1
|
Basara G, Celebi LE, Ronan G, Discua Santos V, Zorlutuna P. 3D bioprinted aged human post-infarct myocardium tissue model. Health Sci Rep 2024; 7:e1945. [PMID: 38655426 PMCID: PMC11035382 DOI: 10.1002/hsr2.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/24/2023] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Fibrotic tissue formed after myocardial infarction (MI) can be as detrimental as MI itself. However, current in vitro cardiac fibrosis models fail to recapitulate the complexities of post-MI tissue. Moreover, although MI and subsequent fibrosis is most prominent in the aged population, the field suffers from inadequate aged tissue models. Herein, an aged human post-MI tissue model, representing the native microenvironment weeks after initial infarction, is engineered using three-dimensional bioprinting via creation of individual bioinks to specifically mimic three distinct regions: remote, border, and scar. Methods The aged post-MI tissue model is engineered through combination of gelatin methacryloyl, methacrylated hyaluronic acid, aged type I collagen, and photoinitiator at variable concentrations with different cell types, including aged human induced pluripotent stem cell-derived cardiomyocytes, endothelial cells, cardiac fibroblasts, and cardiac myofibroblasts, by introducing a methodology which utilizes three printheads of the bioprinter to model aged myocardium. Then, using cell-specific proteins, the cell types that comprised each region are confirmed using immunofluorescence. Next, the beating characteristics are analyzed. Finally, the engineered aged post-MI tissue model is used as a benchtop platform to assess the therapeutic effects of stem cell-derived extracellular vesicles on the scar region. Results As a result, high viability (>74%) was observed in each region of the printed model. Constructs demonstrated functional behavior, exhibiting a beating velocity of 6.7 μm/s and a frequency of 0.3 Hz. Finally, the effectiveness of hiPSC-EV and MSC-EV treatment was assessed. While hiPSC-EV treatment showed no significant changes, MSC-EV treatment notably increased cardiomyocyte beating velocity, frequency, and confluency, suggesting a regenerative potential. Conclusion In conclusion, we envision that our approach of modeling post-MI aged myocardium utilizing three printheads of the bioprinter may be utilized for various applications in aged cardiac microenvironment modeling and testing novel therapeutics.
Collapse
Affiliation(s)
- Gozde Basara
- Department of Aerospace and Mechanical EngineeringUniversity of Notre DameNotre DameIndianaUSA
| | - Lara Ece Celebi
- Department of Aerospace and Mechanical EngineeringUniversity of Notre DameNotre DameIndianaUSA
- Bioengineering Graduate ProgramUniversity of Notre DameNotre DameIndianaUSA
| | - George Ronan
- Department of Aerospace and Mechanical EngineeringUniversity of Notre DameNotre DameIndianaUSA
- Bioengineering Graduate ProgramUniversity of Notre DameNotre DameIndianaUSA
| | | | - Pinar Zorlutuna
- Department of Aerospace and Mechanical EngineeringUniversity of Notre DameNotre DameIndianaUSA
- Bioengineering Graduate ProgramUniversity of Notre DameNotre DameIndianaUSA
- Department of Chemical and Biomolecular EngineeringUniversity of Notre DameNotre DameIndianaUSA
- Harper Cancer Research InstituteUniversity of Notre DameNotre DameIndianaUSA
| |
Collapse
|
2
|
Mohl W, Kiseleva Z, Jusic A, Bruckner M, Mader RM. Signs and signals limiting myocardial damage using PICSO: a scoping review decoding paradigm shifts toward a new encounter. Front Cardiovasc Med 2023; 10:1030842. [PMID: 37229230 PMCID: PMC10204926 DOI: 10.3389/fcvm.2023.1030842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Background Inducing recovery in myocardial ischemia is limited to a timely reopening of infarct vessels and clearing the cardiac microcirculation, but additional molecular factors may impact recovery. Objective In this scoping review, we identify the paradigm shifts decoding the branching points of experimental and clinical evidence of pressure-controlled intermittent coronary sinus occlusion (PICSO), focusing on myocardial salvage and molecular implications on infarct healing and repair. Design The reporting of evidence was structured chronologically, describing the evolution of the concept from mainstream research to core findings dictating a paradigm change. All data reported in this scoping review are based on published data, but new evaluations are also included. Results Previous findings relate hemodynamic PICSO effects clearing reperfused microcirculation to myocardial salvage. The activation of venous endothelium opened a new avenue for understanding PICSO. A flow-sensitive signaling molecule, miR-145-5p, showed a five-fold increase in porcine myocardium subjected to PICSO.Verifying our theory of "embryonic recall," an upregulation of miR-19b and miR-101 significantly correlates to the time of pressure increase in cardiac veins during PICSO (r2 = 0.90, p < 0.05; r2 = 0.98, p < 0.03), suggesting a flow- and pressure-dependent secretion of signaling molecules into the coronary circulation. Furthermore, cardiomyocyte proliferation by miR-19b and the protective role of miR-101 against remodeling show another potential interaction of PICSO in myocardial healing. Conclusion Molecular signaling during PICSO may contribute to retroperfusion toward deprived myocardium and clearing the reperfused cardiac microcirculation. A burst of specific miRNA reiterating embryonic molecular pathways may play a role in targeting myocardial jeopardy and will be an essential therapeutic contribution in limiting infarcts in recovering patients.
Collapse
Affiliation(s)
- Werner Mohl
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Zlata Kiseleva
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alem Jusic
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthäus Bruckner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Robert M. Mader
- Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna,Austria
| |
Collapse
|
3
|
Pathophysiology of LV Remodeling Following STEMI: A Longitudinal Diffusion Tensor CMR Study. JACC Cardiovasc Imaging 2023; 16:159-171. [PMID: 36412993 PMCID: PMC9902278 DOI: 10.1016/j.jcmg.2022.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/28/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adverse LV remodeling post-ST-segment elevation myocardial infarction (STEMI) is associated with a poor prognosis, but the underlying mechanisms are not fully understood. Diffusion tensor (DT)-cardiac magnetic resonance (CMR) allows in vivo characterization of myocardial architecture and provides unique mechanistic insight into pathophysiologic changes following myocardial infarction. OBJECTIVES This study evaluated the potential associations between DT-CMR performed soon after STEMI and long-term adverse left ventricular (LV) remodeling following STEMI. METHODS A total of 100 patients with STEMI underwent CMR at 5 days and 12 months post-reperfusion. The protocol included DT-CMR for assessing fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA), cine imaging for assessing LV volumes, and late gadolinium enhancement for calculating infarct and microvascular obstruction size. Adverse remodeling was defined as a 20% increase in LV end-diastolic volume at 12 months. RESULTS A total of 32 patients experienced adverse remodeling at 12 months. Compared with patients without adverse remodeling, they had lower FA (0.23 ± 0.03 vs 0.27 ± 0.04; P < 0.001), lower E2A (37 ± 6° vs 51 ± 7°; P < 0.001), and, on HA maps, a lower proportion of myocytes with right-handed orientation (RHM) (8% ± 5% vs 17% ± 9%; P < 0.001) in their acutely infarcted myocardium. On multivariable logistic regression analysis, infarct FA (odds ratio [OR]: <0.01; P = 0.014) and E2A (OR: 0.77; P = 0.001) were independent predictors of adverse LV remodeling after adjusting for left ventricular ejection fraction (LVEF) and infarct size. There were no significant changes in infarct FA, E2A, or RHM between the 2 scans. CONCLUSIONS Extensive cardiomyocyte disorganization (evidenced by low FA), acute loss of sheetlet angularity (evidenced by low E2A), and a greater loss of organization among cardiomyocytes with RHM, corresponding to the subendocardium, can be detected within 5 days post-STEMI. These changes persist post-injury, and low FA and E2A are independently associated with long-term adverse remodeling.
Collapse
|
4
|
Ferreira PF, Banerjee A, Scott AD, Khalique Z, Yang G, Rajakulasingam R, Dwornik M, De Silva R, Pennell DJ, Firmin DN, Nielles‐Vallespin S. Accelerating Cardiac Diffusion Tensor Imaging With a U-Net Based Model: Toward Single Breath-Hold. J Magn Reson Imaging 2022; 56:1691-1704. [PMID: 35460138 PMCID: PMC9790699 DOI: 10.1002/jmri.28199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In vivo cardiac diffusion tensor imaging (cDTI) characterizes myocardial microstructure. Despite its potential clinical impact, considerable technical challenges exist due to the inherent low signal-to-noise ratio. PURPOSE To reduce scan time toward one breath-hold by reconstructing diffusion tensors for in vivo cDTI with a fitting-free deep learning approach. STUDY TYPE Retrospective. POPULATION A total of 197 healthy controls, 547 cardiac patients. FIELD STRENGTH/SEQUENCE A 3 T, diffusion-weighted stimulated echo acquisition mode single-shot echo-planar imaging sequence. ASSESSMENT A U-Net was trained to reconstruct the diffusion tensor elements of the reference results from reduced datasets that could be acquired in 5, 3 or 1 breath-hold(s) (BH) per slice. Fractional anisotropy (FA), mean diffusivity (MD), helix angle (HA), and sheetlet angle (E2A) were calculated and compared to the same measures when using a conventional linear-least-square (LLS) tensor fit with the same reduced datasets. A conventional LLS tensor fit with all available data (12 ± 2.0 [mean ± sd] breath-holds) was used as the reference baseline. STATISTICAL TESTS Wilcoxon signed rank/rank sum and Kruskal-Wallis tests. Statistical significance threshold was set at P = 0.05. Intersubject measures are quoted as median [interquartile range]. RESULTS For global mean or median results, both the LLS and U-Net methods with reduced datasets present a bias for some of the results. For both LLS and U-Net, there is a small but significant difference from the reference results except for LLS: MD 5BH (P = 0.38) and MD 3BH (P = 0.09). When considering direct pixel-wise errors the U-Net model outperformed significantly the LLS tensor fit for reduced datasets that can be acquired in three or just one breath-hold for all parameters. DATA CONCLUSION Diffusion tensor prediction with a trained U-Net is a promising approach to minimize the number of breath-holds needed in clinical cDTI studies. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Pedro F. Ferreira
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | | | - Andrew D. Scott
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Zohya Khalique
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Guang Yang
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ramyah Rajakulasingam
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Maria Dwornik
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Ranil De Silva
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Dudley J. Pennell
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - David N. Firmin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| | - Sonia Nielles‐Vallespin
- Cardiovascular Magnetic Resonance UnitRoyal Brompton HospitalLondonUK
- National Heart and Lung InstituteImperial CollegeLondonUK
| |
Collapse
|
5
|
Wilson AJ, Sands GB, LeGrice IJ, Young AA, Ennis DB. Myocardial mesostructure and mesofunction. Am J Physiol Heart Circ Physiol 2022; 323:H257-H275. [PMID: 35657613 PMCID: PMC9273275 DOI: 10.1152/ajpheart.00059.2022] [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: 02/02/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
Abstract
The complex and highly organized structural arrangement of some five billion cardiomyocytes directs the coordinated electrical activity and mechanical contraction of the human heart. The characteristic transmural change in cardiomyocyte orientation underlies base-to-apex shortening, circumferential shortening, and left ventricular torsion during contraction. Individual cardiomyocytes shorten ∼15% and increase in diameter ∼8%. Remarkably, however, the left ventricular wall thickens by up to 30-40%. To accommodate this, the myocardium must undergo significant structural rearrangement during contraction. At the mesoscale, collections of cardiomyocytes are organized into sheetlets, and sheetlet shear is the fundamental mechanism of rearrangement that produces wall thickening. Herein, we review the histological and physiological studies of myocardial mesostructure that have established the sheetlet shear model of wall thickening. Recent developments in tissue clearing techniques allow for imaging of whole hearts at the cellular scale, whereas magnetic resonance imaging (MRI) and computed tomography (CT) can image the myocardium at the mesoscale (100 µm to 1 mm) to resolve cardiomyocyte orientation and organization. Through histology, cardiac diffusion tensor imaging (DTI), and other modalities, mesostructural sheetlets have been confirmed in both animal and human hearts. Recent in vivo cardiac DTI methods have measured reorientation of sheetlets during the cardiac cycle. We also examine the role of pathological cardiac remodeling on sheetlet organization and reorientation, and the impact this has on ventricular function and dysfunction. We also review the unresolved mesostructural questions and challenges that may direct future work in the field.
Collapse
Affiliation(s)
- Alexander J Wilson
- Department of Radiology, Stanford University, Stanford, California
- Stanford Cardiovascular Institute, Stanford University, Stanford, California
| | - Gregory B Sands
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ian J LeGrice
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, California
- Veterans Administration Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
6
|
Bracamonte JH, Saunders SK, Wilson JS, Truong UT, Soares JS. Patient-Specific Inverse Modeling of In Vivo Cardiovascular Mechanics with Medical Image-Derived Kinematics as Input Data: Concepts, Methods, and Applications. APPLIED SCIENCES-BASEL 2022; 12:3954. [PMID: 36911244 PMCID: PMC10004130 DOI: 10.3390/app12083954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inverse modeling approaches in cardiovascular medicine are a collection of methodologies that can provide non-invasive patient-specific estimations of tissue properties, mechanical loads, and other mechanics-based risk factors using medical imaging as inputs. Its incorporation into clinical practice has the potential to improve diagnosis and treatment planning with low associated risks and costs. These methods have become available for medical applications mainly due to the continuing development of image-based kinematic techniques, the maturity of the associated theories describing cardiovascular function, and recent progress in computer science, modeling, and simulation engineering. Inverse method applications are multidisciplinary, requiring tailored solutions to the available clinical data, pathology of interest, and available computational resources. Herein, we review biomechanical modeling and simulation principles, methods of solving inverse problems, and techniques for image-based kinematic analysis. In the final section, the major advances in inverse modeling of human cardiovascular mechanics since its early development in the early 2000s are reviewed with emphasis on method-specific descriptions, results, and conclusions. We draw selected studies on healthy and diseased hearts, aortas, and pulmonary arteries achieved through the incorporation of tissue mechanics, hemodynamics, and fluid-structure interaction methods paired with patient-specific data acquired with medical imaging in inverse modeling approaches.
Collapse
Affiliation(s)
- Johane H. Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Sarah K. Saunders
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - John S. Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Uyen T. Truong
- Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Joao S. Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA 23284, USA
- Correspondence:
| |
Collapse
|
7
|
Tan Y, Bie YL, Chen L, Zhao YH, Song L, Miao LN, Yu YQ, Chai H, Ma XJ, Shi DZ. Lingbao Huxin Pill Alleviates Apoptosis and Inflammation at Infarct Border Zone through SIRT1-Mediated FOXO1 and NF- κ B Pathways in Rat Model of Acute Myocardial Infarction. Chin J Integr Med 2022; 28:330-338. [PMID: 34826042 DOI: 10.1007/s11655-021-2881-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether Lingbao Huxin Pill (LBHX) protects against acute myocardial infarction (AMI) at the infarct border zone (IBZ) of myocardial tissue by regulating apoptosis and inflammation through the sirtuin 1 (SIRT1)-mediated forkhead box protein O1 (FOXO1) and nuclear factor-κ B (NF-κ B) signaling pathways. METHODS Six-week-old Wistar rats with normal diet were randomized into the sham, the model, Betaloc (0.9 mg/kg daily), LBHX-L (0.45 mg/kg daily), LBHX-M (0.9 mg/kg daily), LBHX-H (1.8 mg/kg daily), and LBHX+EX527 (0.9 mg/kg daily) groups according to the method of random number table, 13 in each group. In this study, left anterior descending coronary artery (LADCA) ligation was performed to induce an AMI model in rats. The myocardial infarction area was examined using a 2,3,5-triphenyltetrazolium chloride solution staining assay. A TdT-mediated dUTP nick-end labeling (TUNEL) assay was conducted to assess cardiomyocyte apoptosis in the IBZ. The histopathology of myocardial tissue at the IBZ was assessed with Heidenhain, Masson and hematoxylineosin (HE) staining assays. The expression levels of tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-1 β, and intercellular adhesion molecule-1 were measured using enzyme-linked immunosorbent assays (ELISAs). The mRNA expressions of SIRT1 and FOXO1 were detected by real-time qPCR (RT-qPCR). The protein expressions of SIRT1, FOXO1, SOD2, BAX and NF- κ B p65 were detected by Western blot analysis. RESULTS The ligation of the LADCA successfully induced an AMI model. The LBHX pretreatment reduced the infarct size in the AMI rats (P<0.01). The TUNEL assay revealed that LBHX inhibited cardiomyocyte apoptosis at the IBZ. Further, the histological examination showed that the LBHX pretreatment decreased the ischemic area of myocardial tissue (P<0.05), myocardial interstitial collagen deposition (P<0.05) and inflammation at the IBZ. The ELISA results indicated that LBHX decreased the serum levels of inflammatory cytokines in the AMI rats (P<0.05 or P<0.01). Furthermore, Western blot analysis revealed that the LBHX pretreatment upregulated the protein levels of SIRT1, FOXO1 and SOD2 (P<0.05) and downregulated NF- κ B p65 and BAX expressions (P<0.05). The RT-qPCR results showed that LBHX increased the SIRT1 mRNA and FOXO1 mRNA levels (P<0.05). These protective effects, including inhibiting apoptosis and alleviating inflammation in the IBZ, were partially abolished by EX527, an inhibitor of SIRT1. CONCLUSION LBHX could protect against AMI by suppressing apoptosis and inflammation in AMI rats and the SIRT1-mediated FOXO1 and NF- κ B signaling pathways were involved in the cardioprotection effect of LBHX.
Collapse
Affiliation(s)
- Yu Tan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Yu-Long Bie
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Li Chen
- Peking University Traditional Chinese Medicine Clinical Medical School (Xiyuan Hospital), Beijing, 100191, China
| | - Yi-Han Zhao
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Lei Song
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Li-Na Miao
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yan-Qiao Yu
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Hua Chai
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Xiao-Juan Ma
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Da-Zhuo Shi
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| |
Collapse
|
8
|
Rahman T, Moulin K, Perotti LE. Cardiac Diffusion Tensor Biomarkers of Chronic Infarction Based on In Vivo Data. APPLIED SCIENCES-BASEL 2022; 12. [PMID: 36032414 PMCID: PMC9408809 DOI: 10.3390/app12073512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In vivo cardiac diffusion tensor imaging (cDTI) data were acquired in
swine subjects six to ten weeks post-myocardial infarction (MI) to identify
microstructural-based biomarkers of MI. Diffusion tensor invariants, diffusion
tensor eigenvalues, and radial diffusivity (RD) are evaluated in the infarct,
border, and remote myocardium, and compared with extracellular volume fraction
(ECV) and native T1 values. Additionally, to aid the interpretation of the
experimental results, the diffusion of water molecules was numerically simulated
as a function of ECV. Finally, findings based on in vivo measures were confirmed
using higher-resolution and higher signal-to-noise data acquired ex vivo in the
same subjects. Mean diffusivity, diffusion tensor eigenvalues, and RD increased
in the infarct and border regions compared to remote myocardium, while
fractional anisotropy decreased. Secondary (e2) and tertiary
(e3) eigenvalues increased more significantly than the primary
eigenvalue in the infarct and border regions. These findings were confirmed by
the diffusion simulations. Although ECV presented the largest increase in
infarct and border regions, e2, e3, and RD increased the
most among non-contrast-based biomarkers. RD is of special interest as it
summarizes the changes occurring in the radial direction and may be more robust
than e2 or e3 alone.
Collapse
Affiliation(s)
- Tanjib Rahman
- Department of Mechanical and Aerospace Engineering,
University of Central Florida, Orlando, FL 32816, USA
| | - Kévin Moulin
- CREATIS Laboratory, Univ. Lyon, UJM-Saint-Etienne, INSA,
CNRS UMR 5520, INSERM, 69100 Villeurbanne, France
- Department of Radiology, University Hospital Saint-Etienne,
42270 Saint-Priest-en-Jarez, France
| | - Luigi E. Perotti
- Department of Mechanical and Aerospace Engineering,
University of Central Florida, Orlando, FL 32816, USA
- Correspondence:
| |
Collapse
|
9
|
Stoeck CT, von Deuster C, Fuetterer M, Polacin M, Waschkies CF, van Gorkum RJH, Kron M, Fleischmann T, Cesarovic N, Weisskopf M, Kozerke S. Cardiovascular magnetic resonance imaging of functional and microstructural changes of the heart in a longitudinal pig model of acute to chronic myocardial infarction. J Cardiovasc Magn Reson 2021; 23:103. [PMID: 34538266 PMCID: PMC8451129 DOI: 10.1186/s12968-021-00794-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We examined the dynamic response of the myocardium to infarction in a longitudinal porcine study using relaxometry, functional as well as diffusion cardiovascular magnetic resonance (CMR). We sought to compare non contrast CMR methods like relaxometry and in-vivo diffusion to contrast enhanced imaging and investigate the link of microstructural and functional changes in the acute and chronically infarcted heart. METHODS CMR was performed on five myocardial infarction pigs and four healthy controls. In the infarction group, measurements were obtained 2 weeks before 90 min occlusion of the left circumflex artery, 6 days after ischemia and at 5 as well as 9 weeks as chronic follow-up. The timing of measurements was replicated in the control cohort. Imaging consisted of functional cine imaging, 3D tagging, T2 mapping, native as well as gadolinium enhanced T1 mapping, cardiac diffusion tensor imaging, and late gadolinium enhancement imaging. RESULTS Native T1, extracellular volume (ECV) and mean diffusivity (MD) were significantly elevated in the infarcted region while fractional anisotropy (FA) was significantly reduced. During the transition from acute to chronic stages, native T1 presented minor changes (< 3%). ECV as well as MD increased from acute to the chronic stages compared to baseline: ECV: 125 ± 24% (day 6) 157 ± 24% (week 5) 146 ± 60% (week 9), MD: 17 ± 7% (day 6) 33 ± 14% (week 5) 29 ± 15% (week 9) and FA was further reduced: - 31 ± 10% (day 6) - 38 ± 8% (week 5) - 36 ± 14% (week 9). T2 as marker for myocardial edema was significantly increased in the ischemic area only during the acute stage (83 ± 3 ms infarction vs. 58 ± 2 ms control p < 0.001 and 61 ± 2 ms in the remote area p < 0.001). The analysis of functional imaging revealed reduced left ventricular ejection fraction, global longitudinal strain and torsion in the infarct group. At the same time the transmural helix angle (HA) gradient was steeper in the chronic follow-up and a correlation between longitudinal strain and transmural HA gradient was detected (r = 0.59 with p < 0.05). Comparing non-gadolinium enhanced data T2 mapping showed the largest relative change between infarct and remote during the acute stage (+ 33 ± 4% day 6, with p = 0.013 T2 vs. MD, p = 0.009 T2 vs. FA and p = 0.01 T2 vs. T1) while FA exhibited the largest relative change between infarct and remote during the chronic follow-up (+ 31 ± 2% week 5, with p = N.S. FA vs. MD, p = 0.03 FA vs. T2 and p = 0.003 FA vs. T1). Overall, diffusion parameters provided a higher contrast (> 23% for MD and > 27% for FA) during follow-up compared to relaxometry (T1 17-18%/T2 10-20%). CONCLUSION During chronic follow-up after myocardial infarction, cardiac diffusion tensor imaging provides a higher sensitivity for mapping microstructural alterations when compared to non-contrast enhanced relaxometry with the added benefit of providing directional tensor information to assess remodelling of myocyte aggregate orientations, which cannot be otherwise assessed.
Collapse
Affiliation(s)
- Christian T. Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Constantin von Deuster
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Maximilian Fuetterer
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Malgorzata Polacin
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Conny F. Waschkies
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Robbert J. H. van Gorkum
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| | - Mareike Kron
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
- Institute of Translational Cardiovascular Technologies, ETH Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, 8092 Zurich, Switzerland
| |
Collapse
|
10
|
Noordman ABP, Maass AH, Groenveld H, Mulder BA, Rienstra M, Blaauw Y. Myocardial Scar Characterization and Future Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter-Defibrillator. Front Cardiovasc Med 2021; 8:708406. [PMID: 34485409 PMCID: PMC8415981 DOI: 10.3389/fcvm.2021.708406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Implantable cardioverter-defibrillator (ICD) therapy is associated with several deleterious effects, which can be reduced by antiarrhythmic drugs or catheter ablation. However, it is largely unknown which patients might benefit from these therapies. Therefore, this study aimed to investigate whether myocardial scar characterization improves risk stratification for ventricular arrhythmia (VA) occurrence in patients with ischemic cardiomyopathy and an ICD. Methods: In this study, 82 patients with ischemic cardiomyopathy who received an ICD were enrolled retrospectively. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images were analyzed using an investigational software tool to obtain quantitative data regarding the total scar, core, and border zone (BZ). Data regarding the QRS complex was obtained from electrocardiography (ECG). The primary endpoint was appropriate ICD therapy. Results: During a median follow-up duration of 3.98 years [interquartile range (IQR) 2.89–5.14 years], appropriate therapy occurred in 24 (29.3%) patients. Patients with appropriate ICD therapy had a significantly larger total scar mass [60.0 (IQR 41.2–73.4) vs. 43.3 (IQR 31.2–61.2) g; P = 0.009] and BZ mass [32.9 (IQR 26.9–42.4) vs. 24.5 (IQR 18.8–32.5) g; P = 0.001] than those without appropriate therapy. In multivariable Cox regression analyses, total scar mass [hazard ratio (HR) 1.02 [95% confidence interval (CI) 1.00–1.04]; P = 0.014] and BZ mass (HR 1.04 [95% CI 1.01–1.07]; P = 0.009) independently predicted appropriate ICD therapy. Core mass and the QRS complex, however, were not significantly associated with the primary endpoint. Conclusion: LGE-CMR-based, but not ECG-based myocardial scar characterization improves risk stratification for VA occurrence in patients with ischemic cardiomyopathy who received an ICD.
Collapse
Affiliation(s)
- Alwin B P Noordman
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alexander H Maass
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hessel Groenveld
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bart A Mulder
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
11
|
Mori D, Miyagawa S, Kido T, Hata H, Ueno T, Toda K, Kuratani T, Oota M, Kawai K, Kurata H, Nishida H, Sawa Y. Adipose-derived mesenchymal stem cells preserve cardiac function via ANT-1 in dilated cardiomyopathy hamster model. Regen Ther 2021; 18:182-190. [PMID: 34307796 PMCID: PMC8278151 DOI: 10.1016/j.reth.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Idiopathic dilated cardiomyopathy (DCM) is associated with abnormalities in cytoskeletal proteins, mitochondrial ATP transporter, microvasculature, and fibrosis. Mesenchymal stem cells (MSCs) can ameliorate distressed mitochondrial and structural proteins, as well as fibrosis, via the paracrine effect of cytokines. This study aimed to investigate whether the transplantation of adipose tissue-derived MSCs (ADSCs) reverses histological and functional abnormalities in the distressed myocardium of DCM-like hamsters by modulating the expression of adenine nucleotide translocase 1 (ANT-1). Methods Eighteen weeks after birth, ADSCs were implanted onto the cardiac surface of δ-sarcoglycan (SG)-deficient hamsters or sham surgery was performed. Results Left ventricular ejection fraction and end-systolic diameter were maintained in ADSC-treated animals for four weeks, ATP concentration was considerably elevated in the cardiomyocytes of these animals, and ANT-1 expression was significantly upregulated as well. The expression of extracellular matrix and myocardial cytoskeletal proteins, such as collagen, SG, and α-dystroglycan, did not differ between groups. However, significant improvements in myosin and Smad4 expression, cardiomyocyte hypertrophy, and capillary density occurred in the ADSC-treated group. Conclusions We demonstrated that ADSCs might maintain cardiac function in the DCM hamster model by enhancing ATP concentration, as well as mitochondrial transporter and myosin expression, indicating their potential for DCM treatment.
Collapse
Affiliation(s)
- Daisuke Mori
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Kido
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toru Kuratani
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Miwa Oota
- Institute of Advanced Stem Cell Therapy, Osaka University, Osaka, Japan
| | - Kotoe Kawai
- Institute of Advanced Stem Cell Therapy, Osaka University, Osaka, Japan
| | - Hayato Kurata
- Institute of Advanced Stem Cell Therapy, Osaka University, Osaka, Japan
| | - Hiroyuki Nishida
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.,Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| |
Collapse
|
12
|
Basara G, Ozcebe SG, Ellis BW, Zorlutuna P. Tunable Human Myocardium Derived Decellularized Extracellular Matrix for 3D Bioprinting and Cardiac Tissue Engineering. Gels 2021; 7:70. [PMID: 34208210 PMCID: PMC8293197 DOI: 10.3390/gels7020070] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
The generation of 3D tissue constructs with multiple cell types and matching mechanical properties remains a challenge in cardiac tissue engineering. Recently, 3D bioprinting has become a powerful tool to achieve these goals. Decellularized extracellular matrix (dECM) is a common scaffold material due to providing a native biochemical environment. Unfortunately, dECM's low mechanical stability prevents usage for bioprinting applications alone. In this study, we developed bioinks composed of decellularized human heart ECM (dhECM) with either gelatin methacryloyl (GelMA) or GelMA-methacrylated hyaluronic acid (MeHA) hydrogels dual crosslinked with UV light and microbial transglutaminase (mTGase). We characterized the bioinks' mechanical, rheological, swelling, printability, and biocompatibility properties. Composite GelMA-MeHA-dhECM (GME) hydrogels demonstrated improved mechanical properties by an order of magnitude compared to the GelMA-dhECM (GE) hydrogels. All hydrogels were extrudable and compatible with human induced pluripotent stem cell derived cardiomyocytes (iCMs) and human cardiac fibroblasts (hCFs). Tissue-like beating of the printed constructs with striated sarcomeric alpha-actinin and connexin 43 expression was observed. The order of magnitude difference between the elastic modulus of these hydrogel composites offers applications in in vitro modeling of the myocardial infarct boundary. Here, as a proof of concept, we created an infarct boundary region with control over the mechanical properties along with the cellular and macromolecular content through printing iCMs with GE bioink and hCFs with GME bioink.
Collapse
Affiliation(s)
- Gozde Basara
- Aerospace and Mechanical Engineering Department, University of Notre Dame, Notre Dame, IN 46556, USA;
| | - S. Gulberk Ozcebe
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA; (S.G.O.); (B.W.E.)
| | - Bradley W. Ellis
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA; (S.G.O.); (B.W.E.)
| | - Pinar Zorlutuna
- Aerospace and Mechanical Engineering Department, University of Notre Dame, Notre Dame, IN 46556, USA;
- Bioengineering Graduate Program, University of Notre Dame, Notre Dame, IN 46556, USA; (S.G.O.); (B.W.E.)
| |
Collapse
|
13
|
Rahman T, Moulin K, Ennis DB, Perotti LE. Diffusion biomarkers in chronic myocardial infarction. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2021; 12738:137-147. [PMID: 34585174 PMCID: PMC8476206 DOI: 10.1007/978-3-030-78710-3_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cardiac diffusion tensor magnetic resonance imaging (cDTI) allows estimating the aggregate cardiomyocyte architecture in healthy subjects and its remodeling as a result of cardiac disease. In this study, cDTI was used to quantify microstructural changes occurring in swine (N=7) six to ten weeks after myocardial infarction. Each heart was extracted and imaged ex vivo with 1mm isotropic spatial resolution. Microstructural changes were quantified in the border zone and infarct region by comparing diffusion tensor invariants - fractional anisotropy (FA), mode, and mean diffusivity (MD) - radial diffusivity, and diffusion tensor eigenvalues with the corresponding values in the remote myocardium. MD and radial diffusivity increased in the infarct and border regions with respect to the remote myocardium (p<0.01). In contrast, FA and mode decreased in the infarct and border regions (p<0.01). Diffusion tensor eigenvalues also increased in the infarct and border regions, with a larger increase in the secondary and tertiary eigenvalues.
Collapse
Affiliation(s)
- Tanjib Rahman
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Kévin Moulin
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| |
Collapse
|
14
|
Petersen AP, Cho N, Lyra-Leite DM, Santoso JW, Gupta D, Ariyasinghe NR, McCain ML. Regulation of calcium dynamics and propagation velocity by tissue microstructure in engineered strands of cardiac tissue. Integr Biol (Camb) 2021; 12:34-46. [PMID: 32118279 DOI: 10.1093/intbio/zyaa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 01/13/2023]
Abstract
Disruptions to cardiac tissue microstructure are common in diseased or injured myocardium and are known substrates for arrhythmias. However, we have a relatively coarse understanding of the relationships between myocardial tissue microstructure, propagation velocity and calcium cycling, due largely to the limitations of conventional experimental tools. To address this, we used microcontact printing to engineer strands of cardiac tissue with eight different widths, quantified several structural and functional parameters and established correlation coefficients. As strand width increased, actin alignment, nuclei density, sarcomere index and cell aspect ratio decreased with unique trends. The propagation velocity of calcium waves decreased and the rise time of calcium transients increased with increasing strand width. The decay time constant of calcium transients decreased and then slightly increased with increasing strand width. Based on correlation coefficients, actin alignment was the strongest predictor of propagation velocity and calcium transient rise time. Sarcomere index and cell aspect ratio were also strongly correlated with propagation velocity. Actin alignment, sarcomere index and cell aspect ratio were all weak predictors of the calcium transient decay time constant. We also measured the expression of several genes relevant to propagation and calcium cycling and found higher expression of the genes that encode for connexin 43 (Cx43) and a subunit of L-type calcium channels in thin strands compared to isotropic tissues. Together, these results suggest that thinner strands have higher values of propagation velocity and calcium transient rise time due to a combination of favorable tissue microstructure and enhanced expression of genes for Cx43 and L-type calcium channels. These data are important for defining how microstructural features regulate intercellular and intracellular calcium handling, which is needed to understand mechanisms of propagation in physiological situations and arrhythmogenesis in pathological situations.
Collapse
Affiliation(s)
- Andrew P Petersen
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Nathan Cho
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Davi M Lyra-Leite
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey W Santoso
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Divya Gupta
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Nethika R Ariyasinghe
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Megan L McCain
- Laboratory for Living Systems Engineering, Department of Biomedical Engineering, USC Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.,Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
15
|
Li W, Gao H, Mangion K, Berry C, Luo X. Apparent growth tensor of left ventricular post myocardial infarction - In human first natural history study. Comput Biol Med 2020; 129:104168. [PMID: 33341555 DOI: 10.1016/j.compbiomed.2020.104168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
An outstanding challenge in modelling biomechanics after myocardial infarction (MI) is to estimate the so-called growth tensor. Since it is impossible to track pure growth induced geometry change from in vivo magnetic resonance images alone, in this work, we propose a way of estimating a surrogate or apparent growth tensor of the human left ventricle using cine magnetic resonance (CMR) and late gadolinium enhanced (LGE) images of 16 patients following acute MI. The apparent growth tensor is evaluated at four time-points following myocardial reperfusion: 4-12 h (baseline), 3 days, 10 days and 7 months. We have identified three different growth patterns classified as the Dilation, No-Change and Shrinkage groups defined by the left ventricle end-diastole cavity volume change from baseline. We study the- trends in both the infarct and remote regions. Importantly, although the No-Change group has little change in the ventricular cavity volume, significant remodelling changes are seen within the myocardial wall, both in the infarct and remote regions. Through statistical analysis, we show that the growth tensor invariants can be used as effective biomarkers for adverse and favourable remodelling of the heart from 10 days onwards post-MI with statistically significant changes over time, in contrast to most of the routine clinical indices. We believe this is the first time that the apparent growth tensor has been estimated from in vivo CMR images post-MI. Our study not only provides much-needed information for understanding growth and remodelling in the human heart following acute MI, but also identifies novel biomarker for assessing heart disease progression.
Collapse
Affiliation(s)
- Wenguang Li
- School of Engineering, University of Glasgow, UK.
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, UK.
| | - Kenneth Mangion
- College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Colin Berry
- College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, UK.
| |
Collapse
|
16
|
Wan Ab Naim WN, Mokhtarudin MJM, Lim E, Chan BT, Ahmad Bakir A, Nik Mohamed NA. The study of border zone formation in ischemic heart using electro-chemical coupled computational model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3398. [PMID: 32857480 DOI: 10.1002/cnm.3398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Myocardial infarction (MI) is the most common cause of a heart failure, which occurs due to myocardial ischemia leading to left ventricular (LV) remodeling. LV remodeling particularly occurs at the ischemic area and the region surrounds it, known as the border zone. The role of the border zone in initiating LV remodeling process urges the investigation on the correlation between early border zone changes and remodeling outcome. Thus, this study aims to simulate a preliminary conceptual work of the border zone formation and evolution during onset of MI and its effect towards early LV remodeling processes by incorporating the oxygen concentration effect on the electrophysiology of an idealized three-dimensional LV through electro-chemical coupled mathematical model. The simulation result shows that the region of border zone, represented by the distribution of electrical conductivities, keeps expanding over time. Based on this result, the border zone is also proposed to consist of three sub-regions, namely mildly, moderately, and seriously impaired conductivity regions, which each region categorized depending on its electrical conductivities. This division could be used as a biomarker for classification of reversible and irreversible myocardial injury and will help to identify the different risks for the survival of patient. Larger ischemic size and complete occlusion of the coronary artery can be associated with an increased risk of developing irreversible injury, in particular if the reperfusion treatment is delayed. Increased irreversible injury area can be related with cardiovascular events and will further deteriorate the LV function over time.
Collapse
Affiliation(s)
- Wan N Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, Pekan, Malaysia
| | - Mohd J Mohamed Mokhtarudin
- Department of Mechanical Engineering, College of Engineering, University Malaysia Pahang, Kuantan, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee T Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham, Semenyih, Malaysia
| | - Azam Ahmad Bakir
- University of Southampton Malaysia Campus, Iskandar Puteri, Malaysia
| | - Nik A Nik Mohamed
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, Pekan, Malaysia
| |
Collapse
|
17
|
Abstract
Advances in technology have made it possible to image the microstructure of the heart with diffusion-weighted magnetic resonance. The technique provides unique insights into the cellular architecture of the myocardium and how this is perturbed in a range of disease contexts. In this review, the physical basis of diffusion MRI and the challenges of implementing it in the beating heart are discussed. Cutting edge acquisition and analysis techniques, as well as the results of initial clinical studies, are reported.
Collapse
Affiliation(s)
- David E Sosnovik
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Health Sciences and Technology, Harvard Medical School and Massachusetts Institute of Technology, Cambridge, MA, USA.
| |
Collapse
|
18
|
Wan Ab Naim WN, Mohamed Mokhtarudin MJ, Chan BT, Lim E, Ahmad Bakir A, Nik Mohamed NA. The study of myocardial ischemia-reperfusion treatment through computational modelling. J Theor Biol 2020; 509:110527. [PMID: 33096094 DOI: 10.1016/j.jtbi.2020.110527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
Reperfusion of the blood flow to ischemic myocardium is the standard treatment for patients suffering myocardial infarction. However, the reperfusion itself can also induce myocardial injury, in which the actual mechanism and its risk factors remain unclear. This work aims to study the mechanism of ischemia-reperfusion treatment using a three-dimensional (3D) oxygen diffusion model. An electrical model is then coupled to an oxygen model to identify the possible region of myocardial damage. Our findings show that the value of oxygen exceeds its optimum (>1.0) at the ischemic area during early reperfusion period. This complication was exacerbated in a longer ischemic period. While a longer reperfusion time causes a continuous excessive oxygen supply to the ischemic area throughout the reperfusion time. This work also suggests the use of less than 0.8 of initial oxygen concentration in the reperfusion treatment to prevent undesired upsurge at the early reperfusion period and further myocardial injury. We also found the region at risk for myocardial injury is confined in the ischemic vicinity revealed by its electrical conductivity impairment. Although there is a risk that reperfusion leads to myocardial injury for excessive oxygen accumulation, the reperfusion treatment is helpful in reducing the infarct size.
Collapse
Affiliation(s)
- Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
| | - Mohd Jamil Mohamed Mokhtarudin
- Department of Mechanical Engineering, College of Engineering, University Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia.
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing Engineering, Faculty of Science and Engineering, University of Nottingham, 43500 Selangor, Malaysia
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Azam Ahmad Bakir
- University of Southampton Malaysia Campus, No 3, Persiaran Canselor 1, Kota Ilmu Educity, 79200 Iskandar Puteri, Johor, Malaysia
| | - Nik Abdullah Nik Mohamed
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600 Pekan, Pahang, Malaysia
| |
Collapse
|
19
|
Guan D, Yao J, Luo X, Gao H. Effect of myofibre architecture on ventricular pump function by using a neonatal porcine heart model: from DT-MRI to rule-based methods. ROYAL SOCIETY OPEN SCIENCE 2020; 7:191655. [PMID: 32431869 PMCID: PMC7211874 DOI: 10.1098/rsos.191655] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/26/2020] [Indexed: 05/17/2023]
Abstract
Myofibre architecture is one of the essential components when constructing personalized cardiac models. In this study, we develop a neonatal porcine bi-ventricle model with three different myofibre architectures for the left ventricle (LV). The most realistic one is derived from ex vivo diffusion tensor magnetic resonance imaging, and other two simplifications are based on rule-based methods (RBM): one is regionally dependent by dividing the LV into 17 segments, each with different myofibre angles, and the other is more simplified by assigning a set of myofibre angles across the whole ventricle. Results from different myofibre architectures are compared in terms of cardiac pump function. We show that the model with the most realistic myofibre architecture can produce larger cardiac output, higher ejection fraction and larger apical twist compared with those of the rule-based models under the same pre/after-loads. Our results also reveal that when the cross-fibre contraction is included, the active stress seems to play a dual role: its sheet-normal component enhances the ventricular contraction while its sheet component does the opposite. We further show that by including non-symmetric fibre dispersion using a general structural tensor, even the most simplified rule-based myofibre model can achieve similar pump function as the most realistic one, and cross-fibre contraction components can be determined from this non-symmetric dispersion approach. Thus, our study highlights the importance of including myofibre dispersion in cardiac modelling if RBM are used, especially in personalized models.
Collapse
Affiliation(s)
- Debao Guan
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Jiang Yao
- Dassault Systemes, Johnston, RI, USA
| | - Xiaoyu Luo
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
| | - Hao Gao
- School of Mathematics & Statistics, University of Glasgow, Glasgow, UK
- Author for correspondence: Hao Gao e-mail:
| |
Collapse
|
20
|
Nielles-Vallespin S, Scott A, Ferreira P, Khalique Z, Pennell D, Firmin D. Cardiac Diffusion: Technique and Practical Applications. J Magn Reson Imaging 2019; 52:348-368. [PMID: 31482620 DOI: 10.1002/jmri.26912] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022] Open
Abstract
The 3D microarchitecture of the cardiac muscle underlies the mechanical and electrical properties of the heart. Cardiomyocytes are arranged helically through the depth of the wall, and their shortening leads to macroscopic torsion, twist, and shortening during cardiac contraction. Furthermore, cardiomyocytes are organized in sheetlets separated by shear layers, which reorientate, slip, and shear during macroscopic left ventricle (LV) wall thickening. Cardiac diffusion provides a means for noninvasive interrogation of the 3D microarchitecture of the myocardium. The fundamental principle of MR diffusion is that an MRI signal is attenuated by the self-diffusion of water in the presence of large diffusion-encoding gradients. Since water molecules are constrained by the boundaries in biological tissue (cell membranes, collagen layers, etc.), depicting their diffusion behavior elucidates the shape of the myocardial microarchitecture they are embedded in. Cardiac diffusion therefore provides a noninvasive means to understand not only the dynamic changes in cardiac microstructure of healthy myocardium during cardiac contraction but also the pathophysiological changes in the presence of disease. This unique and innovative technology offers tremendous potential to enable improved clinical diagnosis through novel microstructural and functional assessment. in vivo cardiac diffusion methods are immediately translatable to patients, opening new avenues for diagnostic investigation and treatment evaluation in a range of clinically important cardiac pathologies. This review article describes the 3D microstructure of the LV, explains in vivo and ex vivo cardiac MR diffusion acquisition and postprocessing techniques, as well as clinical applications to date. Level of Evidence: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019. J. Magn. Reson. Imaging 2020;52:348-368.
Collapse
Affiliation(s)
- Sonia Nielles-Vallespin
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| | - Andrew Scott
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| | - Pedro Ferreira
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| | - Zohya Khalique
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| | - Dudley Pennell
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| | - David Firmin
- Cardiovascular MR Unit, Royal Brompton And Harefield NHS Foundation Trust, London, UK.,NHLI, Imperial College of Science, Technology and Medicine, London, UK
| |
Collapse
|
21
|
Cork TE, Perotti LE, Verzhbinsky IA, Loecher M, Ennis DB. High-Resolution Ex Vivo Microstructural MRI After Restoring Ventricular Geometry via 3D Printing. FUNCTIONAL IMAGING AND MODELING OF THE HEART : ... INTERNATIONAL WORKSHOP, FIMH ..., PROCEEDINGS. FIMH 2019; 11504:177-186. [PMID: 31432042 DOI: 10.1007/978-3-030-21949-9_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Computational modeling of the heart requires accurately incorporating both gross anatomical detail and local microstructural information. Together, these provide the necessary data to build 3D meshes for simulation of cardiac mechanics and electrophysiology. Recent MRI advances make it possible to measure detailed heart motion in vivo, but in vivo microstructural imaging of the heart remains challenging. Consequently, the most detailed measurements of microstructural organization and microanatomical infarct details are obtained ex vivo. The objective of this work was to develop and evaluate a new method for restoring ex vivo ventricular geometry to match the in vivo configuration. This approach aids the integration of high-resolution ex vivo microstructural information with in vivo motion measurements. The method uses in vivo cine imaging to generate surface meshes, then creates a 3D printed left ventricular (LV) blood pool cast and a pericardial mold to restore the ex vivo cardiac geometry to a mid-diastasis reference configuration. The method was evaluated in healthy (N = 7) and infarcted (N = 3) swine. Dice similarity coefficients were calculated between in vivo and ex vivo images for the LV cavity (0.93 ± 0.01), right ventricle (RV) cavity (0.80 ± 0.05), and the myocardium (0.72 ± 0.04). The R 2 coefficient between in vivo and ex vivo LV and RV cavity volumes were 0.95 and 0.91, respectively. These results suggest that this method adequately restores ex vivo geometry to match in vivo geometry. This approach permits a more precise incorporation of high-resolution ex vivo anatomical and microstructural data into computational models that use in vivo data for simulation of cardiac mechanics and electrophysiology.
Collapse
Affiliation(s)
- Tyler E Cork
- Department of Radiology, Stanford University, Stanford, CA 94305, USA.,Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Luigi E Perotti
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | | | - Michael Loecher
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| |
Collapse
|