TY - JOUR
T1 - Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Assessment of Substrate for Ventricular Tachycardia With Hemodynamic Compromise
AU - Whitaker, John
AU - Neji, Radhouene
AU - Kim, Steven
AU - Connolly, Adam
AU - Aubriot, Thierry
AU - Calvo, Justo Juliá
AU - Karim, Rashed
AU - Roney, Caroline H.
AU - Murfin, Brendan
AU - Richardson, Carla
AU - Morgan, Stephen
AU - Ismail, Tevfik F.
AU - Harrison, James
AU - de Vos, Judith
AU - Aalders, Maurice C.G.
AU - Williams, Steven E.
AU - Mukherjee, Rahul
AU - O'Neill, Louisa
AU - Chubb, Henry
AU - Tschabrunn, Cory
AU - Anter, Elad
AU - Camporota, Luigi
AU - Niederer, Steven
AU - Roujol, Sébastien
AU - Bishop, Martin J.
AU - Wright, Matthew
AU - Silberbauer, John
AU - Razavi, Reza
AU - O'Neill, Mark
N1 - Funding Information: We are grateful to the Abbott UK, France and US teams who generously loaned the Precision and Claris systems for these experiments, provided outstanding technical support and donated all the EP mapping catheters, cables and consumables, Sagar Haval, Lynn Calvert and the Maquet, Getinge Group who generously provided a CardioHelp machine, provided technical support and donated all the ECMO consumables as well as Sophie Pernot and the staff at the Institute de Chirurgie Guidée par l'image (IHU), Strasbourg, France for their support for these experiments and the outstanding animal care they provided. We are grateful to Professor Maria Siebes for her assistance with establishing the protocol for and assistance with the processing of the cryomicrotome imaging. Funding Information: This work was supported by a Medical Research Council UK Clinical Research Training Fellowship (grant code MR/N001877/1) which funded JW; the Health Innovation Challenge Fund (HICF-R10-698), a parallel funding partnership between the Department of Health and the Wellcome Trust, the Wellcome Engineering and Physical Sciences Research Council (EPSRC) Centre for Medical Engineering at King's College London (WT203148/Z/16/Z); EPSRC grant (EP/R010935/1); National Institute for Health Research (NIHR) Biomedical Research Centre award to Guy's and St Thomas' National Health Service (NHS) Foundation Trust in partnership with King's College London, and by the NIHR Healthcare Technology Co-operative for Cardiovascular Disease at Guy's and St Thomas' NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The CardioHelp machine and all ECMO consumables were donated by Maquet, Getinge Group without conditions on their use. The Precision and Claris system and all EP mapping consumables were donated by Abbott without conditions on their use. This research was funded in whole, or in part, by the Wellcome Trust [Grant Number WT203148/Z/16/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted manuscript version arising from this submission. This project was supported by the National Institute of General Medical Sciences of the National Institutes of Health [Grant Numbers P41 GM103545 and R24 GM136986]. SW was supported by British Heart Foundation [Grant Number FS/20/26/34952]. Publisher Copyright: Copyright © 2021 Whitaker, Neji, Kim, Connolly, Aubriot, Calvo, Karim, Roney, Murfin, Richardson, Morgan, Ismail, Harrison, de Vos, Aalders, Williams, Mukherjee, O'Neill, Chubb, Tschabrunn, Anter, Camporota, Niederer, Roujol, Bishop, Wright, Silberbauer, Razavi and O'Neill.
PY - 2021/10
Y1 - 2021/10
N2 - Background: The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model. Methods: Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC. Results: Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, p < 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, p < 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, p < 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness. Conclusions: Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.
AB - Background: The majority of data regarding tissue substrate for post myocardial infarction (MI) VT has been collected during hemodynamically tolerated VT, which may be distinct from the substrate responsible for VT with hemodynamic compromise (VT-HC). This study aimed to characterize tissue at diastolic locations of VT-HC in a porcine model. Methods: Late Gadolinium Enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging was performed in eight pigs with healed antero-septal infarcts. Seven pigs underwent electrophysiology study with venous arterial-extra corporeal membrane oxygenation (VA-ECMO) support. Tissue thickness, scar and heterogeneous tissue (HT) transmurality were calculated at the location of the diastolic electrograms of mapped VT-HC. Results: Diastolic locations had median scar transmurality of 33.1% and a median HT transmurality 7.6%. Diastolic activation was found within areas of non-transmural scar in 80.1% of cases. Tissue activated during the diastolic component of VT circuits was thinner than healthy tissue (median thickness: 5.5 mm vs. 8.2 mm healthy tissue, p < 0.0001) and closer to HT (median distance diastolic tissue: 2.8 mm vs. 11.4 mm healthy tissue, p < 0.0001). Non-scarred regions with diastolic activation were closer to steep gradients in thickness than non-scarred locations with normal EGMs (diastolic locations distance = 1.19 mm vs. 9.67 mm for non-diastolic locations, p < 0.0001). Sites activated late in diastole were closest to steep gradients in tissue thickness. Conclusions: Non-transmural scar, mildly decreased tissue thickness, and steep gradients in tissue thickness represent the structural characteristics of the diastolic component of reentrant circuits in VT-HC in this porcine model and could form the basis for imaging criteria to define ablation targets in future trials.
KW - cardiovascular magnetic resonance
KW - late gadolinium enhancement
KW - mechanical circulatory support
KW - venous-arterial extra corporeal membrane oxygenation (VA-ECMO)
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85128137549&partnerID=8YFLogxK
UR - https://pure.uva.nl/ws/files/73490153/5678297.zip
U2 - https://doi.org/10.3389/fcvm.2021.744779
DO - https://doi.org/10.3389/fcvm.2021.744779
M3 - Article
C2 - 34765656
SN - 2297-055X
VL - 8
JO - Frontiers in cardiovascular medicine
JF - Frontiers in cardiovascular medicine
M1 - 744779
ER -