Staff View: The role of regional myocardial topography post-myocardial infarction on infarct extension

The role of regional myocardial topography post-myocardial infarction on infarct extension

Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching ha...

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Main Authors:	Leong, Chen Onn, Leong, Chin Neng, Liew, Yih Miin, Al Abed, Amr, Abdul Aziz, Yang Faridah, Chee, Kok Han, Sridhar, Ganiga Srinivasaiah, Dokos, Socrates, Lim, Einly
Format:	Article
Published:	Wiley 2021
Subjects:	QA Mathematics QH301 Biology TA Engineering (General). Civil engineering (General)
Online Access:	http://eprints.um.edu.my/34210/
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spelling	my.um.eprints.342102022-09-08T01:48:14Z http://eprints.um.edu.my/34210/ The role of regional myocardial topography post-myocardial infarction on infarct extension Leong, Chen Onn Leong, Chin Neng Liew, Yih Miin Al Abed, Amr Abdul Aziz, Yang Faridah Chee, Kok Han Sridhar, Ganiga Srinivasaiah Dokos, Socrates Lim, Einly QA Mathematics QH301 Biology TA Engineering (General). Civil engineering (General) Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ. Wiley 2021-08 Article PeerReviewed Leong, Chen Onn and Leong, Chin Neng and Liew, Yih Miin and Al Abed, Amr and Abdul Aziz, Yang Faridah and Chee, Kok Han and Sridhar, Ganiga Srinivasaiah and Dokos, Socrates and Lim, Einly (2021) The role of regional myocardial topography post-myocardial infarction on infarct extension. International Journal for Numerical Methods in Biomedical Engineering, 37 (8). ISSN 2040-7939, DOI https://doi.org/10.1002/cnm.3501 <https://doi.org/10.1002/cnm.3501>. 10.1002/cnm.3501
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	QA Mathematics QH301 Biology TA Engineering (General). Civil engineering (General)
spellingShingle	QA Mathematics QH301 Biology TA Engineering (General). Civil engineering (General) Leong, Chen Onn Leong, Chin Neng Liew, Yih Miin Al Abed, Amr Abdul Aziz, Yang Faridah Chee, Kok Han Sridhar, Ganiga Srinivasaiah Dokos, Socrates Lim, Einly The role of regional myocardial topography post-myocardial infarction on infarct extension
description	Infarct extension involves necrosis of healthy myocardium in the border zone (BZ), progressively enlarging the infarct zone (IZ) and recruiting the remote zone (RZ) into the BZ, eventually leading to heart failure. The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient-specific left-ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress-strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter-clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ-BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ.
format	Article
author	Leong, Chen Onn Leong, Chin Neng Liew, Yih Miin Al Abed, Amr Abdul Aziz, Yang Faridah Chee, Kok Han Sridhar, Ganiga Srinivasaiah Dokos, Socrates Lim, Einly
author_facet	Leong, Chen Onn Leong, Chin Neng Liew, Yih Miin Al Abed, Amr Abdul Aziz, Yang Faridah Chee, Kok Han Sridhar, Ganiga Srinivasaiah Dokos, Socrates Lim, Einly
author_sort	Leong, Chen Onn
title	The role of regional myocardial topography post-myocardial infarction on infarct extension
title_short	The role of regional myocardial topography post-myocardial infarction on infarct extension
title_full	The role of regional myocardial topography post-myocardial infarction on infarct extension
title_fullStr	The role of regional myocardial topography post-myocardial infarction on infarct extension
title_full_unstemmed	The role of regional myocardial topography post-myocardial infarction on infarct extension
title_sort	role of regional myocardial topography post-myocardial infarction on infarct extension
publisher	Wiley
publishDate	2021
url	http://eprints.um.edu.my/34210/
_version_	1744649164039389184
score	13.211869

The role of regional myocardial topography post-myocardial infarction on infarct extension

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