Abstract
This paper presents a morphological analysis of fibrotic scarring in non-ischemic dilated cardiomyopathy, and its relationship to electrical instabilities which underlie reentrant arrhythmias. Two dimensional electrophysiological simulation models were constructed from a set of 699 late gadolinium enhanced cardiac magnetic resonance images originating from 157 patients. Areas of late gadolinium enhancement (LGE) in each image were assigned one of 10 possible microstructures, which modelled the details of fibrotic scarring an order of magnitude below the MRI scan resolution. A simulated programmed electrical stimulation protocol tested each model for the possibility of generating either a transmural block or a transmural reentry. The outcomes of the simulations were compared against morphological LGE features extracted from the images. Models which blocked or reentered, grouped by microstructure, were significantly different from one another in myocardial-LGE interface length, number of components and entropy, but not in relative area and transmurality. With an unknown microstructure, transmurality alone was the best predictor of block, whereas a combination of interface length, transmurality and number of components was the best predictor of reentry in linear discriminant analysis.
Highlights
Non-ischemic cardiomyopathies are a class of cardiac pathologies in which the myocardial tissue undergoes remodelling due to causes other than compromised coronary perfusion
Many patients with non-ischemic dilated cardiomyopathy have scars in their hearts which can be detected with magnetic resonance imaging
Progress has been made in the case of non-ischemic dilated cardiomyopathy (NIDCM) in which an association has been shown between arrhythmias and the presence of fibrotic scarring, as detected by late gadolinium enhanced cardiovascular magnetic resonance imaging (LGE-CMR) [2]
Summary
Non-ischemic cardiomyopathies are a class of cardiac pathologies in which the myocardial tissue undergoes remodelling due to causes other than compromised coronary perfusion. Due to the complex and multifactorial aetiology of non-ischemic disease, assessing the risk of cardiac arrhythmias in these patients remains a major challenge. Progress has been made in the case of non-ischemic dilated cardiomyopathy (NIDCM) in which an association has been shown between arrhythmias and the presence of fibrotic scarring, as detected by late gadolinium enhanced cardiovascular magnetic resonance imaging (LGE-CMR) [2]. Further imaging studies have examined the morphology of late gadolinium enhancement (LGE) in greater detail, and its relation to arrhythmic risk. In athletes with non-ischemic scars, a long and thin ‘stria’ pattern of LGE has been shown to be dangerous [7]
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