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Image-Based Left-Ventricular Shape Analysis for Sudden Cardiac Death Risk Stratification
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May 20 2014
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Source: Heart Rhythm. 2014; 11(10):1693-1700
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Alternative Title:Heart Rhythm
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Description:Background
Low left-ventricular ejection fraction (LVEF), the main criterion used in current clinical practice to stratify sudden cardiac death (SCD) risk, has very low sensitivity and specificity.
Objective
To uncover indices of LV shape that differ between patients with a high risk of SCD and those with a low risk.
Methods
Utilizing clinical cardiac magnetic resonance (CMR) imaging and computational anatomy tools, a novel computational framework to compare three-dimensional (3D) LV endocardial surface curvedness, wall thickness (WT), and relative wall thickness (RWT) between patient groups was implemented. The framework was applied to CMR data of 61 patients with ischemic cardiomyopathy who were selected for prophylactic implantable cardioverter defibrillator treatment based on reduced LVEF. The patients were classified by outcome: group 0 had no events; group 1, arrhythmic events, and group 2, heart failure (HF). Segmental differences in LV shape were assessed.
Results
Global LV volumes and mass were similar amongst groups. Compared to patients with no events, patients in groups 1 and 2 had lower mean shape metrics in all coronary artery regions, with statistical significance in 9 comparisons, reflecting wall thinning and stretching/flattening.
Conclusions
Among patients with ischemic cardiomyopathy and low LVEF, there exist quantifiable differences in 3D endocardial surface curvedness, LVWT, and LVRWT between those with no clinical events, and those with arrhythmic or HF outcomes, reflecting adverse LV remodeling. This retrospective study is a proof-of-concept to demonstrate that regional LV remodeling indices have the potential to improve personalized risk assessment for SCD.
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Pubmed ID:24854217
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Pubmed Central ID:PMC4177952
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