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

心肌梗塞 心脏病学 内科学 异常 梗塞 磁共振成像 医学 边境地带 机械 物理 放射科 精神科
作者
Chen Onn Leong,Chin Neng Leong,Yih Miin Liew,Amr Al Abed,Yang Faridah Abdul Aziz,Kok Han Chee,Ganiga Srinivasaiah Sridhar,Socrates Dokos,Einly Lim
出处
期刊:International Journal for Numerical Methods in Biomedical Engineering [Wiley]
卷期号:37 (8) 被引量:3
标识
DOI:10.1002/cnm.3501
摘要

Abstract 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.
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