title: Three-dimensional rotational angiography fused with multimodal imaging modalities for targeted endomyocardial injections in the ischaemic heart.
abstract: OBJECTIVE
  Biological therapies for ischaemic heart disease require efficient, safe, and affordable intramyocardial delivery. Integration of multiple imaging modalities within the fluoroscopy framework can provide valuable information to guide these procedures. We compared an anatomo-electric method (LARCA) with a non-fluoroscopic electromechanical mapping system (NOGA(®)). LARCA integrates selective three-dimensional-rotational angiograms with biplane fluoroscopy. To identify the infarct region, we studied LARCA-fusion with pre-procedural magnetic resonance imaging (MRI), dedicated CT, or (18)F-FDG-PET/CT.
  
  
  RESULTS
  We induced myocardial infarction in 20 pigs by 90-min LAD occlusion. Six weeks later, we compared peri-infarct delivery accuracy of coloured fluospheres using sequential NOGA(®)- and LARCA-MRI-guided vs. LARCA-CT- and LARCA-(18)F-FDG-PET/CT-guided intramyocardial injections. MRI after 6 weeks revealed significant left ventricular (LV) functional impairment and remodelling (LVEF 31 ± 3%, LVEDV 178 ± 15 mL, infarct size 17 ± 2% LV mass). During NOGA(®)-procedures, three of five animals required DC-shock for major ventricular arrhythmias vs. one of ten during LARCA-procedures. Online procedure time was shorter for LARCA than NOGA(®) (77 ± 6 vs. 130 ± 3 min, P < 0.0001). Absolute distance of injection spots to the infarct border was similar for LARCA-MRI (4.8 ± 0.5 mm) and NOGA(®) (5.4 ± 0.5 mm). LARCA-CT-integration allowed closer approximation of the targeted border zone than LARCA-PET (4.0 ± 0.5 mm vs. 6.2 ± 0.6 mm, P < 0.05).
  
  
  CONCLUSIONS
  Three-dimensional -rotational angiography fused with multimodal imaging offers a new, cost-effective, and safe strategy to guide intramyocardial injections. Endoventricular procedure times and arrhythmias compare favourably to NOGA(®), without compromising injection accuracy. LARCA-based fusion imaging is a promising enabling technology for cardiac biological therapies.
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Dieter Frans
authors.initials: DF
authors.lastname: Dauwe
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Dieter
authors.initials: D
authors.lastname: Nuyens
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: De Buck
authors.affiliation: Department of Cardiovascular Sciences, Imaging and Cardiovascular Dynamics, KULeuven, Leuven, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.affiliation: Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KULeuven, Leuven, Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gheysens
authors.affiliation: Department of Imaging and Pathology, Nuclear Medicine and Molecular Imaging, KULeuven, Leuven, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Koole
authors.affiliation: Clinical Radiology, Gasthuisberg University Hospitals Leuven, Leuven, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Coudyzer
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Nina
authors.initials: N
authors.lastname: Vanden Driessche
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Laurens
authors.initials: L
authors.lastname: Janssens
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Ector
authors.affiliation: Clinical Radiology, Gasthuisberg University Hospitals Leuven, Leuven, Belgium Department of Imaging and Pathology, Translational MRI, KULeuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Dymarkowski
authors.affiliation: Clinical Radiology, Gasthuisberg University Hospitals Leuven, Leuven, Belgium Department of Imaging and Pathology, Translational MRI, KULeuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.affiliation: Department of Cardiovascular Sciences, Clinical Cardiology, KULeuven, Leuven, Belgium stefan.janssens@med.kuleuven.be.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
mesh_terms: D000465:Algorithms; D000818:Animals; D018780:Body Surface Potential Mapping / Q000379:methods*; D004396:Coloring Agents; D017023:Coronary Angiography / Q000379:methods*; D004195:Disease Models, Animal; D055724:Electrophysiological Phenomena; D019788:Fluorodeoxyglucose F18; D005471:Fluoroscopy; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007267:Injections; D019028:Magnetic Resonance Imaging, Cine; D008863:Microspheres; D064847:Multimodal Imaging; D009203:Myocardial Infarction / Q000473:pathology*; D049268:Positron-Emission Tomography; D015641:Radiography, Interventional / Q000379:methods*; D013552:Swine
chemical_list: D004396:Coloring Agents; D019788:Fluorodeoxyglucose F18
keywords: Cardiac computed tomography; Cardiac magnetic resonance imaging; Cardiac positron emission tomography; Cell transplantation; Endomyocardial injections; Ischaemic heart failure; Rotational angiography