Key result
3D personalized left ventricular modeling revealed significantly higher dyssynchrony in AMI patients compared to healthy subjects (15.0% vs. 7.5%, P < 0.01).
Why the study?
Does a 3D personalized LV model and thickening assessment framework accurately assess regional wall thickening dysfunction and dyssynchrony compared to clinical evaluation in AMI patients?
Observational (n=44)
Does a 3D personalized LV model and thickening assessment framework accurately assess regional wall thickening dysfunction and dyssynchrony compared to clinical evaluation in AMI patients?
A novel 3D personalized LV modeling framework using MRI can accurately assess regional wall thickening dysfunction and dyssynchrony, correlating strongly with infarct severity in AMI patients.
May inform dyssynchrony assessment in AMI; leaves open clinical adoption pending prospective validation.
BACKGROUND: Existing clinical diagnostic and assessment methods could be improved to facilitate early detection and treatment of cardiac dysfunction associated with acute myocardial infarction (AMI) to reduce morbidity and mortality. PURPOSE: To develop 3D personalized left ventricular (LV) models and thickening assessment framework for assessing regional wall thickening dysfunction and dyssynchrony in AMI patients. STUDY TYPE: Retrospective study, diagnostic accuracy. SUBJECTS: Forty-four subjects consisting of 15 healthy subjects and 29 AMI patients. FIELD STRENGTH/SEQUENCE: 1.5T/steady-state free precession cine MRI scans; LGE MRI scans. ASSESSMENT: Quantitative thickening measurements across all cardiac phases were correlated and validated against clinical evaluation of infarct transmurality by an experienced cardiac radiologist based on the American Heart Association (AHA) 17-segment model. STATISTICAL TEST: Nonparametric 2-k related sample-based Kruskal-Wallis test; Mann-Whitney U-test; Pearson's correlation coefficient. RESULTS: Healthy LV wall segments undergo significant wall thickening (P < 0.05) during ejection and have on average a thicker wall (8.73 ± 1.01 mm) compared with infarcted wall segments (2.86 ± 1.11 mm). Myocardium with thick infarct (ie, >50% transmurality) underwent remarkable wall thinning during contraction (thickening index [TI] = 1.46 ± 0.26 mm) as opposed to healthy myocardium (TI = 4.01 ± 1.04 mm). For AMI patients, LV that showed signs of thinning were found to be associated with a significantly higher percentage of dyssynchrony as compared with healthy subjects (dyssynchrony index [DI] = 15.0 ± 5.0% vs. 7.5 ± 2.0%, P < 0.01). Also, a strong correlation was found between our TI and left ventricular ejection fraction (LVEF) (r = 0.892, P < 0.01), and moderate correlation between DI and LVEF (r = 0.494, P < 0.01). DATA CONCLUSION: The extracted regional wall thickening and DIs are shown to be strongly correlated with infarct severity, therefore suggestive of possible practical clinical utility. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1006-1019.
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Khalid et al. (2018) conducted an observational in Acute myocardial infarction (AMI) (n=44). 3D personalized left ventricular models and thickening assessment framework vs. Healthy subjects was evaluated on Dyssynchrony index (DI) (p=<0.01). 3D personalized left ventricular modeling revealed significantly higher dyssynchrony in AMI patients compared to healthy subjects (15.0% vs. 7.5%, P < 0.01).
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