Image-Based Left-Ventricular Shape Analysis for Sudden Cardiac Death Risk Stratification
Published Date:May 20 2014
Source:Heart Rhythm. 2014; 11(10):1693-1700.
Cardiac Magnetic Resonance Imaging
Death, Sudden, Cardiac
Image Processing, Computer-Assisted
Implantable Cardioverter Defibrillator
Magnetic Resonance Imaging, Cine
Sudden Cardiac Death
Ventricular Function, Left
Pubmed Central ID:PMC4177952
Funding:DP1 HL123271/HL/NHLBI NIH HHS/United States
DP1HL123271/DP/NCCDPHP CDC HHS/United States
R01 HL103428/HL/NHLBI NIH HHS/United States
R01 HL103812/HL/NHLBI NIH HHS/United States
R01HL103428/HL/NHLBI NIH HHS/United States
R01HL103812/HL/NHLBI NIH HHS/United States
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.
To uncover indices of LV shape that differ between patients with a high risk of SCD and those with a low risk.
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.
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.
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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