Computational Identification of Ventricular Arrhythmia Risk in Pediatric Myocarditis
Computational Identification of Ventricular Arrhythmia Risk in Pediatric Myocarditis
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DOI：
10.1007/s00246-019-02082-7
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发表时间：
2019-04-01
影响因子：
1.6
通讯作者：
Trayanova, Natalia A.
中科院分区：
文献类型：
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作者：
Cartoski, Mark J.;Nikolov, Plamen P.;Trayanova, Natalia A.
心肌炎患儿由于心肌炎症和重塑，室性心动过速（VT）的风险增加。目前尚无可接受的方法对该人群进行室性心动过速风险分层。我们假设，根据心脏晚期钆增强磁共振成像（LGE-MRI）开发的个性化模型可以使用先前验证的方案确定心肌炎患者的VT风险。个性化的三维计算心脏模型重建12例诊断为心肌炎患者的LGE-MRI扫描。本回顾性分析纳入了4例临床室性心动过速患者和8例无室性心动过速患者。在每个模型中，我们纳入了个性化的空间分布的纤维化和心肌纤维的方向。然后，通过从分布在两个心室中的26个部位快速起搏来评估每个模型中的VT诱导。所有临床室性心动过速患者均从多个起搏部位诱发持续性折返性室性心动过速。在8例无临床室性心动过速的患者中，我们无法在使用快速心室起搏的模拟中诱导持续折返。我们的非侵入性方法在心肌炎儿童中的应用有可能正确识别那些有发生室性心动过速风险的人。
Children with myocarditis have increased risk of ventricular tachycardia (VT) due to myocardial inflammation and remodeling. There is currently no accepted method for VT risk stratification in this population. We hypothesized that personalized models developed from cardiac late gadolinium enhancement magnetic resonance imaging (LGE-MRI) could determine VT risk in patients with myocarditis using a previously-validated protocol. Personalized three-dimensional computational cardiac models were reconstructed from LGE-MRI scans of 12 patients diagnosed with myocarditis. Four patients with clinical VT and eight patients without VT were included in this retrospective analysis. In each model, we incorporated a personalized spatial distribution of fibrosis and myocardial fiber orientations. Then, VT inducibility was assessed in each model by pacing rapidly from 26 sites distributed throughout both ventricles. Sustained reentrant VT was induced from multiple pacing sites in all patients with clinical VT. In the eight patients without clinical VT, we were unable to induce sustained reentry in our simulations using rapid ventricular pacing. Application of our non-invasive approach in children with myocarditis has the potential to correctly identify those at risk for developing VT.