Abstract
PurposeDiffuse remodeling of myocardial extra-cellular matrix is largely responsible for left ventricle (LV) dysfunction and arrhythmias. Our hypothesis is that the texture analysis of late iodine enhancement (LIE) cardiac computed tomography (cCT) images may improve characterization of the diffuse extra-cellular matrix changes. Our aim was to extract volumetric extracellular volume (ECV) and LIE texture features of non-scarred (remote) myocardium from cCT of patients with recurrent ventricular tachycardia (rVT), and to compare these radiomic features with LV-function, LV-remodeling, and underlying cardiac disease.ProceduresForty-eight patients suffering from rVT were prospectively enrolled: 5/48 with idiopathic VT (IVT), 23/48 with post-ischemic dilated cardiomyopathy (ICM), 9/48 with idiopathic dilated cardiomyopathy (IDCM), and 11/48 with scars from a previous healed myocarditis (MYO). All patients underwent echocardiography to assess LV systolic and diastolic function and cCT with pre-contrast, angiographic, and LIE scan to obtain end-diastolic volume (EDV), ECV, and first-order texture parameters of Hounsfield Unit (HU) of remote myocardium in LIE [energy, entropy, HU-mean, HU-median, standard deviation (SD), and mean absolute deviation (MAD)].ResultsEnergy, HU mean, and HU median by cCT texture analysis correlated with ECV (rho = 0.5650, rho = 0.5741, rho = 0.5068; p < 0.0005). cCT-derived ECV, HU-mean, HU-median, SD, and MAD correlated directly to EDV by cCT and inversely to ejection fraction by echocardiography (p < 0.05). SD and MAD correlated with diastolic function by echocardiography (rho = 0.3837, p = 0.0071; rho = 0.3330, p = 0.0208). MYO and IVT patients were characterized by significantly lower values of SD and MAD when compared with ICM and IDCM patients, independently of LV-volume systolic and diastolic function.ConclusionsTexture analysis of LIE may expand cCT capability of myocardial characterization. Myocardial heterogeneity (SD and MAD) was associated with LV dilatation, systolic and diastolic function, and is able to potentially identify the different patterns of structural remodeling characterizing patients with rVT of different etiology.
Highlights
Cardiac computed tomography has impressively evolved in the last years, following the continuous improvement in temporal and spatial resolution
Further emerging application comes from the possibility to characterize myocardial scars using late iodine enhancement (LIE) [2,3,4], based on the delayed wash-in and washout kinetic of the contrast media related to the presence of fibrosis and scar [5]
MYO patients were slightly younger than ischemic dilated cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy (IDCM) patients
Summary
Cardiac computed tomography (cCT) has impressively evolved in the last years, following the continuous improvement in temporal and spatial resolution. The detection of myocardial dense scars is fundamental to therapeutic decision-making, risk stratification, and therapeutic monitoring [3,4,5,6,7]; the assessment of diffuse remodeling of extracellular matrix is important. Multiple non-invasive diagnostic strategies have been tested for the non-invasive assessment of diffuse extracellular matrix remodeling. T1 mapping assessed by cardiac magnetic resonance represents the new noninvasive standard of reference. ECV can be calculated on cCT with optimal correlation with cardiac magnetic resonance [16] and with the advantage of whole heart assessment [17]. A heterogeneous remodeling of extracellular matrix was found to have a strong impact on the myocardial electrical instability and, on the ventricular arrhythmic vulnerability [18, 19]. Changes in the extracellular matrix amount, composition, metabolism, and crosslinking are deeply involved in the increase of myocardial stiffness and in geometric remodeling of the left ventricle [20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
