title: Three dimensional fusion of electromechanical mapping and magnetic resonance imaging for real-time navigation of intramyocardial cell injections in a porcine model of chronic myocardial infarction.
abstract: For cardiac regenerative therapy intramyocardial catheter guided cell transplantations are targeted to the infarct border zone (IBZ) i.e. the closest region of viable myocardium in the vicinity of the infarct area. For optimal therapeutic effect this area should be accurately identified. However late gadolinium enhanced magnetic resonance imaging (LGE-MRI) is the gold standard technique to determine the infarct size and location, electromechanical mapping (EMM) is used to guide percutaneous intramyocardial injections to the IBZ. Since EMM has a low spatial resolution, we aim to develop a practical and accurate technique to fuse EMM with LGE-MRI to guide intramyocardial injections. LGE-MRI and EMM were obtained in 17 pigs with chronic myocardial infarction created by balloon occlusion of LCX and LAD coronary arteries. LGE-MRI and EMM datasets were registered using our in-house developed 3D CartBox image registration software toolbox to assess: (1) the feasibility of the 3D CartBox toolbox, (2) the EMM values measured in the areas with a distinct infarct transmurality (IT), and (3) the highest sensitivity and specificity of the EMM to assess IT and define the IBZ. Registration of LGE-MRI and EMM resulted in a mean error of 3.01 ± 1.94 mm between the LGE-MRI mesh and EMM points. The highest sensitivity and specificity were found for UV <9.4 mV and bipolar voltage <1.2 mV to respectively identify IT of ≥5 and ≥97.5 %. The 3D CartBox image registration toolbox enables registration of EMM data on pre-acquired MRI during the EMM guided procedure and allows physicians to easily guide injections to the most optimal injection location for cardiac regenerative therapy and harness the full therapeutic effect of the therapy.
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. F.J.vanSlochteren@umcutrecht.nl.
authors.forename: F J
authors.initials: FJ
authors.lastname: van Slochteren
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Es
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Gyöngyösi
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: T I G
authors.initials: TI
authors.lastname: van der Spoel
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Koudstaal
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Leiner
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.|Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands.
authors.forename: P A
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, E03.511, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.|Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands.
authors.forename: S A J
authors.initials: SA
authors.lastname: Chamuleau
mesh_terms: D000818:Animals; D019540:Area Under Curve; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D019028:Magnetic Resonance Imaging, Cine; D064847:Multimodal Imaging / Q000379:methods*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012038:Regeneration; D033581:Stem Cell Transplantation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D034421:Sus scrofa; D013997:Time Factors; D014022:Tissue Survival
keywords: Cardiac regenerative therapy; Electromechanical mapping; Intramyocardial stem cell injections; Late gadolinium enhancement; MRI; Myocardial fibrosis