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Cardiac MRI and Myocardial Infarction: the role of Mathematical Modelling
Kenneth Mangion,
Clinical Research Fellow
Developments in Healthcare Imaging
Cambridge, 19/04/17
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Body text
Acute
STEMI Angiography Primary PCI Stent
Velagaleti et al., Circulation 2008
Coronary
Occlusion
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Body text
Target
identifiable
difference
Sample size
reduction by
CMR
EDV (ml/m2) 10 74%
ESV (ml/m2) 10 83%
SV (ml/m2) 10 84%
LVEF (%) 3 87%
Mass (g/m2) 10 90%
Grothues et al., 2004
Background: imaging biomarkers
Why use CMR?
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Body text
Golden Jubilee National Hospital
BHF GCRC Maths & Stats
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Body text
Cine
LVEF is an
indirect
measure of
contractility
Haemorrhage
occurs in a
subset
Infarct size
overestimated
MVO varies
dynamically
T2* mapping LGE
Occluded Circumflex
artery
Angio
Background: imaging biomarkers
Derived from multi parametric CMR
Dall’ Armelina et al., Circ. Cardiovasc. Imaging , 2011. Carrick et al., JACC Imaging, 2015
Requires eGFR
>30ml/min
14% STEMI
23% NSTEMI
have eGFR
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A
B
LVEF
38%
LVEF
37.5%
LVEF
54.6%
LVEF
29.3%
6 months
post MI
Day 2
post MI
BHF- MRMI
STUDY
Infarct
36% LV
mass
Infarct
35% LV
mass
Background: imaging biomarkers
Case example
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SofTMech
EPSRC Centre for Multiscale Soft Tissue Mechanics
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Mathematical modelling
6 healthy volunteers 6 STEMI patients
Novel Biomarkers
Age: 52±9
EF: 66±3%
Age: 55±12
EF: 40±3%
Padmanabhan et al., 2010. Delles et al., 2010.
Need for personalised modelling
Case example
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• Passive stiffness
• Contractility (Tref)
• Normalised Active
Tension (AT/SBP)
Healthy volunteer
STEMI patient
Need for personalised modelling
Image derived LV model
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Healthy volunteer STEMI patient
Need for personalised modelling
4D LV models
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Clinical data LV reconstruction
Strain estimation
Mesh generation
FEM simulation
Personalised
Parameters
Parameter
identification
optimisation
Model Personalisation
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1 1.02 1.04 1.06 1.08 1.1 1.12 1.14 1.16 1.18 1.20
5
10
15
20
25
30
35
40
45
50stress in fiber orientation
HV1 HV2 HV3
HV4
HV5
HV6
MI1
MI2
MI3
MI4
MI5
MI6
Amount of fiber stretch
Cauch
y S
tress
(kP
a)
Amount of fiber stretch
Wall
str
ess (
KP
a)
STEMI patients
Healthy volunteers
Results (1)
Passive stiffness
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Healthy volunteers 64.8±8kPa
STEMI patients 69±7kPa
Ave
rag
e A
ctive
Te
nsio
n
(KP
a)
p=0.15
Results (2)
Active Tension
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Healthy volunteers 0.44 ± 0.05
p<0.01
STEMI patients 0.57 ± 0.05
AT
/SB
P (
KP
a/m
mH
g)
Results (3)
Normalised Active Tension
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• 1. Development of novel biomarkers
• 2. Validation against more
established markers (LVEF, infarct
size)
• 3. Clinically accessible!
Cardiac MRI and Myocardial Infarction
The Role of Mathematical Modelling
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Thank you for your attention
http://www.glasgowheart.org
http://www.softmech.org