title: Arrhythmia risk stratification of patients after myocardial infarction using personalized heart models.
abstract: Sudden cardiac death (SCD) from arrhythmias is a leading cause of mortality. For patients at high SCD risk, prophylactic insertion of implantable cardioverter defibrillators (ICDs) reduces mortality. Current approaches to identify patients at risk for arrhythmia are, however, of low sensitivity and specificity, which results in a low rate of appropriate ICD therapy. Here, we develop a personalized approach to assess SCD risk in post-infarction patients based on cardiac imaging and computational modelling. We construct personalized three-dimensional computer models of post-infarction hearts from patients' clinical magnetic resonance imaging data and assess the propensity of each model to develop arrhythmia. In a proof-of-concept retrospective study, the virtual heart test significantly outperformed several existing clinical metrics in predicting future arrhythmic events. The robust and non-invasive personalized virtual heart risk assessment may have the potential to prevent SCD and avoid unnecessary ICD implantations.
authors.affiliation: Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.
authors.forename: Hermenegild J
authors.initials: HJ
authors.lastname: Arevalo
authors.affiliation: Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.
authors.forename: Fijoy
authors.initials: F
authors.lastname: Vadakkumpadan
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21287, USA.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jebb
authors.affiliation: Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Malamas
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Institute for Computational Medicine and Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA.
authors.forename: Natalia A
authors.initials: NA
authors.lastname: Trayanova
mesh_terms: D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008954:Models, Biological; D009203:Myocardial Infarction / Q000150:complications*; D012189:Retrospective Studies; D018570:Risk Assessment; D014584:User-Computer Interface