Virtual Electrophysiological Study in a 3-Dimensional Cardiac Magnetic Resonance Imaging Model of Porcine Myocardial Infarction
Virtual Electrophysiological Study in a 3-Dimensional Cardiac Magnetic Resonance Imaging Model of Porcine Myocardial Infarction
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DOI：
10.1016/j.jacc.2012.03.029
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发表时间：
2012-07-31
影响因子：
24
通讯作者：
Goldberger, Jeffrey J.
中科院分区：
文献类型：
--
作者：
Ng, Jason;Jacobson, Jason T.;Goldberger, Jeffrey J.
目的本研究旨在验证以下假设：在猪心肌梗死模型中，通过三维磁共振成像重建左心室产生的解剖平台上的“虚拟”电生理研究（EPS）可以再现诱发性室性心动过速（VT）的折返回路。背景延迟增强磁共振成像已被用于表征心肌梗死和“灰区”，方法采用冠状动脉闭塞法建立猪心肌梗死模型，观察心肌梗死后存活心肌细胞的形态学变化。恢复期后，从每只猪体内获得三维心脏磁共振图像。根据体素强度对正常区、灰色区和梗死核心进行分类。在计算机模型中，灰区被分配较慢的传导和较长的动作电位持续时间比正常心肌。结果左心室容积为97.8 ~ 166.2cm（3），梗死区占4.9%~ 17.5%;在实际EPS期间发生VT的7头猪中，有6头也可通过虚拟EPS诱导。4的6只猪，模拟室性心动过速有折返电路，近似电路看到非接触式映射，而其余2个有类似的电路，但在相反的方向传播。结论这初步研究表明，应用数学模型的可行性磁共振成像重建左心室预测室性心动过速电路。虚拟EPS可能有助于计划导管消融策略或识别未来有VT发作风险的患者。（J Am科尔心脏病学杂志2012;60：423-30）（C）美国心脏病学会基金会2012年
Objectives This study sought to test the hypothesis that "virtual" electrophysiological studies (EPS) on an anatomic platform generated by 3-dimensional magnetic resonance imaging reconstruction of the left ventricle can reproduce the reentrant circuits of induced ventricular tachycardia (VT) in a porcine model of myocardial infarction.Background Delayed-enhancement magnetic resonance imaging has been used to characterize myocardial infarction and "gray zones," which are thought to reflect heterogeneous regions of viable and nonviable myocytes.Methods Myocardial infarction by coronary artery occlusion was induced in 8 pigs. After a recovery period, 3-dimensional cardiac magnetic resonance images were obtained from each pig in vivo. Normal areas, gray zones, and infarct cores were classified based on voxel intensity. In the computer model, gray zones were assigned slower conduction and longer action potential durations than those for normal myocardium. Virtual EPS was performed and compared with results of actual in vivo programmed stimulation and noncontact mapping.Results The left ventricular volumes ranged from 97.8 to 166.2 cm(3), with 4.9% to 17.5% of voxels classified as infarct zones. Six of the 7 pigs in which VT developed during actual EPS were also inducible with virtual EPS. Four of the 6 pigs that had simulated VT had reentrant circuits that approximated the circuits seen with noncontact mapping, whereas the remaining 2 had similar circuits but propagating in opposite directions.Conclusions This initial study demonstrates the feasibility of applying a mathematical model to magnetic resonance imaging reconstructions of the left ventricle to predict VT circuits. Virtual EPS may be helpful to plan catheter ablation strategies or to identify patients who are at risk of future episodes of VT. (J Am Coll Cardiol 2012;60:423-30) (C) 2012 by the American College of Cardiology Foundation