Dynamic mapping of ventricular function from cardiovascular magnetic resonance imaging
Insights
Cardiac resynchronization therapy (CRT) planning for heart failure can be improved by mapping mechanical activation using cardiac magnetic resonance (CMR). This 3D+t map helps identify optimal left ventricular (LV) pacing sites, potentially reducing CRT non-responders.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Heart failure significantly impacts mortality and morbidity, particularly in older adults.
- Cardiac resynchronization therapy (CRT) is crucial for heart failure management, but optimal left ventricular (LV) pacing site selection remains challenging.
- Current methods for identifying the optimal LV pacing site involve complex 3D mapping of scar and activation data, which is time-consuming.
Purpose of the Study:
- To develop and validate a novel method for improving CRT patient planning.
- To map mechanical activation propagation from cardiac magnetic resonance (CMR) onto a 3D+t model.
- To assist cardiologists in determining the optimal LV pacing site for enhanced CRT outcomes.
Main Methods:
- Automatic motion analysis of patient-specific LV anatomical models segmented from cine MR data.
- Extraction of regional volume change curves and intraventricular dyssynchrony indices.
- Mapping regional volume changes onto 3D+t CMR data to create a mechanical activation map throughout the cardiac cycle.
Main Results:
- A 3D+t mechanical activation map was successfully generated for each subject.
- The workflow was tested on 7 heart failure patients and 3 healthy volunteers.
- Demonstrated feasibility of mapping regional LV volume changes during ventricular pacing.
Conclusions:
- The developed 3D+t mechanical activation mapping facilitates optimal LV pacing site selection during CRT planning.
- This approach has the potential to decrease the number of patients who inadequately respond to CRT.
- Improved planning may lead to more effective CRT interventions for heart failure patients.
Abstract:
Heart failure is associated with substantial mortality and morbidity and remains the most common diagnosis in older patients. Based on experimental electrophysiologic studies, cardiac resynchronization therapy (CRT) for heart failure results in a maximum resynchronization effect when applied to the most delayed left ventricular (LV) site. Current clinical practice is to identify the optimal site using separate visualisation of scar and activation information. These must be mentally mapped into 3D, which is challenging and time-consuming for the electrophysiologist. The aim of this work is to improve patient planning for CRT by mapping propagation of mechanical activation from cardiac magnetic resonance (CMR) onto a three-dimensional plus time (3D+t) model map to assist the cardiologist in determining the optimal LV pacing site. Automatic motion analysis of the 16-segment patient-specific LV anatomical model, automatically segmented from cine MR data, was done and regional volume change curves as a function of the cardiac cycle along with intraventricular dyssynchrony indices were extracted. The regional volume information computed was then mapped onto all phases of the 3D+t CMR data, which provides a 3D+t mechanical activation map over the whole cardiac cycle. This workflow was tested on 7 patients and 3 healthy volunteers. This mapping of the regional change of volume across the LV during ventricular pacing could facilitate the selection of the optimum pacing segment at the planning stage of the procedure, and consequently decrease the number of inadequate responders to CRT.
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