Synchrotron-based X-ray 3D phase contrast imaging and analysis of transmural myocardial tissue from heart failure patients

Figures

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  Fig. 1. Non-invasive imaging phenotypes. The four-chamber apical view (central images) shows that the structural phenotype of the heart is similar in end-stage HF (i.e., eccentric remodelling, enlarged LV end-diastolic diameter and volume, enlarged LA), whereas the global longitudinal strain bullseye plots (left and right columns) show different functional phenotypes associated with disease aetiologies (i.e., regional differences in peak systolic deformation in ischaemic cardiomyopathy related to the coronary blood flow distribution vs. global deformation impairment in dilated and toxic cardiomyopathies). Patient ICM-2 had a poor echocardiographic window with image quality that did not permit deformation analysis. HF heart failure, LV left ventricle, LA left atrium, DCM dilated cardiomyopathy, ICM ischaemic cardiomyopathy, TCM toxic cardiomyopathy.

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  Fig. 2. Virtual histopathology of ICM-1 (HTx) sample via X-PCI. Orthogonal views taken from a 3D X-PCI scan of the transmural myocardial tissue sample in a patient undergoing HTx due to ischaemic cardiomyopathy. The colour-coded horizontal and vertical dotted lines relate to the LR orthogonal cuts of the tissue sample shown in colour-coded frames below. The yellow rectangles show selected regions of the myocardium that were scanned with the HR imaging setup enabling analysis of cardiac microstructure. Fibrotic tissue replacement in the selected HR mid-myocardial region marked in red. Corresponding zoomed colour coded frames also shown in the Supplementary Fig. S1-S1.4. ICM ischaemic cardiomyopathy, HTx heart transplantation, X-PCI X-ray phase contrast imaging, LR low resolution, HR high resolution.

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  Fig. 3. Virtual histopathology of DCM (LVAD) sample via X-PCI. Orthogonal views taken from a 3D X-PCI scan of the transmural myocardial tissue sample in a patient undergoing LVAD implantation due to dilated cardiomyopathy. The colour-coded horizontal and vertical dotted lines relate to the LR orthogonal cuts of the tissue sample shown in colour-coded frames below. The yellow rectangles show selected regions of the myocardium that were scanned with the HR imaging setup enabling analysis of cardiac microstructure. Perivascular and interstitial fibrotic changes in the selected HR mid-myocardial region marked in red. Corresponding zoomed colour coded frames also shown in the Supplementary Fig. S2-S2.4. DCM dilated cardiomyopathy, LVAD left ventricular assist device, X-PCI X-ray phase contrast imaging, LR low resolution, HR high resolution.

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  Fig. 4. Visualisation of orientation of myocyte aggregates using helical angle (HA), intrusion angle (IA) and fractional anisotropy (FA). The epicardium and endocardium have been labelled as epi and endo, respectively. Epicardial adipose layer was thicker in DCM samples with a thinner epicardial myocyte layer (indicated by yellow arrows). DCM dilated cardiomyopathy, ICM ischaemic cardiomyopathy, TCM toxic cardiomyopathy, LVAD left ventricular assist device, HTx heart transplantation, X-PCI X-ray phase contrast imaging.

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  Fig. 5. Semi-automatic 2D collagen segmentation and 3D rendering. Selected HR ROIs showing segmented collagen distribution in both 2D slices and 3D rendering. Collagen is shown in light blue, while myocardial cells are red in 2D slices. Rendered 3D models show just collagen in light blue. Light blue cubes represent the selected sub volume of tissue for the 3D models. Corresponding calculated percentages of collagen are shown below the selected 2D ROI. HR high resolution, ROI region of interest, DCM dilated cardiomyopathy, ICM ischaemic cardiomyopathy, TCM toxic cardiomyopathy, HTx heart transplantation, LVAD left ventricular assist device.