time from TOF repair to baseline evaluation 13.5 years). Linear discriminant analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events. Adverse events included death, arrhythmias, and cardiac arrest with median follow-up of 10 years. RESULTS LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular left ventricle (LV) (decreased eccentricity), dilated (increased sphericity) LV base, increased right ventricular (RV) apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.77). PRVI did not add value, and shape changes associated with increased PRVI were not predictive of adverse outcomes. CONCLUSION Pathological remodelling patterns in patients with rToF are significantly associated with adverse events, independent of PRVI. Mechanisms related to incident events include LV basal dilation with a reduced RV apical ejection fraction.
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Affiliation(s)
- Anna Mîra
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Pablo Lamata
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Kuberan Pushparajah
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Georgina Abraham
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Charlène A Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Malenka M Bissell
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - Zach Blair
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Huffaker
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Animesh Tandon
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Sandy Engelhardt
- Department of Internal Medicine III, Group Artificial Intelligence in Cardiovascular Medicine, Heidelberg University Hospital, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Sven Koehler
- Department of Internal Medicine III, Group Artificial Intelligence in Cardiovascular Medicine, Heidelberg University Hospital, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Heidelberg/Mannheim, Germany
| | - Thomas Pickardt
- German Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Philipp Beerbaum
- German Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department for Paediatric Cardiology and Paediatric Intensive Care Medicine, University Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- German Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heiner Latus
- Department of Paediatric Cardiology and Congenital Heart Defects, German Heart Centre Munich, Munich, Germany
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alistair A Young
- Department of Biomedical Engineering, King's College London, 1 Lambeth Palace Road, London, SE1 7EU, UK.
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
| | - Tarique Hussain
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Colford K, Price AN, Sigurdardottir J, Fotaki A, Steinweg J, Story L, Ho A, Chappell LC, Hajnal JV, Rutherford M, Pushparajah K, Lamata P, Hutter J. Cardiac and placental imaging (CARP) in pregnancy to assess aetiology of preeclampsia. Placenta 2022; 122:46-55. [PMID: 35430505 PMCID: PMC9810538 DOI: 10.1016/j.placenta.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The CARP study aims to investigate placental function, cardiac function and fetal growth comprehensively during pregnancy, a time of maximal cardiac stress, to work towards disentangling the complex cardiac and placental interactions presenting in the aetiology of pre-eclampsia as well as predicting maternal Cardiovascular Disease (CVD) risk in later life. BACKGROUND The involvement of the cardiovascular system in pre-eclampsia, one of the most serious complications of pregnancy, is evident. While the manifestations of pre-eclampsia during pregnancy (high blood pressure, multi-organ disease, and placental dysfunction) resolve after delivery, a lifelong elevated CVD risk remains. METHOD An assessment including both cardiac and placental Magnetic Resonance Imaging (MRI) optimised for use in pregnancy and bespoke to the expected changes was developed. Simultaneous structural and functional MRI data from the placenta, the heart and the fetus were obtained in a total of 32 pregnant women (gestational ages from 18.1 to 37.5 weeks), including uncomplicated pregnancies and five cases with early onset pre-eclampsia. RESULTS The achieved comprehensive MR acquisition was able to demonstrate a phenotype associated with pre-eclampsia linking both placental and cardiac factors, reduced mean T2* (p < 0.005), increased heterogeneity (p < 0.005) and a trend towards an increase in cardiac work, larger average mass (109.4 vs 93.65 gr), wall thickness (7.0 vs 6.4 mm), blood pool volume (135.7 vs 127.48 mL) and mass to volume ratio (0.82 vs 0.75). The cardiac output in the controls was, controlling for gestational age, positively correlated with placental volume (p < 0.05). DISCUSSION The CARP study constitutes the first joint assessment of functional and structural properties of the cardiac system and the placenta during pregnancy. Early indications of cardiac remodelling in pre-eclampsia were demonstrated paving the way for larger studies.
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Affiliation(s)
- Kathleen Colford
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Anthony N. Price
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Julie Sigurdardottir
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Anastasia Fotaki
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Johannes Steinweg
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Lisa Story
- Academic Women's Health Department, King's College London, London, UK
| | - Alison Ho
- Academic Women's Health Department, King's College London, London, UK
| | - Lucy C. Chappell
- Academic Women's Health Department, King's College London, London, UK
| | - Joseph V. Hajnal
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Mary Rutherford
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK
| | - Kuberan Pushparajah
- Centre for Medical Engineering, King's College London, London, UK,Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom
| | - Pablo Lamata
- Centre for Medical Engineering, King's College London, London, UK
| | - Jana Hutter
- Centre for Medical Engineering, King's College London, London, UK,Centre for the Developing Brain, King's College London, London, UK,Corresponding author. Perinatal Imaging, 1st Floor South Wing, St THomas' Hospital, Westminster Bridge Road, SE17EH, London, UK.
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12
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Nedios S, Iliodromitis K, Kowalewski C, Bollmann A, Hindricks G, Dagres N, Bogossian H. Big Data in electrophysiology. Herzschrittmacherther Elektrophysiol 2022; 33:26-33. [PMID: 35137276 DOI: 10.1007/s00399-022-00837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
The quantity of data produced and captured in medicine today is unprecedented. Technological improvements and automation have expanded the traditional statistical methods and enabled the analysis of Big Data. This has permitted the discovery of new associations with a granularity that was previously hidden to human eyes. In the first part of this review, the authors would like to provide an overview of basic Machine Learning (ML) principles and techniques in order to better understand their application in recent publications about cardiac arrhythmias. In the second part, ML-enabled advances in disease detection and diagnosis, outcome prediction, and novel disease characterization in topics like electrocardiography, atrial fibrillation, ventricular arrhythmias, and cardiac devices are presented. Finally, the limitations and challenges of applying ML in clinical practice, such as validation, replication, generalizability, and regulatory issues, are discussed. More carefully designed studies and collaborations are needed for ML to become feasible, trustworthy, accurate, and reproducible and to reach its full potential for patient-oriented precision medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany.
- Rhythmologie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Konstantinos Iliodromitis
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
| | - Christopher Kowalewski
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Harilaos Bogossian
- Department of Cardiology and Rhythmology, Ev. Krankenhaus Hagen, Hagen, Germany
- Department of Cardiology, University Witten/Herdecke, Witten, Germany
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13
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Roney CH, Sim I, Yu J, Beach M, Mehta A, Alonso Solis-Lemus J, Kotadia I, Whitaker J, Corrado C, Razeghi O, Vigmond E, Narayan SM, O’Neill M, Williams SE, Niederer SA. Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models. Circ Arrhythm Electrophysiol 2022; 15:e010253. [PMID: 35089057 PMCID: PMC8845531 DOI: 10.1161/circep.121.010253] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. METHODS Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. RESULTS We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). CONCLUSION A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation.
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Affiliation(s)
- Caroline H. Roney
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- School of Engineering and Materials Science, Queen Mary University of London, United Kingdom (C.H.R.)
| | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jin Yu
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Marianne Beach
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Arihant Mehta
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Jose Alonso Solis-Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- The Department of Internal Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (J.W.)
| | - Cesare Corrado
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Orod Razeghi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, France (E.V.)
- Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France (E.V.)
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA (S.M.N.)
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
- Centre for Cardiovascular Science, College of Medicine and Veterinary Medicine, University of Edinburgh (S.E.W.)
| | - Steven A. Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (C.H.R., I.S., J.Y., M.B., A.M., J.A.S.-L., I.K., J.W., C.C., O.R., M.O., S.E.W., S.A.N.)
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14
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Uslu F, Varela M, Boniface G, Mahenthran T, Chubb H, Bharath AA. LA-Net: A Multi-Task Deep Network for the Segmentation of the Left Atrium. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:456-464. [PMID: 34606450 DOI: 10.1109/tmi.2021.3117495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although atrial fibrillation (AF) is the most common sustained atrial arrhythmia, treatment success for this condition remains suboptimal. Information from magnetic resonance imaging (MRI) has the potential to improve treatment efficacy, but there are currently few automatic tools for the segmentation of the atria in MR images. In the study, we propose a LA-Net, a multi-task network optimised to simultaneously generate left atrial segmentation and edge masks from MRI. LA-Net includes cross attention modules (CAMs) and enhanced decoder modules (EDMs) to purposefully select the most meaningful edge information for segmentation and smoothly incorporate it into segmentation masks at multiple-scales. We evaluate the performance of LA-Net on two MR sequences: late gadolinium enhanced (LGE) atrial MRI and atrial short axis balanced steady state free precession (bSSFP) MRI. LA-Net gives Hausdorff distances of 12.43 mm and Dice scores of 0.92 on the LGE (STACOM 2018) dataset and Hausdorff distances of 17.41 mm and Dice scores of 0.90 on the bSSFP (in-house) dataset without any post-processing, surpassing previously proposed segmentation networks, including U-Net and SEGANet. Our method allows automatic extraction of information about the LA from MR images, which can play an important role in the management of AF patients.
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15
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Jia S, Nivet H, Harrison J, Pennec X, Camaioni C, Jaïs P, Cochet H, Sermesant M. Left atrial shape is independent predictor of arrhythmia recurrence after catheter ablation for atrial fibrillation: A shape statistics study. Heart Rhythm O2 2022; 2:622-632. [PMID: 34988507 PMCID: PMC8703187 DOI: 10.1016/j.hroo.2021.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Markers of left atrial (LA) shape may improve the prediction of postablation outcomes in atrial fibrillation (AF). Correlations to LA volume and AF persistence limit their incremental value over current clinical predictors. Objective To develop a shape score independent from AF persistence and LA volume using shape-based statistics, and to test its ability to predict postablation outcome. Methods Preablation computed tomography (CT) images from 141 patients with paroxysmal (57%) or persistent (43%) AF were segmented. Deformation of an average LA shape into each patient encoded patient-specific shape. Local analysis investigates regional differences between patient groups. Linear regression was used to remove shape variations related to LA volume and AF persistence, and to build a shape score to predict postablation outcome. Cross-validation was performed to evaluate its accuracy. Results Ablation failure rate was 23% over a median 12-month follow-up. Regions associated with ablation failure mostly consisted of a large area on posteroinferior LA, mitral isthmus, and left inferior vein. On univariate analysis, strongest predictors were AF persistence (P = .005), LA indexed volume (P = .02), and the proposed shape score (P = .001). On multivariate analysis, all 3 were independent predictors of ablation failure, with the LA shape score showing the highest predictive value (odds ratio [OR] = 6.2 [2.5–15.8], P < .001), followed by LA indexed volume (OR = 3.1 [1.2–7.9], P = .019) and AF persistence (OR = 2.9 [1.2–7.6], P = .022). Conclusion Posteroinferior LA, mitral isthmus, and left inferior vein are the regions whose shape have the highest impact on outcome. LA shape predicts AF ablation failure independently from, and more accurately than, atrial volume and AF persistence.
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Affiliation(s)
- Shuman Jia
- Team Epione, Inria Sophia Antipolis, Sophia Antipolis, France.,IHU Liryc, Pessac, France
| | - Hubert Nivet
- CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | | | - Xavier Pennec
- Team Epione, Inria Sophia Antipolis, Sophia Antipolis, France
| | | | - Pierre Jaïs
- CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France.,IHU Liryc, Pessac, France
| | - Hubert Cochet
- CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France.,IHU Liryc, Pessac, France
| | - Maxime Sermesant
- Team Epione, Inria Sophia Antipolis, Sophia Antipolis, France.,IHU Liryc, Pessac, France
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16
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Roney CH, Sillett C, Whitaker J, Lemus JAS, Sim I, Kotadia I, O'Neill M, Williams SE, Niederer SA. Applications of multimodality imaging for left atrial catheter ablation. Eur Heart J Cardiovasc Imaging 2021; 23:31-41. [PMID: 34747450 PMCID: PMC8685603 DOI: 10.1093/ehjci/jeab205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which includes patient selection, pre-procedural planning, intra-procedural guidance, and post-procedural assessment, is typically characterized by the use of several imaging modalities to sequentially inform key clinical decisions. Increasingly, advanced imaging modalities are processed via specialized image analysis techniques and combined with intra-procedural electrical measurements to inform treatment approaches. Here, we review the use of multimodality imaging for left atrial ablation procedures. The article first outlines how imaging modalities are routinely used in the peri-ablation period. We then describe how advanced imaging techniques may inform patient selection for ablation and ablation targets themselves. Ongoing research directions for improving catheter ablation outcomes by using imaging combined with advanced analyses for personalization of ablation targets are discussed, together with approaches for their integration in the standard clinical environment. Finally, we describe future research areas with the potential to improve catheter ablation outcomes.
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Affiliation(s)
- Caroline H Roney
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Charles Sillett
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Iain Sim
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Irum Kotadia
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Scotland, UK
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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17
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Labarbera MA, Atta-Fosu T, Feeny AK, Firouznia M, Mchale M, Cantlay C, Roach T, Axtell A, Schoenhagen P, Barnard J, Smith JD, Van Wagoner DR, Madabhushi A, Chung MK. New Radiomic Markers of Pulmonary Vein Morphology Associated With Post-Ablation Recurrence of Atrial Fibrillation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 10:1800209. [PMID: 34976444 PMCID: PMC8716081 DOI: 10.1109/jtehm.2021.3134160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Objective: To identify radiomic and clinical features associated with post-ablation recurrence of AF, given that cardiac morphologic changes are associated with persistent atrial fibrillation (AF), and initiating triggers of AF often arise from the pulmonary veins which are targeted in ablation. Methods: Subjects with pre-ablation contrast CT scans prior to first-time catheter ablation for AF between 2014-2016 were retrospectively identified. A training dataset (D1) was constructed from left atrial and pulmonary vein morphometric features extracted from equal numbers of consecutively included subjects with and without AF recurrence determined at 1 year. The top-performing combination of feature selection and classifier methods based on C-statistic was evaluated on a validation dataset (D2), composed of subjects retrospectively identified between 2005-2010. Clinical models ([Formula: see text]) were similarly evaluated and compared to radiomic ([Formula: see text]) and radiomic-clinical models ([Formula: see text]), each independently validated on D2. Results: Of 150 subjects in D1, 108 received radiofrequency ablation and 42 received cryoballoon. Radiomic features of recurrence included greater right carina angle, reduced anterior-posterior atrial diameter, greater atrial volume normalized to height, and steeper right inferior pulmonary vein angle. Clinical features predicting recurrence included older age, greater BMI, hypertension, and warfarin use; apixaban use was associated with reduced recurrence. AF recurrence was predicted with radio-frequency ablation models on D2 subjects with C-statistics of 0.68, 0.63, and 0.70 for radiomic, clinical, and combined feature models, though these were not prognostic in patients treated with cryoballoon. Conclusions: Pulmonary vein morphology associated with increased likelihood of AF recurrence within 1 year of catheter ablation was identified on cardiac CT. Significance: Radiomic and clinical features-based predictive models may assist in identifying atrial fibrillation ablation candidates with greatest likelihood of successful outcome.
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Affiliation(s)
- Michael A. Labarbera
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Thomas Atta-Fosu
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Albert K. Feeny
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Marjan Firouznia
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Meghan Mchale
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Catherine Cantlay
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Tyler Roach
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Alexis Axtell
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
| | - John Barnard
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Jonathan D. Smith
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - David R. Van Wagoner
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Anant Madabhushi
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
- Louis Stokes Cleveland Veterans Administration Medical CenterClevelandOH44106USA
| | - Mina K. Chung
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
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18
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Lamata P. Unleashing the prognostic value of atrial shape in atrial fibrillation. Heart Rhythm O2 2021; 2:633-634. [PMID: 34988508 PMCID: PMC8703176 DOI: 10.1016/j.hroo.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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19
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Guo F, Li C, Yang L, Chen C, Chen Y, Ni J, Fu R, Jiao Y, Meng Y. Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation. J Cardiovasc Med (Hagerstown) 2021; 22:909-916. [PMID: 34506349 DOI: 10.2459/jcm.0000000000001255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. METHODS A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. RESULTS After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. CONCLUSION The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.
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Affiliation(s)
- Fuqian Guo
- Department of Medical Imaging, The Second Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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20
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Romero P, Lozano M, Martínez-Gil F, Serra D, Sebastián R, Lamata P, García-Fernández I. Clinically-Driven Virtual Patient Cohorts Generation: An Application to Aorta. Front Physiol 2021; 12:713118. [PMID: 34539438 PMCID: PMC8440937 DOI: 10.3389/fphys.2021.713118] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022] Open
Abstract
The combination of machine learning methods together with computational modeling and simulation of the cardiovascular system brings the possibility of obtaining very valuable information about new therapies or clinical devices through in-silico experiments. However, the application of machine learning methods demands access to large cohorts of patients. As an alternative to medical data acquisition and processing, which often requires some degree of manual intervention, the generation of virtual cohorts made of synthetic patients can be automated. However, the generation of a synthetic sample can still be computationally demanding to guarantee that it is clinically meaningful and that it reflects enough inter-patient variability. This paper addresses the problem of generating virtual patient cohorts of thoracic aorta geometries that can be used for in-silico trials. In particular, we focus on the problem of generating a cohort of patients that meet a particular clinical criterion, regardless the access to a reference sample of that phenotype. We formalize the problem of clinically-driven sampling and assess several sampling strategies with two goals, sampling efficiency, i.e., that the generated individuals actually belong to the target population, and that the statistical properties of the cohort can be controlled. Our results show that generative adversarial networks can produce reliable, clinically-driven cohorts of thoracic aortas with good efficiency. Moreover, non-linear predictors can serve as an efficient alternative to the sometimes expensive evaluation of anatomical or functional parameters of the organ of interest.
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Affiliation(s)
- Pau Romero
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Miguel Lozano
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Francisco Martínez-Gil
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Dolors Serra
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Rafael Sebastián
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Pablo Lamata
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Ignacio García-Fernández
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
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21
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A bi-atrial statistical shape model for large-scale in silico studies of human atria: Model development and application to ECG simulations. Med Image Anal 2021; 74:102210. [PMID: 34450467 DOI: 10.1016/j.media.2021.102210] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/29/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Large-scale electrophysiological simulations to obtain electrocardiograms (ECG) carry the potential to produce extensive datasets for training of machine learning classifiers to, e.g., discriminate between different cardiac pathologies. The adoption of simulations for these purposes is limited due to a lack of ready-to-use models covering atrial anatomical variability. We built a bi-atrial statistical shape model (SSM) of the endocardial wall based on 47 segmented human CT and MRI datasets using Gaussian process morphable models. Generalization, specificity, and compactness metrics were evaluated. The SSM was applied to simulate atrial ECGs in 100 random volumetric instances. The first eigenmode of our SSM reflects a change of the total volume of both atria, the second the asymmetry between left vs. right atrial volume, the third a change in the prominence of the atrial appendages. The SSM is capable of generalizing well to unseen geometries and 95% of the total shape variance is covered by its first 24 eigenvectors. The P waves in the 12-lead ECG of 100 random instances showed a duration of 109.7±12.2 ms in accordance with large cohort studies. The novel bi-atrial SSM itself as well as 100 exemplary instances with rule-based augmentation of atrial wall thickness, fiber orientation, inter-atrial bridges and tags for anatomical structures have been made publicly available. This novel, openly available bi-atrial SSM can in future be employed to generate large sets of realistic atrial geometries as a basis for in silico big data approaches.
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22
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Personalized Evaluation of Atrial Complexity of Patients Undergoing Atrial Fibrillation Ablation: A Clinical Computational Study. BIOLOGY 2021; 10:biology10090838. [PMID: 34571716 PMCID: PMC8469429 DOI: 10.3390/biology10090838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Atrial fibrillation is a type of arrhythmia that occurs when the electrical activity of the heart in the atrium is not coordinated, and its consequences can be lethal. The driving source that initiates this chaotic activity can be located anywhere in the atrium, but most frequently appears in certain areas such as the pulmonary veins. In this study, we developed a new estimation method to evaluate possible source location and complexity of the arrhythmia using computer simulations. This method represents mathematical descriptions of natural processes that can be used to mimic a real scenario, including specific information such as the atrial anatomy. Here, we identified a specific biomarker the enabled obtaining a foci distribution map and found that elimination of pulmonary vein drivers was associated with a successful long-term ablation outcome. This study could, therefore, help to identify and characterize patients in order to better plan the ablation procedure. Abstract Current clinical guidelines establish Pulmonary Vein (PV) isolation as the indicated treatment for Atrial Fibrillation (AF). However, AF can also be triggered or sustained due to atrial drivers located elsewhere in the atria. We designed a new simulation workflow based on personalized computer simulations to characterize AF complexity of patients undergoing PV ablation, validated with non-invasive electrocardiographic imaging and evaluated at one year after ablation. We included 30 patients using atrial anatomies segmented from MRI and simulated an automata model for the electrical modelling, consisting of three states (resting, excited and refractory). In total, 100 different scenarios were simulated per anatomy varying rotor number and location. The 3 states were calibrated with Koivumaki action potential, entropy maps were obtained from the electrograms and compared with ECGi for each patient to analyze PV isolation outcome. The completion of the workflow indicated that successful AF ablation occurred in patients with rotors mainly located at the PV antrum, while unsuccessful procedures presented greater number of driving sites outside the PV area. The number of rotors attached to the PV was significantly higher in patients with favorable long-term ablation outcome (1-year freedom from AF: 1.61 ± 0.21 vs. AF recurrence: 1.40 ± 0.20; p-value = 0.018). The presented workflow could improve patient stratification for PV ablation by screening the complexity of the atria.
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23
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The Role of Artificial Intelligence and Machine Learning in Clinical Cardiac Electrophysiology. Can J Cardiol 2021; 38:246-258. [PMID: 34333029 DOI: 10.1016/j.cjca.2021.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/11/2021] [Accepted: 07/25/2021] [Indexed: 11/21/2022] Open
Abstract
In recent years, artificial intelligence (AI) has found numerous applications in cardiology due in part to large digitized datasets and the evolution of high performance computing. In the discipline of cardiac electrophysiology (EP), a number of clinical, imaging, and electrical waveform data are considered in the diagnosis, prognostication and management of arrhythmias, which lend themselves well to automation through AI. But equally relevant, AI offers a unique opportunity to discover novel EP concepts and improve clinical care through its inherent, hierarchical tenets of self-learning. This review will focus on the application of AI in clinical EP and summarize state-of-the art, large, clinical studies in the following key domains: (1) ECG-based arrhythmia and disease classification, (2) atrial fibrillation source detection, (3) substrate and risk assessment for atrial fibrillation and ventricular tachyarrhythmias, and (4) predicting outcomes after cardiac resynchronization therapy. Many are small, single-center, proof-of-concept investigations, but they still demonstrate groundbreaking performance of deep learning, a subdomain of AI, which surpasses traditional statistical analysis. Larger studies, for instance classifying arrhythmias from ECG recordings, have further provided external validation of their high accuracy. Ultimately, the performance of AI is dependent on the quality of the input data and the rigor of algorithm development. The field is still nascent and several barriers will need to be overcome, including prospective validation in large, well-labelled datasets and more seamless information technology-based data collection/integration, before AI can be adopted into broader clinical EP practice. This review will conclude with a discussion of these challenges and future work.
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24
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Nedios S, Lindemann F, Heijman J, Crijns HJGM, Bollmann A, Hindricks G. Atrial remodeling and atrial fibrillation recurrence after catheter ablation : Past, present, and future developments. Herz 2021; 46:312-317. [PMID: 34223914 DOI: 10.1007/s00059-021-05050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/30/2022]
Abstract
The term "atrial remodeling" is used to describe the electrical, mechanical, and structural changes associated with the presence of an arrhythmogenic substrate for atrial fibrillation. Rhythm control therapy may slow down or even reverse progressive atrial remodeling. Atrial remodeling has long been recognized as an important predictor of clinical outcomes and therapeutic success, but recent advances have highlighted its clinical relevance and revealed the implications of specific anatomical changes such as atrial asymmetry or shape. This has opened the path to computational precision medicine that captures these data in detail and combines them with other factors, to provide patient-specific solutions. The goal of precision medicine lies in improving clinical outcomes, reducing costs, and avoiding unnecessary procedures. In this article, we review the history of atrial remodeling and we summarize the insights from our research on anatomical atrial remodeling and its association with rhythm outcomes after catheter ablation. Finally, we present recent advances in the field, reflecting the beginning of a new technological era that will enable us to improve patient care by personalized patient-specific medicine.
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Affiliation(s)
- Sotirios Nedios
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
| | - Frank Lindemann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Jordi Heijman
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, CardiovascularResearch Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
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25
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Heijman J, Sutanto H, Crijns HJGM, Nattel S, Trayanova NA. Computational models of atrial fibrillation: achievements, challenges, and perspectives for improving clinical care. Cardiovasc Res 2021; 117:1682-1699. [PMID: 33890620 PMCID: PMC8208751 DOI: 10.1093/cvr/cvab138] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Indexed: 12/11/2022] Open
Abstract
Despite significant advances in its detection, understanding and management, atrial fibrillation (AF) remains a highly prevalent cardiac arrhythmia with a major impact on morbidity and mortality of millions of patients. AF results from complex, dynamic interactions between risk factors and comorbidities that induce diverse atrial remodelling processes. Atrial remodelling increases AF vulnerability and persistence, while promoting disease progression. The variability in presentation and wide range of mechanisms involved in initiation, maintenance and progression of AF, as well as its associated adverse outcomes, make the early identification of causal factors modifiable with therapeutic interventions challenging, likely contributing to suboptimal efficacy of current AF management. Computational modelling facilitates the multilevel integration of multiple datasets and offers new opportunities for mechanistic understanding, risk prediction and personalized therapy. Mathematical simulations of cardiac electrophysiology have been around for 60 years and are being increasingly used to improve our understanding of AF mechanisms and guide AF therapy. This narrative review focuses on the emerging and future applications of computational modelling in AF management. We summarize clinical challenges that may benefit from computational modelling, provide an overview of the different in silico approaches that are available together with their notable achievements, and discuss the major limitations that hinder the routine clinical application of these approaches. Finally, future perspectives are addressed. With the rapid progress in electronic technologies including computing, clinical applications of computational modelling are advancing rapidly. We expect that their application will progressively increase in prominence, especially if their added value can be demonstrated in clinical trials.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Henry Sutanto
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Duisburg, Germany
- IHU Liryc and Fondation Bordeaux Université, Bordeaux, France
| | - Natalia A Trayanova
- Alliance for Cardiovascular Diagnostic and Treatment Innovation, and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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26
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Rodero C, Strocchi M, Marciniak M, Longobardi S, Whitaker J, O’Neill MD, Gillette K, Augustin C, Plank G, Vigmond EJ, Lamata P, Niederer SA. Linking statistical shape models and simulated function in the healthy adult human heart. PLoS Comput Biol 2021; 17:e1008851. [PMID: 33857152 PMCID: PMC8049237 DOI: 10.1371/journal.pcbi.1008851] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/03/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiac anatomy plays a crucial role in determining cardiac function. However, there is a poor understanding of how specific and localised anatomical changes affect different cardiac functional outputs. In this work, we test the hypothesis that in a statistical shape model (SSM), the modes that are most relevant for describing anatomy are also most important for determining the output of cardiac electromechanics simulations. We made patient-specific four-chamber heart meshes (n = 20) from cardiac CT images in asymptomatic subjects and created a SSM from 19 cases. Nine modes captured 90% of the anatomical variation in the SSM. Functional simulation outputs correlated best with modes 2, 3 and 9 on average (R = 0.49 ± 0.17, 0.37 ± 0.23 and 0.34 ± 0.17 respectively). We performed a global sensitivity analysis to identify the different modes responsible for different simulated electrical and mechanical measures of cardiac function. Modes 2 and 9 were the most important for determining simulated left ventricular mechanics and pressure-derived phenotypes. Mode 2 explained 28.56 ± 16.48% and 25.5 ± 20.85, and mode 9 explained 12.1 ± 8.74% and 13.54 ± 16.91% of the variances of mechanics and pressure-derived phenotypes, respectively. Electrophysiological biomarkers were explained by the interaction of 3 ± 1 modes. In the healthy adult human heart, shape modes that explain large portions of anatomical variance do not explain equivalent levels of electromechanical functional variation. As a result, in cardiac models, representing patient anatomy using a limited number of modes of anatomical variation can cause a loss in accuracy of simulated electromechanical function.
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Affiliation(s)
- Cristobal Rodero
- Cardiac Electromechanics Research Group, Biomedical Engineering Department, King´s College London, London, United Kingdom
- Cardiac Modelling and Imaging Biomarkers, Biomedical Engineering Department, King´s College London, London, United Kingdom
- * E-mail:
| | - Marina Strocchi
- Cardiac Electromechanics Research Group, Biomedical Engineering Department, King´s College London, London, United Kingdom
| | - Maciej Marciniak
- Cardiac Modelling and Imaging Biomarkers, Biomedical Engineering Department, King´s College London, London, United Kingdom
| | - Stefano Longobardi
- Cardiac Electromechanics Research Group, Biomedical Engineering Department, King´s College London, London, United Kingdom
| | - John Whitaker
- Cardiovascular Imaging Department, King’s College London, London, United Kingdom
| | - Mark D. O’Neill
- Department of Cardiology, St Thomas’ Hospital, London, United Kingdom
| | - Karli Gillette
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Gernot Plank
- Institute of Biophysics, Medical University of Graz, Graz, Austria
| | - Edward J. Vigmond
- Institute of Electrophysiology and Heart Modeling, Foundation Bordeaux University, Bordeaux, France
- Bordeaux Institute of Mathematics, University of Bordeaux, Bordeaux, France
| | - Pablo Lamata
- Cardiac Modelling and Imaging Biomarkers, Biomedical Engineering Department, King´s College London, London, United Kingdom
| | - Steven A. Niederer
- Cardiac Electromechanics Research Group, Biomedical Engineering Department, King´s College London, London, United Kingdom
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27
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Vella D, Monteleone A, Musotto G, Bosi GM, Burriesci G. Effect of the Alterations in Contractility and Morphology Produced by Atrial Fibrillation on the Thrombosis Potential of the Left Atrial Appendage. Front Bioeng Biotechnol 2021; 9:586041. [PMID: 33718333 PMCID: PMC7952649 DOI: 10.3389/fbioe.2021.586041] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia mainly affecting the elderly population, which can lead to serious complications such as stroke, ischaemic attack and vascular dementia. These problems are caused by thrombi which mostly originate in the left atrial appendage (LAA), a small muscular sac protruding from left atrium. The abnormal heart rhythm associated with AF results in alterations in the heart muscle contractions and in some reshaping of the cardiac chambers. This study aims to verify if and how these physiological changes can establish hemodynamic conditions in the LAA promoting thrombus formation, by means of computational fluid dynamic (CFD) analyses. In particular, sinus and fibrillation contractility was replicated by applying wall velocity/motion to models based on healthy and dilated idealized shapes of the left atrium with a common LAA morphology. The models were analyzed and compared in terms of shear strain rate (SSR) and vorticity, which are hemodynamic parameters directly associated with thrombogenicity. The study clearly indicates that the alterations in contractility and morphology associated with AF pathologies play a primary role in establishing hemodynamic conditions which promote higher incidence of ischaemic events, consistently with the clinical evidence. In particular, in the analyzed models, the impairment in contractility determined a decrease in SSR of about 50%, whilst the chamber pathological dilatation contributed to a 30% reduction, indicating increased risk of clot formation. The equivalent rigid wall model was characterized by SSR values about one order of magnitude smaller than in the contractile models, and substantially different vortical behavior, suggesting that analyses based on rigid chambers, although common in the literature, are inadequate to provide realistic results on the LAA hemodynamics.
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Affiliation(s)
- Danila Vella
- Bioengineering Unit, Ri. MED Foundation, Palermo, Italy
| | | | - Giulio Musotto
- Bioengineering Unit, Ri. MED Foundation, Palermo, Italy.,Department of Mechanical Engineering, University of Palermo, Palermo, Italy
| | - Giorgia Maria Bosi
- UCL Mechanical Engineering, University College London, London, United Kingdom
| | - Gaetano Burriesci
- Bioengineering Unit, Ri. MED Foundation, Palermo, Italy.,UCL Mechanical Engineering, University College London, London, United Kingdom
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28
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Nedios S, Sanatkhani S, Oladosu M, Seewöster T, Richter S, Arya A, Heijman J, J G M Crijns H, Hindricks G, Bollmann A, Menon PG. Association of low-voltage areas with the regional wall deformation and the left atrial shape in patients with atrial fibrillation: A proof of concept study. IJC HEART & VASCULATURE 2021; 33:100730. [PMID: 33718586 PMCID: PMC7933256 DOI: 10.1016/j.ijcha.2021.100730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/03/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
Background Left atrium (LA) remodeling is associated with atrial fibrillation (AF) and reduced success after AF ablation, but its relation with low-voltage areas (LVA) is not known. This study aimed to evaluate the relation between regional LA changes and LVAs in AF patients. Methods Pre-interventional CT data of patients (n = 24) with LA-LVA (<0.5 mV) in voltage mapping after AF ablation were analyzed (Surgery Explorer, QuantMD LLC). To quantify asymmetry (ASI = LA-A/LAV) a cutting plane parallel to the rear wall and along the pulmonary veins divided the LA-volume (LAV) into anterior (LA-A) and posterior parts. To quantify sphericity (LAS = 1-R/S), a patient-specific best-fit LA sphere was created. The average radius (R) and the mean deviation (S) from this sphere were calculated. The average local deviation (D) was measured for the roof, posterior, septum, inferior septum, inferior-posterior and lateral walls. Results The roof, posterior and septal regions had negative local deviations. There was a correlation between roof and septum (r = 0.42, p = 0.04), lateral and inferior-posterior (r = 0.48, p = 0.02) as well as posterior and inferior-septal deviations (r = −0.41, p = 0.046). ASI correlated with septum deformation (r = −0.43, p = 0.04). LAS correlated with dilatation (LAV, r = 0.49, p = 0.02), roof (r = 0.52, p = 0.009) and posterior deformation (r = −0.56, p = 0.005). Extended LVA correlated with local deformation of all LA walls, except the roof and the septum. LVA association with LAV, ASI and LAS did not reach statistical significance. Conclusion Extended LVA correlates with local wall deformations better than other remodeling surrogates. Therefore, their calculation could help predict LVA presence and deserve further evaluation in clinical studies.
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Key Words
- AF, atrial fibrillation
- AR, average radius
- ASI, asymmetry index
- Atrial fibrillation
- Atrial remodeling
- CA, catheter ablation
- CT, computed tomography
- Computer tomography
- IQR, inter-quartile range
- LA, left atrium
- LA-A, left atrial anterior (LA-A) partial volume
- LA-P, left atrial posterior (LA-P) partial volume
- LAA, left atrial appendage
- LAV, left atrial volume with anterior (LA-A) and posterior (LA-P) partial volumes
- LV, left ventricle
- LV-EF, left ventricular ejection fraction
- LVA, low-voltage area
- LVDD, left ventricular diastolic dysfunction
- MRI, magnetic resonance imaging
- PVI, pulmonary vein isolation
- S, mean deviation
- SD, standard deviation
- Sphericity
- Voltage mapping
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Affiliation(s)
- Sotirios Nedios
- Heart Center, University of Leipzig, Germany.,Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA.,Department of Cardiology and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands
| | | | | | | | | | - Arash Arya
- Heart Center, University of Leipzig, Germany
| | - Jordi Heijman
- Department of Cardiology and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands
| | | | | | - Prahlad G Menon
- University of Pittsburgh, Pittsburgh, PA, USA.,Duquesne University, Pittsburgh, PA, USA.,QuantMD LLC, Pittsburgh, PA, USA
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Abstract
Machine learning (ML), a branch of artificial intelligence, where machines learn from big data, is at the crest of a technological wave of change sweeping society. Cardiovascular medicine is at the forefront of many ML applications, and there is a significant effort to bring them into mainstream clinical practice. In the field of cardiac electrophysiology, ML applications have also seen a rapid growth and popularity, particularly the use of ML in the automatic interpretation of ECGs, which has been extensively covered in the literature. Much lesser known are the other aspects of ML application in cardiac electrophysiology and arrhythmias, such as those in basic science research on arrhythmia mechanisms, both experimental and computational; in the development of better techniques for mapping of cardiac electrical function; and in translational research related to arrhythmia management. In the current review, we examine comprehensively such ML applications as they match the scope of this journal. The current review is organized in 3 parts. The first provides an overview of general ML principles and methodologies that will afford readers of the necessary information on the subject, serving as the foundation for inviting further ML applications in arrhythmia research. The basic information we provide can serve as a guide on how one might design and conduct an ML study. The second part is a review of arrhythmia and electrophysiology studies in which ML has been utilized, highlighting the broad potential of ML approaches. For each subject, we outline comprehensively the general topics, while reviewing some of the research advances utilizing ML under the subject. Finally, we discuss the main challenges and the perspectives for ML-driven cardiac electrophysiology and arrhythmia research.
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Affiliation(s)
- Natalia A. Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
- Alliance for Cardiovascular Diagnosis and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD, USA 21205
| | - Dan M. Popescu
- Alliance for Cardiovascular Diagnosis and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
- Department of Applied Mathematics and Statistics, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
| | - Julie K. Shade
- Department of Biomedical Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
- Alliance for Cardiovascular Diagnosis and Treatment Innovation, Whiting School of Engineering and School of Medicine, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, USA 21218
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30
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Firouznia M, Feeny AK, LaBarbera MA, McHale M, Cantlay C, Kalfas N, Schoenhagen P, Saliba W, Tchou P, Barnard J, Chung MK, Madabhushi A. Machine Learning-Derived Fractal Features of Shape and Texture of the Left Atrium and Pulmonary Veins From Cardiac Computed Tomography Scans Are Associated With Risk of Recurrence of Atrial Fibrillation Postablation. Circ Arrhythm Electrophysiol 2021; 14:e009265. [PMID: 33576688 DOI: 10.1161/circep.120.009265] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Marjan Firouznia
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University
| | - Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Michael A LaBarbera
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University
| | - Meghan McHale
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Catherine Cantlay
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Natalie Kalfas
- Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic
| | - Paul Schoenhagen
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.).,Imaging Institute (P.S.), Diagnostic Radiology, Cleveland Clinic
| | - Walid Saliba
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Patrick Tchou
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - John Barnard
- Quantitative Health Sciences, Lerner Research Institute (J.B.), Diagnostic Radiology, Cleveland Clinic
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L., P.S., M.K.C.), Case Western Reserve University.,Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute (M.M., P.S., W.S., P.T., M.K.C.)
| | - Anant Madabhushi
- Department of Biomedical Engineering (M.F., A.M.), Case Western Reserve University.,Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.M., C.C., N.K., M.K.C.), Diagnostic Radiology, Cleveland Clinic.,Louis Stokes Cleveland Veterans Administration Medical Center, OH (A.M.)
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31
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Marta Varela, Roy A, Lee J. A survey of pathways for mechano-electric coupling in the atria. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2020; 159:136-145. [PMID: 33053408 PMCID: PMC7848589 DOI: 10.1016/j.pbiomolbio.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Abstract
Mechano-electric coupling (MEC) in atrial tissue has received sparse investigation to date, despite the well-known association between chronic atrial dilation and atrial fibrillation (AF). Of note, no fewer than six different mechanisms pertaining to stretch-activated channels, cellular capacitance and geometric effects have been identified in the literature as potential players. In this mini review, we briefly survey each of these pathways to MEC. We then perform computational simulations using single cell and tissue models in presence of various stretch regimes and MEC pathways. This allows us to assess the relative significance of each pathway in determining action potential duration, conduction velocity and rotor stability. For chronic atrial stretch, we find that stretch-induced alterations in membrane capacitance decrease conduction velocity and increase action potential duration, in agreement with experimental findings. In the presence of time-dependent passive atrial stretch, stretch-activated channels play the largest role, leading to after-depolarizations and rotor hypermeandering. These findings suggest that physiological atrial stretches, such as passive stretch during the atrial reservoir phase, may play an important part in the mechanisms of atrial arrhythmogenesis. Passive strains caused by ventricular contraction need to be considered when incorporating mechano-electro feedback in atrial electrophysiology models. In chronic stretch, stretch-induced capacitance changes dominate. Chronic stretch leads to an increase in action potential duration and a reduction in conduction velocity, consistent with experimental studies. In the presence of passive stretch, stretch-activated channels can induce delayed after-depolarisations and lead to rotor hypermeandering. Mechano-electro feedback is thus likely to have implications for the genesis and maintenance of atrial arrhythmias.
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Affiliation(s)
- Marta Varela
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Aditi Roy
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Department of Computing, University of Oxford, Oxford, UK
| | - Jack Lee
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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32
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Feeny AK, Chung MK, Madabhushi A, Attia ZI, Cikes M, Firouznia M, Friedman PA, Kalscheur MM, Kapa S, Narayan SM, Noseworthy PA, Passman RS, Perez MV, Peters NS, Piccini JP, Tarakji KG, Thomas SA, Trayanova NA, Turakhia MP, Wang PJ. Artificial Intelligence and Machine Learning in Arrhythmias and Cardiac Electrophysiology. Circ Arrhythm Electrophysiol 2020; 13:e007952. [PMID: 32628863 PMCID: PMC7808396 DOI: 10.1161/circep.119.007952] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) and machine learning (ML) in medicine are currently areas of intense exploration, showing potential to automate human tasks and even perform tasks beyond human capabilities. Literacy and understanding of AI/ML methods are becoming increasingly important to researchers and clinicians. The first objective of this review is to provide the novice reader with literacy of AI/ML methods and provide a foundation for how one might conduct an ML study. We provide a technical overview of some of the most commonly used terms, techniques, and challenges in AI/ML studies, with reference to recent studies in cardiac electrophysiology to illustrate key points. The second objective of this review is to use examples from recent literature to discuss how AI and ML are changing clinical practice and research in cardiac electrophysiology, with emphasis on disease detection and diagnosis, prediction of patient outcomes, and novel characterization of disease. The final objective is to highlight important considerations and challenges for appropriate validation, adoption, and deployment of AI technologies into clinical practice.
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Affiliation(s)
- Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.K.C.), Case Western Reserve University, OH
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.K.C.), Case Western Reserve University, OH
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.K.C., K.G.T., S.A.T.)
| | - Anant Madabhushi
- Department of Biomedical Engineering (A.M., M.F.), Case Western Reserve University, OH
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH (A.M.)
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (Z.I.A., P.A.F., S.K., P.A.N., )
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine & University Hospital Center Zagreb, Croatia (M.C.)
| | - Marjan Firouznia
- Department of Biomedical Engineering (A.M., M.F.), Case Western Reserve University, OH
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (Z.I.A., P.A.F., S.K., P.A.N., )
| | - Matthew M Kalscheur
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine & Public Health, University of Wisconsin (M.M.K.)
- William S. Middleton Veterans Hospital, Madison, WI (M.M.K.)
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (Z.I.A., P.A.F., S.K., P.A.N., )
| | - Sanjiv M Narayan
- Division of Cardiovascular Medicine, Stanford University, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
- Veterans Affairs Palo Alto Health Care System, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN (Z.I.A., P.A.F., S.K., P.A.N., )
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (R.S.P.)
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
- Veterans Affairs Palo Alto Health Care System, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
| | - Nicholas S Peters
- National Heart Lung Institute & Centre for Cardiac Engineering, Imperial College London, United Kingdom (N.S.P.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (J.P.P.)
| | - Khaldoun G Tarakji
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.K.C., K.G.T., S.A.T.)
| | - Suma A Thomas
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.K.C., K.G.T., S.A.T.)
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD (N.A.T.)
| | - Mintu P Turakhia
- Division of Cardiovascular Medicine, Stanford University, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
- Veterans Affairs Palo Alto Health Care System, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
- Center for Digital Health, Stanford University School of Medicine, CA (M.P.T.)
| | - Paul J Wang
- Division of Cardiovascular Medicine, Stanford University, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
- Veterans Affairs Palo Alto Health Care System, CA (S.M.N., M.V.P., M.P.T., P.J.W.)
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33
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Abstract
Atrial anisotropy affects electrical propagation patterns, anchor locations of atrial reentrant drivers, and atrial mechanics. However, patient-specific atrial fibre fields and anisotropy measurements are not currently available, and consequently assigning fibre fields to atrial models is challenging. We aimed to construct an atrial fibre atlas from a high-resolution DTMRI dataset that optimally reproduces electrophysiology simulation predictions corresponding to patient-specific fibre fields, and to develop a methodology for automatically assigning fibres to patient-specific anatomies. We extended an atrial coordinate system to map the pulmonary veins, vena cava and appendages to standardised positions in the coordinate system corresponding to the average location across the anatomies. We then expressed each fibre field in this atrial coordinate system and calculated an average fibre field. To assess the effects of fibre field on patient-specific modelling predictions, we calculated paced activation time maps and electrical driver locations during AF. In total, 756 activation time maps were calculated (7 anatomies with 9 fibre maps and 2 pacing locations, for the endocardial, epicardial and bilayer surface models of the LA and RA). Patient-specific fibre fields had a relatively small effect on average paced activation maps (range of mean local activation time difference for LA fields: 2.67-3.60 ms, and for RA fields: 2.29-3.44 ms), but had a larger effect on maximum LAT differences (range for LA 12.7-16.6%; range for RA 11.9-15.0%). A total of 126 phase singularity density maps were calculated (7 anatomies with 9 fibre maps for the LA and RA bilayer models). The fibre field corresponding to anatomy 1 had the highest median PS density map correlation coefficient for LA bilayer simulations (0.44 compared to the other correlations, ranging from 0.14 to 0.39), while the average fibre field had the highest correlation for the RA bilayer simulations (0.61 compared to the other correlations, ranging from 0.37 to 0.56). For sinus rhythm simulations, average activation time is robust to fibre field direction; however, maximum differences can still be significant. Patient specific fibres are more important for arrhythmia simulations, particularly in the left atrium. We propose using the fibre field corresponding to DTMRI dataset 1 for LA simulations, and the average fibre field for RA simulations as these optimally predicted arrhythmia properties.
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34
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Corrado C, Razeghi O, Roney C, Coveney S, Williams S, Sim I, O'Neill M, Wilkinson R, Oakley J, Clayton RH, Niederer S. Quantifying atrial anatomy uncertainty from clinical data and its impact on electro-physiology simulation predictions. Med Image Anal 2020; 61:101626. [PMID: 32000114 DOI: 10.1016/j.media.2019.101626] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/05/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022]
Abstract
Patient-specific computational models of structure and function are increasingly being used to diagnose disease and predict how a patient will respond to therapy. Models of anatomy are often derived after segmentation of clinical images or from mapping systems which are affected by image artefacts, resolution and contrast. Quantifying the impact of uncertain anatomy on model predictions is important, as models are increasingly used in clinical practice where decisions need to be made regardless of image quality. We use a Bayesian probabilistic approach to estimate the anatomy and to quantify the uncertainty about the shape of the left atrium derived from Cardiac Magnetic Resonance images. We show that we can quantify uncertain shape, encode uncertainty about the left atrial shape due to imaging artefacts, and quantify the effect of uncertain shape on simulations of left atrial activation times.
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Affiliation(s)
- Cesare Corrado
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom.
| | - Orod Razeghi
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
| | - Caroline Roney
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
| | - Sam Coveney
- Insigneo Institute for in-silico Medicine and Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Steven Williams
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
| | - Iain Sim
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
| | - Mark O'Neill
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
| | - Richard Wilkinson
- School of Mathematics and Statistics, University of Sheffield, Sheffield, United Kingdom
| | - Jeremy Oakley
- School of Mathematics and Statistics, University of Sheffield, Sheffield, United Kingdom
| | - Richard H Clayton
- Insigneo Institute for in-silico Medicine and Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Steven Niederer
- Division of Imaging Sciences & Biomedical Engineering, King's College London, London SE17EH, United Kingdom
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35
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Bernardino G, Sanz de la Garza M, Domenech-Ximenos B, Prat-Gonzàlez S, Perea RJ, Blanco I, Burgos F, Sepulveda-Martinez A, Rodriguez-Lopez M, Crispi F, Butakoff C, González Ballester MA, De Craene M, Sitges M, Bijnens B. Three-dimensional regional bi-ventricular shape remodeling is associated with exercise capacity in endurance athletes. Eur J Appl Physiol 2020; 120:1227-1235. [PMID: 32130484 DOI: 10.1007/s00421-020-04335-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
AIMS Endurance athletes develop cardiac remodeling to cope with increased cardiac output during exercise. This remodeling is both anatomical and functional and shows large interindividual variability. In this study, we quantify local geometric ventricular remodeling related to long-standing endurance training and assess its relationship with cardiovascular performance during exercise. METHODS We extracted 3D models of the biventricular shape from end-diastolic cine magnetic resonance images acquired from a cohort of 89 triathlon athletes and 77 healthy sedentary subjects. Additionally, the athletes underwent cardio-pulmonary exercise testing, together with an echocardiographic study at baseline and few minutes after maximal exercise. We used statistical shape analysis to identify regional bi-ventricular shape differences between athletes and non-athletes. RESULTS The ventricular shape was significantly different between athletes and controls (p < 1e-6). The observed regional remodeling in the right heart was mainly a shift of the right ventricle (RV) volume distribution towards the right ventricular infundibulum, increasing the overall right ventricular volume. In the left heart, there was an increment of left ventricular mass and a dilation of the left ventricle. Within athletes, the amount of such remodeling was independently associated to higher peak oxygen pulse (p < 0.001) and weakly with greater post-exercise RV free wall longitudinal strain (p = 0.03). CONCLUSIONS We were able to identify specific bi-ventricular regional remodeling induced by long-lasting endurance training. The amount of remodeling was associated with better cardiopulmonary performance during an exercise test.
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Affiliation(s)
- G Bernardino
- BCN Medtech, DTIC Universitat Pompeu Fabra, Barcelona, Spain. .,Medisys, Philips, Paris, France.
| | - M Sanz de la Garza
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.,CIBERCV, Barcelona, Spain
| | - B Domenech-Ximenos
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - S Prat-Gonzàlez
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.,CIBERCV, Barcelona, Spain
| | - R J Perea
- Radiology Department, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - I Blanco
- ICR, IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - F Burgos
- ICR, IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain
| | - A Sepulveda-Martinez
- BCNatal, ICGON, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,CIBER-ER, Barcelona, Spain.,Fetal Medicine Unit, Department of Obstetrics and Gynecology Hospital Clínico de la Universidad de Chile, Santiago de Chile, Chile
| | - M Rodriguez-Lopez
- BCNatal, ICGON, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,CIBER-ER, Barcelona, Spain.,Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - F Crispi
- BCNatal, ICGON, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,CIBER-ER, Barcelona, Spain
| | | | | | | | - M Sitges
- Cardiovascular Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.,CIBERCV, Barcelona, Spain
| | - B Bijnens
- BCN Medtech, DTIC Universitat Pompeu Fabra, Barcelona, Spain.,ICREA, Barcelona, Spain
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36
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Li B, Ma H, Guo H, Liu P, Wu Y, Fan L, Cao Y, Jian Z, Sun C, Li H. Pulmonary vein parameters are similar or better predictors than left atrial diameter for paroxysmal atrial fibrillation after cryoablation. ACTA ACUST UNITED AC 2019; 52:e8446. [PMID: 31482999 PMCID: PMC6720024 DOI: 10.1590/1414-431x20198446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022]
Abstract
Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031–0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004–0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.
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Affiliation(s)
- Bolin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Honglan Ma
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Medical College, Xi'an, Shaanxi, China
| | - Huihui Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lihong Fan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yumeng Cao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhijie Jian
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongbing Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Improving performance of 3D speckle tracking in arterial hypertension and paroxysmal atrial fibrillation by using novel strain parameters. Sci Rep 2019; 9:7382. [PMID: 31089252 PMCID: PMC6517438 DOI: 10.1038/s41598-019-43855-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 04/30/2019] [Indexed: 01/08/2023] Open
Abstract
The function of left atrium (LA) is closely related to LA remodeling and one of the most important mechanisms is an increased deposition of fibrous tissue that often is the basis for LA electro-mechanical changes before the onset of atrial fibrillation (AF). This study evaluated LA shape and function, by investigating standard and novel strain parameters calculated by a new approach based on homologous times derived from 3D speckle tracking echocardiography (3DSTE) in hypertensive (HT) and paroxysmal atrial fibrillation (PAF) patients with or without left ventricular hypertrophy (LVH), compared to control (C) subjects. LA function was assessed using homologous times to compare strain variables among different individuals, acquired at different physiological time periods. Standard global longitudinal (GLS) and circumferential (GCS) strains were measured at peak of atrial diastole, while longitudinal and circumferential strains (GLSh, GCSh), strain rate (GLSr, GCSr), volume (Vh) and volume rate (Vr) were measured during the atrial telediastolic phase (fifth homologous time) and atrial pre-active phase (tenth homologous time). Using ANOVA, we found an impaired LA deformation detected by standard, interpolated strains and strain rates in both HT and PAF groups compared to C. We also performed ROC analysis to identify different performances of each parameter to discriminate groups (GLSr10 + GCSr10: C vs PAF 0.935; C vs PAF_LVH 0.924; C vs HT_LVH 0.844; C vs HT 0.756). Our study showed anatomical and functional LA remodeling in patients with PAF and HT. 3D strains and strain rates derived from the homologous times approach provide more functional information with improved performance to identify among the explored groups, in particular PAF patients.
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Combinational Biomarkers for Atrial Fibrillation Derived from Atrial Appendage and Plasma Metabolomics Analysis. Sci Rep 2018; 8:16930. [PMID: 30446671 PMCID: PMC6240090 DOI: 10.1038/s41598-018-34930-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 10/18/2018] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common types of arrhythmias and often leads to clinical complications. The objectives of this study were to offer insights into the metabolites of AF and to determine biomarkers for AF diagnosis or prediction. Sixty atrial appendage samples (AF group: 30; non-AF group: 30) and 163 plasma samples (AF group: 48; non-AF group: 115) from 49 AF patients and 116 non-AF patients were subjected to liquid chromatography positive ion electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) metabolomics analysis. Consequently, 24 metabolites in atrial appendage samples and 24 metabolites in plasma samples were found to reflect metabolic differences between AF and non-AF patients (variable importance in projection (VIP) ≥ 1, P ≤ 0.05). Five identical metabolites including creatinine, D-glutamic acid, choline, hypoxanthine, and niacinamide (VIP ≥ 1.5, P < 0.01, FDR < 0.05) in atrial appendage and plasma samples were considered prominent features of AF patients, and the D-glutamine and D-glutamate metabolic pathway was also identified as a feature of AF patients. Finally, in plasma samples, the combination of D-glutamic acid, creatinine, and choline had an AUC value of 0.927 (95% CI: 0.875-0.979, P < 0.001) and displayed 90.5% sensitivity and 83.3% specificity; this group of metabolites was thus defined as a combinational biomarker for the recognition of AF and non-AF patients.
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39
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Roy A, Varela M, Aslanidi O. Image-Based Computational Evaluation of the Effects of Atrial Wall Thickness and Fibrosis on Re-entrant Drivers for Atrial Fibrillation. Front Physiol 2018; 9:1352. [PMID: 30349483 PMCID: PMC6187302 DOI: 10.3389/fphys.2018.01352] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction: Catheter ablation (CA) is a common treatment for atrial fibrillation (AF), but the knowledge of optimal ablation sites, and hence clinical outcomes, are suboptimal. Increasing evidence suggest that ablation strategies based on patient-specific substrates information, such as distributions of fibrosis and atrial wall thickness (AWT), may be used to improve therapy. We hypothesized that competing influences of large AWT gradients and fibrotic patches on conductive properties of atrial tissue can determine locations of re-entrant drivers (RDs) sustaining AF. Methods: Two sets of models were used: (1) a simple model of 3D atrial tissue slab with a step change in AWT and a synthetic fibrosis patch, and (2) 3D models based on patient-specific right atrial (RA) and left atrial (LA) geometries. The latter were obtained from four healthy volunteers and two AF patients, respectively, using magnetic resonance imaging (MRI). A synthetic fibrotic patch was added in the RA and fibrosis distributions in the LA were obtained from gadolinium-enhanced MRI of the same patients. In all models, 3D geometry was combined with the Fenton-Karma atrial cell model to simulate RDs. Results: In the slab, RDs drifted toward, and then along the AWT step. However, with additional fibrosis, the RDs were localized in regions between the step and fibrosis. In the RA, RDs drifted toward and anchored to a large AWT gradient between the crista terminalis (CT) region and the surrounding atrial wall. Without such a gradient, RDs drifted toward the superior vena cava (SVC) or the tricuspid valve (TSV). With additional fibrosis, RDs initiated away from the CT anchored to the fibrotic patch, whereas RDs initiated close to the CT region remained localized between the two structures. In the LA, AWT was more uniform and RDs drifted toward the pulmonary veins (PVs). However, with additional fibrotic patches, RDs either anchored to them or multiplied. Conclusion: In the RA, RD locations are determined by both fibrosis and AWT gradients at the CT region. In the LA, they are determined by fibrosis due to the absence of large AWT gradients. These results elucidate mechanisms behind the stabilization of RDs sustaining AF and can help guide ablation therapy.
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Affiliation(s)
| | | | - Oleg Aslanidi
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London, United Kingdom
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van den Berg NWE, Chan Pin Yin DRPP, Berger WR, Neefs J, De Bruin-Bon RHACM, Marquering HA, Slaar A, Planken RN, de Groot JR. Comparison of non-triggered magnetic resonance imaging and echocardiography for the assessment of left atrial volume and morphology. Cardiovasc Ultrasound 2018; 16:17. [PMID: 30223837 PMCID: PMC6142376 DOI: 10.1186/s12947-018-0134-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced atrial fibrillation (AF) patients have persistent AF, failed previous catheter ablation and/or an enlarged left atrium (LA), which is associated with a reduced success of AF ablation. Transthoracic echocardiography (TTE) and contrast enhanced magnetic resonance angiography (CE-MRA) are available to assess LA volume. However, it is unknown how these modalities relate in patients with advanced AF. We therefore compared the reproducibility of TTE and non-triggered CE-MRA in advanced AF patients and their ability to select patients with successful thoracoscopic AF ablation. METHODS Two independent observers measured LA volumes on 65 TTE and CE-MRA exams of advanced AF patients prior to AF ablation. Patients were followed after AF ablation with rhythm monitoring every 3 months for 1 year to determine AF recurrence. Inter-modality, inter- and intra-observer variability were determined using intraclass correlation coefficients (ICC). Receiver-operating characteristic (ROC) analysis was performed to determine sensitivity and specificity of TTE and CE-MRA volume and CE-MRA dimensions to identify patients with AF recurrence during follow-up. RESULTS LA enlargement ≥ 34 ml/m2 was present in 60% of the patients. CE-MRA and TTE demonstrated a good correlation for LA volume assessment (intraclass correlation, ICC = 0.86; p < 0.001) with larger volumes consistently measured by CE-MRA. Major discrepancies were mostly attributed to TTE acquisition. Craniocaudal enlargement discriminated patients with AF recurrence (AUC 0.67 [95% CI 0.55-0.85], p = 0.01). CONCLUSIONS Non-triggered CE-MRA is a viable and reproducible 3D alternative for 2D TTE to assess LA volume in advanced AF patients. Craniocaudal enlargement was the only discriminator of AF recurrence after AF ablation.
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Affiliation(s)
- Nicoline W. E. van den Berg
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | | | - Wouter R. Berger
- Onze Lieve Vrouwe Hospital, Department of Cardiology, Amsterdam, The Netherlands
| | - Jolien Neefs
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rianne H. A. C. M. De Bruin-Bon
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Henk A. Marquering
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Radiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annelie Slaar
- Westfriesgasthuis, Department of Radiology, Hoorn, The Netherlands
| | - R. Nils Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Joris R. de Groot
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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Mancusi C, Canciello G, Izzo R, Damiano S, Grimaldi MG, de Luca N, de Simone G, Trimarco B, Losi MA. Left atrial dilatation: A target organ damage in young to middle-age hypertensive patients. The Campania Salute Network. Int J Cardiol 2018; 265:229-233. [DOI: 10.1016/j.ijcard.2018.03.120] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 11/28/2022]
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42
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Varela M, Morgan R, Theron A, Dillon-Murphy D, Chubb H, Whitaker J, Henningsson M, Aljabar P, Schaeffter T, Kolbitsch C, Aslanidi OV. Novel MRI Technique Enables Non-Invasive Measurement of Atrial Wall Thickness. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1607-1614. [PMID: 28422654 PMCID: PMC5549842 DOI: 10.1109/tmi.2017.2671839] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Knowledge of atrial wall thickness (AWT) has the potential to provide important information for patient stratification and the planning of interventions in atrial arrhythmias. To date, information about AWT has only been acquired in post-mortem or poor-contrast computed tomography (CT) studies, providing limited coverage and highly variable estimates of AWT. We present a novel contrast agent-free MRI sequence for imaging AWT and use it to create personalized AWT maps and a biatrial atlas. A novel black-blood phase-sensitive inversion recovery protocol was used to image ten volunteers and, as proof of concept, two atrial fibrillation patients. Both atria were manually segmented to create subject-specific AWT maps using an average of nearest neighbors approach. These were then registered non-linearly to generate an AWT atlas. AWT was 2.4 ± 0.7 and 2.7 ± 0.7 mm in the left and right atria, respectively, in good agreement with post-mortem and CT data, where available. AWT was 2.6 ± 0.7 mm in the left atrium of a patient without structural heart disease, similar to that of volunteers. In a patient with structural heart disease, the AWT was increased to 3.1 ± 1.3 mm. We successfully designed an MRI protocol to non-invasively measure AWT and create the first whole-atria AWT atlas. The atlas can be used as a reference to study alterations in thickness caused by atrial pathology. The protocol can be used to acquire personalized AWT maps in a clinical setting and assist in the treatment of atrial arrhythmias.
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