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Maillot A, Sridi S, Pineau X, André-Billeau A, Hosteins S, Maes JD, Montier G, Nuñez-Garcia M, Quesson B, Sermesant M, Cochet H, Stuber M, Bustin A. Automated inversion time selection for black-blood late gadolinium enhancement cardiac imaging in clinical practice. MAGMA 2023; 36:877-885. [PMID: 37294423 PMCID: PMC10667449 DOI: 10.1007/s10334-023-01101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/25/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To simplify black-blood late gadolinium enhancement (BL-LGE) cardiac imaging in clinical practice using an image-based algorithm for automated inversion time (TI) selection. MATERIALS AND METHODS The algorithm selects from BL-LGE TI scout images, the TI corresponding to the image with the highest number of sub-threshold pixels within a region of interest (ROI) encompassing the blood-pool and myocardium. The threshold value corresponds to the most recurrent pixel intensity of all scout images within the ROI. ROI dimensions were optimized in 40 patients' scans. The algorithm was validated retrospectively (80 patients) versus two experts and tested prospectively (5 patients) on a 1.5 T clinical scanner. RESULTS Automated TI selection took ~ 40 ms per dataset (manual: ~ 17 s). Fleiss' kappa coefficient for automated-manual, intra-observer and inter-observer agreements were [Formula: see text]= 0.73, [Formula: see text] = 0.70 and [Formula: see text] = 0.63, respectively. The agreement between the algorithm and any expert was better than the agreement between the two experts or between two selections of one expert. DISCUSSION Thanks to its good performance and simplicity of implementation, the proposed algorithm is a good candidate for automated BL-LGE imaging in clinical practice.
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Affiliation(s)
- Aurélien Maillot
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France
| | - Soumaya Sridi
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Xavier Pineau
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Amandine André-Billeau
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Stéphanie Hosteins
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Jean-David Maes
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Géraldine Montier
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Marta Nuñez-Garcia
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France
| | - Bruno Quesson
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France
| | | | - Hubert Cochet
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- CIBM Center for Biomedical Imaging, Lausanne, Switzerland
| | - Aurélien Bustin
- IHU LIRYC, Electrophysiology and Heart Modelling Institute, Université de Bordeaux, INSERM, U1045, Avenue du Haut-Lévêque, 33604, Pessac, France.
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, 33604, Pessac, France.
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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2
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Kowalewski C, Ascione C, Nuñez-Garcia M, Ly B, Sermesant M, Bustin A, Sridi S, Bouteiller X, Yokoyama M, Vlachos K, Monaco C, Bouyer B, Buliard S, Arnaud M, Tixier R, Chauvel R, Derval N, Pambrun T, Duchateau J, Bordachar P, Hocini M, Hindricks G, Haïssaguerre M, Sacher F, Jais P, Cochet H. Advanced Imaging Integration for Catheter Ablation of Ventricular Tachycardia. Curr Cardiol Rep 2023; 25:535-542. [PMID: 37115434 DOI: 10.1007/s11886-023-01872-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Imaging plays a crucial role in the therapy of ventricular tachycardia (VT). We offer an overview of the different methods and provide information on their use in a clinical setting. RECENT FINDINGS The use of imaging in VT has progressed recently. Intracardiac echography facilitates catheter navigation and the targeting of moving intracardiac structures. Integration of pre-procedural CT or MRI allows for targeting the VT substrate, with major expected impact on VT ablation efficacy and efficiency. Advances in computational modeling may further enhance the performance of imaging, giving access to pre-operative simulation of VT. These advances in non-invasive diagnosis are increasingly being coupled with non-invasive approaches for therapy delivery. This review highlights the latest research on the use of imaging in VT procedures. Image-based strategies are progressively shifting from using images as an adjunct tool to electrophysiological techniques, to an integration of imaging as a central element of the treatment strategy.
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Affiliation(s)
- Christopher Kowalewski
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
| | - Ciro Ascione
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marta Nuñez-Garcia
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Buntheng Ly
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Aurélien Bustin
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Soumaya Sridi
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Xavier Bouteiller
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Masaaki Yokoyama
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Cinzia Monaco
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Benjamin Bouyer
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Gerhard Hindricks
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Sridi S, Nuñez-Garcia M, Sermesant M, Maillot A, Hamrani DE, Magat J, Naulin J, Laurent F, Montaudon M, Jaïs P, Stuber M, Cochet H, Bustin A. Improved myocardial scar visualization with fast free-breathing motion-compensated black-blood T 1-rho-prepared late gadolinium enhancement MRI. Diagn Interv Imaging 2022; 103:607-617. [PMID: 35961843 DOI: 10.1016/j.diii.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Clinical guidelines recommend the use of bright-blood late gadolinium enhancement (BR-LGE) for the detection and quantification of regional myocardial fibrosis and scar. This technique, however, may suffer from poor contrast at the blood-scar interface, particularly in patients with subendocardial myocardial infarction. The purpose of this study was to assess the clinical performance of a two-dimensional black-blood LGE (BL-LGE) sequence, which combines free-breathing T1-rho-prepared single-shot acquisitions with an advanced non-rigid motion-compensated patch-based reconstruction. MATERIALS AND METHODS Extended phase graph simulations and phantom experiments were performed to investigate the performance of the motion-correction algorithm and to assess the black-blood properties of the proposed sequence. Fifty-one patients (37 men, 14 women; mean age, 55 ± 15 [SD] years; age range: 19-81 years) with known or suspected cardiac disease prospectively underwent free-breathing T1-rho-prepared BL-LGE imaging with inline non-rigid motion-compensated patch-based reconstruction at 1.5T. Conventional breath-held BR-LGE images were acquired for comparison purposes. Acquisition times were recorded. Two readers graded the image quality and relative contrasts were calculated. Presence, location, and extent of LGE were evaluated. RESULTS BL-LGE images were acquired with full ventricular coverage in 115 ± 25 (SD) sec (range: 64-160 sec). Image quality was significantly higher on free-breathing BL-LGE imaging than on its breath-held BR-LGE counterpart (3.6 ± 0.7 [SD] [range: 2-4] vs. 3.9 ± 0.2 [SD] [range: 3-4]) (P <0.01) and was graded as diagnostic for 44/51 (86%) patients. The mean scar-to-myocardium and scar-to-blood relative contrasts were significantly higher on BL-LGE images (P < 0.01 for both). The extent of LGE was larger on BL-LGE (median, 5 segments [IQR: 2, 7 segments] vs. median, 4 segments [IQR: 1, 6 segments]) (P < 0.01), the method being particularly sensitive in segments with LGE involving the subendocardium or papillary muscles. In eight patients (16%), BL-LGE could ascertain or rule out a diagnosis otherwise inconclusive on BR-LGE. CONCLUSION Free-breathing T1-rho-prepared BL-LGE imaging with inline motion compensated reconstruction offers a promising diagnostic technology for the non-invasive assessment of myocardial injuries.
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Affiliation(s)
- Soumaya Sridi
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 33000, Pessac, France.
| | - Marta Nuñez-Garcia
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - Maxime Sermesant
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France; INRIA, Université Côte d'Azur, Sophia Antipolis, 06902, Valbonne, France
| | - Aurélien Maillot
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - Dounia El Hamrani
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - Julie Magat
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - Jérôme Naulin
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - François Laurent
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 33000, Pessac, France
| | - Michel Montaudon
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 33000, Pessac, France
| | - Pierre Jaïs
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France; Department of Cardiac Electrophysiologhy, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33600, Pessac, France
| | - Matthias Stuber
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland; Center for Biomedical Imaging (CIBM), 1015, Lausanne, Switzerland
| | - Hubert Cochet
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 33000, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France
| | - Aurélien Bustin
- Department of Cardiovascular Imaging, Groupe Hospitalier Sud, CHU Bordeaux, 33000, Pessac, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, INSERM U1045, 33600, Pessac, France; Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
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5
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Nakatani Y, Nuñez-Garcia M, Cheniti G, Sridi-Cheniti S, Bustin A, Jia S, Goujeau C, André C, Nakashima T, Krisai P, Takagi T, Kamakura T, Derval N, Duchateau J, Pambrun T, Chauvel R, Sacher F, Hocini M, Haïssaguerre M, Sermesant M, Jais P, Cochet H. Preoperative Personalization of Atrial Fibrillation Ablation Strategy to Prevent Esophageal Injury: Impact of Changes in Esophageal Position. J Cardiovasc Electrophysiol 2022; 33:908-916. [PMID: 35274776 DOI: 10.1111/jce.15447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Due to changes in esophageal position, preoperative assessment of the esophageal location may not mitigate the risk of esophageal injury in catheter ablation for atrial fibrillation (AF). This study aimed to assess esophageal motion and its impact on AF ablation strategies. METHODS AND RESULTS Ninety-seven AF patients underwent 2 computed tomography (CT) scans. The area at risk of esophageal injury (AAR) was defined as the left atrial surface ≤3 mm from the esophagus. On CT1, ablation lines were drawn blinded to the esophageal location to create 3 ablation sets: individual pulmonary vein isolation (PVI), wide antral circumferential ablation (WACA), and WACA with linear ablation (WACA+L). Thereafter, ablation lines for WACA and WACA+L were personalized to avoid the AAR. Rigid registration was performed to align CT1 onto CT2, and the relationship between ablation lines and the AAR on CT2 was analyzed. The esophagus moved by 3.6 [2.7 to 5.5] mm. The AAR on CT2 was 8.6 ± 3.3 cm2 , with 77% overlapping that on CT1. High body mass index was associated with the AAR mismatch (standardized β 0.382, P <0.001). Without personalization, AARs on ablation lines for individual PVI, WACA, and WACA+L were 0 [0-0.4], 0.8 [0.5-1.2], 1.7 [1.2-2.0] cm2 . Despite the esophageal position change, the personalization of ablation lines for WACA and WACA+L reduced the AAR on lines to 0 [0-0.5] and 0.7 [0.3-1.0] cm2 (P <0.001 for both). CONCLUSION The personalization of ablation lines based on a preoperative CT reduced ablation to the AAR despite changes in esophageal position. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Marta Nuñez-Garcia
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Soumaya Sridi-Cheniti
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Aurélien Bustin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Shuman Jia
- INRIA Epione research team, Sophia Antipolis, France
| | - Cyril Goujeau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Clementine André
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takashi Nakashima
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Philipp Krisai
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Takamitsu Takagi
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Josselin Duchateau
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Maxime Sermesant
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,INRIA Epione research team, Sophia Antipolis, France
| | - Pierre Jais
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France.,Université de Bordeaux, Bordeaux, France.,Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
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6
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Caixal G, Alarcón F, Althoff TF, Nuñez-Garcia M, Benito EM, Borràs R, Perea RJ, Prat-González S, Garre P, Soto-Iglesias D, Gunturitz C, Cozzari J, Linhart M, Tolosana JM, Arbelo E, Roca-Luque I, Sitges M, Guasch E, Mont L. Accuracy of left atrial fibrosis detection with cardiac magnetic resonance: correlation of late gadolinium enhancement with endocardial voltage and conduction velocity. Europace 2021; 23:380-388. [PMID: 33227129 DOI: 10.1093/europace/euaa313] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/23/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Myocardial fibrosis is a hallmark of atrial fibrillation (AF) and its characterization could be used to guide ablation procedures. Late gadolinium enhanced-magnetic resonance imaging (LGE-MRI) detects areas of atrial fibrosis. However, its accuracy remains controversial. We aimed to analyse the accuracy of LGE-MRI to identify left atrial (LA) arrhythmogenic substrate by analysing voltage and conduction velocity at the areas of LGE. METHODS AND RESULTS Late gadolinium enhanced-magnetic resonance imaging was performed before ablation in 16 patients. Atrial wall intensity was normalized to blood pool and classified as healthy, interstitial fibrosis, and dense scar tissue depending of the resulting image intensity ratio. Bipolar voltage and local conduction velocity were measured in LA with high-density electroanatomic maps recorded in sinus rhythm and subsequently projected into the LGE-MRI. A semi-automatic, point-by-point correlation was made between LGE-MRI and electroanatomical mapping. Mean bipolar voltage and local velocity progressively decreased from healthy to interstitial fibrosis to scar. There was a significant negative correlation between LGE with voltage (r = -0.39, P < 0.001) and conduction velocity (r = -0.25, P < 0.001). In patients showing dilated atria (LA diameter ≥45 mm) the conduction velocity predictive capacity of LGE-MRI was weaker (r = -0.40 ± 0.09 vs. -0.20 ± 0.13, P = 0.02). CONCLUSIONS Areas with higher LGE show lower voltage and slower conduction in sinus rhythm. The enhancement intensity correlates with bipolar voltage and conduction velocity in a point-by-point analysis. The performance of LGE-MRI in assessing local velocity might be reduced in patients with dilated atria (LA diameter ≥45).
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Affiliation(s)
- Gala Caixal
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Till F Althoff
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Department of Cardiology and Angiology, Charité-University Medicine Berlin, Charité Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marta Nuñez-Garcia
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Eva Maria Benito
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Rosario Jesus Perea
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Susana Prat-González
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Paz Garre
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - David Soto-Iglesias
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Clara Gunturitz
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jennifer Cozzari
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Markus Linhart
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Jose Maria Tolosana
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Arbelo
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ivo Roca-Luque
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Marta Sitges
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Guasch
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Mont
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, C/Villarroel 170, 08036 Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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7
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Xiong Z, Xia Q, Hu Z, Huang N, Bian C, Zheng Y, Vesal S, Ravikumar N, Maier A, Yang X, Heng PA, Ni D, Li C, Tong Q, Si W, Puybareau E, Khoudli Y, Géraud T, Chen C, Bai W, Rueckert D, Xu L, Zhuang X, Luo X, Jia S, Sermesant M, Liu Y, Wang K, Borra D, Masci A, Corsi C, de Vente C, Veta M, Karim R, Preetha CJ, Engelhardt S, Qiao M, Wang Y, Tao Q, Nuñez-Garcia M, Camara O, Savioli N, Lamata P, Zhao J. A global benchmark of algorithms for segmenting the left atrium from late gadolinium-enhanced cardiac magnetic resonance imaging. Med Image Anal 2021; 67:101832. [PMID: 33166776 DOI: 10.1016/j.media.2020.101832] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
Segmentation of medical images, particularly late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) used for visualizing diseased atrial structures, is a crucial first step for ablation treatment of atrial fibrillation. However, direct segmentation of LGE-MRIs is challenging due to the varying intensities caused by contrast agents. Since most clinical studies have relied on manual, labor-intensive approaches, automatic methods are of high interest, particularly optimized machine learning approaches. To address this, we organized the 2018 Left Atrium Segmentation Challenge using 154 3D LGE-MRIs, currently the world's largest atrial LGE-MRI dataset, and associated labels of the left atrium segmented by three medical experts, ultimately attracting the participation of 27 international teams. In this paper, extensive analysis of the submitted algorithms using technical and biological metrics was performed by undergoing subgroup analysis and conducting hyper-parameter analysis, offering an overall picture of the major design choices of convolutional neural networks (CNNs) and practical considerations for achieving state-of-the-art left atrium segmentation. Results show that the top method achieved a Dice score of 93.2% and a mean surface to surface distance of 0.7 mm, significantly outperforming prior state-of-the-art. Particularly, our analysis demonstrated that double sequentially used CNNs, in which a first CNN is used for automatic region-of-interest localization and a subsequent CNN is used for refined regional segmentation, achieved superior results than traditional methods and machine learning approaches containing single CNNs. This large-scale benchmarking study makes a significant step towards much-improved segmentation methods for atrial LGE-MRIs, and will serve as an important benchmark for evaluating and comparing the future works in the field. Furthermore, the findings from this study can potentially be extended to other imaging datasets and modalities, having an impact on the wider medical imaging community.
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Affiliation(s)
- Zhaohan Xiong
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Qing Xia
- State Key Lab of Virtual Reality Technology and Systems, Beihang University, Beijing, China
| | - Zhiqiang Hu
- School of Electronics Engineering and Computer Science, Peking University, Beijing, China
| | | | - Cheng Bian
- Tencent Jarvis Laboratory, Shenzhen, China
| | | | - Sulaiman Vesal
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nishant Ravikumar
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Xin Yang
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Caizi Li
- School of Computer Science, Wuhan University, Wuhan, China
| | - Qianqian Tong
- School of Computer Science, Wuhan University, Wuhan, China
| | - Weixin Si
- Shenzhen Key Laboratory of Virtual Reality and Human Interaction Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | | | - Younes Khoudli
- EPITA Research and Development Laboratory, Paris, France
| | - Thierry Géraud
- EPITA Research and Development Laboratory, Paris, France
| | - Chen Chen
- Department of Computing, Imperial College London, London, United Kingdom
| | - Wenjia Bai
- Department of Computing, Imperial College London, London, United Kingdom
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, United Kingdom
| | - Lingchao Xu
- School of Naval Architecture, Ocean & Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, China
| | - Xinzhe Luo
- School of Data Science, Fudan University, Shanghai, China
| | - Shuman Jia
- Inria, Université Côte d'Azur, Epione team, Sophia Antipolis, France
| | - Maxime Sermesant
- Inria, Université Côte d'Azur, Epione team, Sophia Antipolis, France
| | - Yashu Liu
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Kuanquan Wang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Davide Borra
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Alessandro Masci
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Cristiana Corsi
- Department of Electric, Electronic and Information Engineering, University of Bologna, Cesena, Italy
| | - Coen de Vente
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Mitko Veta
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Rashed Karim
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, United Kingdom
| | | | - Sandy Engelhardt
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - Menyun Qiao
- Biomedical Engineering Center, Fudan University, Shanghai, China
| | - Yuanyuan Wang
- Biomedical Engineering Center, Fudan University, Shanghai, China
| | - Qian Tao
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Nuñez-Garcia
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nicolo Savioli
- Department of Bioengineering, Kings College London, London, United Kingdom
| | - Pablo Lamata
- Department of Bioengineering, Kings College London, London, United Kingdom
| | - Jichao Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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8
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Benito EM, Cabanelas N, Nuñez-Garcia M, Alarcón F, Figueras I Ventura RM, Soto-Iglesias D, Guasch E, Prat-Gonzalez S, Perea RJ, Borràs R, Butakoff C, Camara O, Bisbal F, Arbelo E, Tolosana JM, Brugada J, Berruezo A, Mont L. Preferential regional distribution of atrial fibrosis in posterior wall around left inferior pulmonary vein as identified by late gadolinium enhancement cardiac magnetic resonance in patients with atrial fibrillation. Europace 2019; 20:1959-1965. [PMID: 29860416 DOI: 10.1093/europace/euy095] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/04/2018] [Indexed: 11/15/2022] Open
Abstract
Aims Left atrial (LA) fibrosis can be identified by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) in patients with atrial fibrillation (AF). However, there is limited information about anatomical fibrosis distribution in the left atrium. The aim is to determine whether there is a preferential spatial distribution of fibrosis in the left atrium in patients with AF. Methods and results A 3-Tesla LGE-CMR was performed in 113 consecutive patients referred for AF ablation. Images were post-processed and analysed using ADAS-AF software (Galgo Medical), which allows fibrosis identification in 3D colour-coded shells. A regional semiautomatic LA parcellation software was used to divide the atrial wall into 12 segments: 1-4, posterior wall; 5-6, floor; 7, septal wall; 8-11, anterior wall; 12, lateral wall. The presence and amount of fibrosis in each segment was obtained for analysis. After exclusions for artefacts and insufficient image quality, 76 LGE-MRI images (68%) were suitable for fibrosis analysis. Segments 3 and 5, closest to the left inferior pulmonary vein, had significantly higher fibrosis (40.42% ± 23.96 and 25.82% ± 21.24, respectively; P < 0.001), compared with other segments. Segments 8 and 10 in the anterior wall contained the lowest fibrosis (2.54% ± 5.78 and 3.82% ± 11.59, respectively; P < 0.001). Age >60 years was significantly associated with increased LA fibrosis [95% confidence interval (CI) 0.19-8.39, P = 0.04] and persistent AF approached significance (95% CI -0.19% to 7.83%, P = 0.08). Conclusion In patients with AF, the fibrotic area is preferentially located at the posterior wall and floor around the antrum of the left inferior pulmonary vein. Age >60 years was associated with increased fibrosis.
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Affiliation(s)
- Eva M Benito
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Nuno Cabanelas
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Marta Nuñez-Garcia
- Department of Information and Communication Technologies (DTIC), PhySense, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rosa M Figueras I Ventura
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - David Soto-Iglesias
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
| | - Susanna Prat-Gonzalez
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rosario J Perea
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Constantine Butakoff
- Department of Information and Communication Technologies (DTIC), PhySense, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Oscar Camara
- Department of Information and Communication Technologies (DTIC), PhySense, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Felipe Bisbal
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
- Heart Institute (iCOR), Hospital Universitari Germans Trias i Pujol, Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
| | - José Maria Tolosana
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
| | - Josep Brugada
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
| | - Antonio Berruezo
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
| | - Lluís Mont
- Department of Cardiology, Unitat de Fibril.lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, C/ Villarroel N° 170, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
- CIBER de Enfermedades Cardiovasculares, Barcelona, Catalonia, Spain
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9
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Mărgulescu AD, Nuñez-Garcia M, Alarcón F, Benito EM, Enomoto N, Cozzari J, Chipa F, Fernandez H, Borras R, Guasch E, Butakoff C, Tolosana JM, Arbelo E, Camara O, Mont L. Reproducibility and accuracy of late gadolinium enhancement cardiac magnetic resonance measurements for the detection of left atrial fibrosis in patients undergoing atrial fibrillation ablation procedures. Europace 2019; 21:724-731. [DOI: 10.1093/europace/euy314] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/11/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrei D Mărgulescu
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
- Department of Cardiology, Morriston Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
| | - Marta Nuñez-Garcia
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Alarcón
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Eva M Benito
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Norihiro Enomoto
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Jennifer Cozzari
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Fredy Chipa
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Hael Fernandez
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Roger Borras
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
- CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Spain
| | - Constantine Butakoff
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jose M Tolosana
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
| | - Oscar Camara
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluís Mont
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain
- CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Spain
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10
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Nuñez-Garcia M, Camara O, O'Neill MD, Razavi R, Chubb H, Butakoff C. Mind the gap: Quantification of incomplete ablation patterns after pulmonary vein isolation using minimum path search. Med Image Anal 2018; 51:1-12. [PMID: 30347332 DOI: 10.1016/j.media.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
Pulmonary vein isolation (PVI) is a common procedure for the treatment of atrial fibrillation (AF) since the initial trigger for AF frequently originates in the pulmonary veins. A successful isolation produces a continuous lesion (scar) completely encircling the veins that stops activation waves from propagating to the atrial body. Unfortunately, the encircling lesion is often incomplete, becoming a combination of scar and gaps of healthy tissue. These gaps are potential causes of AF recurrence, which requires a redo of the isolation procedure. Late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) is a non-invasive method that may also be used to detect gaps, but it is currently a time-consuming process, prone to high inter-observer variability. In this paper, we present a method to semi-automatically identify and quantify ablation gaps. Gap quantification is performed through minimum path search in a graph where every node is a scar patch and the edges are the geodesic distances between patches. We propose the Relative Gap Measure (RGM) to estimate the percentage of gap around a vein, which is defined as the ratio of the overall gap length and the total length of the path that encircles the vein. Additionally, an advanced version of the RGM has been developed to integrate gap quantification estimates from different scar segmentation techniques into a single figure-of-merit. Population-based statistical and regional analysis of gap distribution was performed using a standardised parcellation of the left atrium. We have evaluated our method on synthetic and clinical data from 50 AF patients who underwent PVI with radiofrequency ablation. The population-based analysis concluded that the left superior PV is more prone to lesion gaps while the left inferior PV tends to have less gaps (p < .05 in both cases), in the processed data. This type of information can be very useful for the optimization and objective assessment of PVI interventions.
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Affiliation(s)
- Marta Nuñez-Garcia
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Oscar Camara
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mark D O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Reza Razavi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - Constantine Butakoff
- Physense, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
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11
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García-Isla G, Olivares AL, Silva E, Nuñez-Garcia M, Butakoff C, Sanchez-Quintana D, G Morales H, Freixa X, Noailly J, De Potter T, Camara O. Sensitivity analysis of geometrical parameters to study haemodynamics and thrombus formation in the left atrial appendage. Int J Numer Method Biomed Eng 2018; 34:e3100. [PMID: 29737037 DOI: 10.1002/cnm.3100] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/02/2018] [Accepted: 04/15/2018] [Indexed: 06/08/2023]
Abstract
The left atrial appendage (LAA) is a complex and heterogeneous protruding structure of the left atrium (LA). In atrial fibrillation patients, it is the location where 90% of the thrombi are formed. However, the role of the LAA in thrombus formation is not fully known yet. The main goal of this work is to perform a sensitivity analysis to identify the most relevant LA and LAA morphological parameters in atrial blood flow dynamics. Simulations were run on synthetic ellipsoidal left atria models where different parameters were individually studied: pulmonary veins and mitral valve dimensions; LAA shape; and LA volume. Our computational analysis confirmed the relation between large LAA ostia, low blood flow velocities and thrombus formation. Additionally, we found that pulmonary vein configuration exerted a critical influence on LAA blood flow patterns. These findings contribute to a better understanding of the LAA and to support clinical decisions for atrial fibrillation patients.
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Affiliation(s)
- Guadalupe García-Isla
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Andy Luis Olivares
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Etelvino Silva
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Center, Aalst, Belgium
| | - Marta Nuñez-Garcia
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Constantine Butakoff
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Hernán G Morales
- Medisys, Philips Research, Paris, France
- Centro de Fisiologia del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago de Chile, Chile
| | - Xavier Freixa
- Department of Cardiology, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jérôme Noailly
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Tom De Potter
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Center, Aalst, Belgium
| | - Oscar Camara
- BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
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12
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Chubb H, Karim R, Roujol S, Nuñez-Garcia M, Williams SE, Whitaker J, Harrison J, Butakoff C, Camara O, Chiribiri A, Schaeffter T, Wright M, O’Neill M, Razavi R. The reproducibility of late gadolinium enhancement cardiovascular magnetic resonance imaging of post-ablation atrial scar: a cross-over study. J Cardiovasc Magn Reson 2018; 20:21. [PMID: 29554919 PMCID: PMC5858144 DOI: 10.1186/s12968-018-0438-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. METHODS Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters ('Repro', n = 10), 3 T scanner ('3 T', n = 10), half-slice thickness ('Half-slice', n = 10) or half GBCA dose ('Half-gad', n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). RESULTS A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for 'Repro' group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454-0.825, PVE 0.618-0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, 'Repro' group). There was no significant relationship between indices of PAAS and AF recurrence. CONCLUSION PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome. TRIAL REGISTRATION United Kingdom National Research Ethics Service 08/H0802/68 - 30th September 2008.
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Affiliation(s)
- Henry Chubb
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Rashed Karim
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Marta Nuñez-Garcia
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Steven E. Williams
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - James Harrison
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Constantine Butakoff
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oscar Camara
- PhySense, Department of Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Tobias Schaeffter
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
| | - Matthew Wright
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Mark O’Neill
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
- Department of Cardiology, St Thomas’ Hospital, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH UK
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13
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Sarvari SI, Rodriguez-Lopez M, Nuñez-Garcia M, Sitges M, Sepulveda-Martinez A, Camara O, Butakoff C, Gratacos E, Bijnens B, Crispi F. Persistence of Cardiac Remodeling in Preadolescents With Fetal Growth Restriction. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005270. [PMID: 28093413 DOI: 10.1161/circimaging.116.005270] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. We evaluated whether prenatal cardiovascular changes previously demonstrated in FGR persist into preadolescence. METHODS AND RESULTS A cohort study of 58 FGR (defined as birth weight below 10th centile) and 94 normally grown fetuses identified in utero and followed-up into preadolescence (8-12 years of age) by echocardiography and 3-dimensional shape computational analysis. Compared with controls, FGR preadolescents had a different cardiac shape, with more spherical and smaller hearts. Left ventricular ejection fraction was similar among groups, whereas FGR had decreased longitudinal motion (decreased mitral annular systolic peak velocities: control median, 0.11 m/s [interquartile range, 0.09-0.12] versus FGR median 0.09 m/s [interquartile range, 0.09-0.10]; P<0.01) and impaired relaxation (isovolumic relaxation time: control, 0.21 ms [interquartile range, 0.12-0.35] versus FGR, 0.35 ms [interquartile range, 0.20-0.46]; P=0.04). Global longitudinal strain was decreased (control mean, -22.4% [SD, 1.37] versus FGR mean, -21.5% [SD, 1.16]; P<0.001) compensated by an increased circumferential strain and with a higher prevalence of postsystolic shortening in FGR as compared with controls. These differences persisted after adjustment for parental ethnicity and smoking, prenatal glucocorticoid administration, preeclampsia, gestational age at delivery, days in intensive care unit, sex, age, and body surface area at evaluation. CONCLUSIONS This study provides evidence that cardiac remodeling induced by FGR persists until preadolescence with findings similar to those reported in their prenatal life and childhood. The findings support the hypothesis of primary cardiac programming in FGR for explaining the association between low birth weight and cardiovascular risk in adulthood.
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Affiliation(s)
- Sebastian Imre Sarvari
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Merida Rodriguez-Lopez
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Marta Nuñez-Garcia
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Marta Sitges
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Alvaro Sepulveda-Martinez
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Oscar Camara
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Constantine Butakoff
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Eduard Gratacos
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Bart Bijnens
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.)
| | - Fatima Crispi
- From the Cardiology Department, Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.I.S., M.S.); Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Norway (S.I.S.); Fetal i+D Fetal Medicine Research Center, IDIBAPS (M.R.-L., A.S.-M., E.G., F.C.) and BCNatal
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu (M.R.-L., A.S.-M., E.G., F.C.), Universitat de Barcelona, Spain; PhySense, Department of Information and Communication Technologies (DTIC), Universitat Pompeu Fabra, Barcelona, Spain (M.N.-G., O.C., C.B., B.B.); Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain (E.G., F.C.); and ICREA, Barcelona, Spain (B.B.).
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