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

Leong, Chen Onn and Leong, Chin Neng and Liew, Yih Miin and Al Abed, Amr and Abdul Aziz, Yang Faridah and Chee, Kok Han and Sridhar, Ganiga Srinivasaiah and Dokos, Socrates and Lim, Einly (2021) The role of regional myocardial topography post-myocardial infarction on infarct extension. International Journal for Numerical Methods in Biomedical Engineering, 37 (8). ISSN 2040-7939, DOI

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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.

Item Type: Article
Funders: Fundamental Research Grant Scheme (FP002-2017A)
Uncontrolled Keywords: Regional myocardial; Topography; Post-myocardial infarction; Infarct extension
Subjects: Q Science > QA Mathematics
Q Science > QH Natural history > QH301 Biology
T Technology > TA Engineering (General). Civil engineering (General)
Divisions: Faculty of Engineering > Biomedical Engineering Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 08 Sep 2022 01:48
Last Modified: 08 Sep 2022 01:48

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