Computational Modeling Identifies Embolic Stroke of Undetermined Source Patients with Potential Arrhythmic Substrate
Computational Modeling Identifies Embolic Stroke of Undetermined Source Patients with Potential Arrhythmic Substrate
复制标题
计算模型识别具有潜在心律失常基质的来源不明的栓塞性中风患者
DOI：
10.1101/2020.09.03.20184051
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Bifulco S
中科院分区：
文献类型：
--
作者：
Bifulco S
心脏磁共振成像（MRI）显示，来源不明（ESUS）患者的栓塞性卒中中的纤维化水平与房颤（AFib）中观察到的水平相当。我们使用计算模型来理解尽管存在肺促纤维化，但ESUS中不存在心律失常。对45例ESUS和45例AFib患者进行了基于MRI的心房模型重建。通过计算评估每个患者的纤维化基质的促炎能力。在24/45（53%）ESUS和22/45（49%）AFib模型中诱导了折返驱动器。诱导型模型的纤维化率（16.7 ± 5.45%）高于非诱导型模型（11.07 ± 3.61%; p<0.0001）;然而，ESUS和AFib模型的诱导型亚组具有相似的纤维化水平（p=0.90），这意味着ESUS和AFib中纤维化的内在促纤维化底物特性是不可区分的。这表明，一些ESUS患者具有潜在的临床前纤维化基质，可能是未来的致炎性来源。因此，我们的工作提示了这样一个假设，即ESUS伴纤维化心房的患者由于没有心律失常触发因素而免于AFib。
Cardiac magnetic resonance imaging (MRI) has revealed fibrosis in embolic stroke of undetermined source (ESUS) patients comparable to levels seen in atrial fibrillation (AFib). We used computational modeling to understand the absence of arrhythmia in ESUS despite the presence of putatively pro-arrhythmic fibrosis. MRI-based atrial models were reconstructed for 45 ESUS and 45 AFib patients. The fibrotic substrate’s arrhythmogenic capacity in each patient was assessed computationally. Reentrant drivers were induced in 24/45 (53%) ESUS and 22/45 (49%) AFib models. Inducible models had more fibrosis (16.7 ± 5.45%) than non-inducible models (11.07 ± 3.61%; p<0.0001); however, inducible subsets of ESUS and AFib models had similar fibrosis levels (p=0.90), meaning that theintrinsic pro-arrhythmic substrate propertiesof fibrosis in ESUS and AFib are indistinguishable. This suggests that some ESUS patients have latent pre-clinical fibrotic substrate that could be a future source of arrhythmogenicity. Thus, our work prompts the hypothesis that ESUS patients with fibrotic atria are spared from AFib due to an absence of arrhythmia triggers.