Heart failure is increasing at an alarming rate, making it a worldwide epidemic. As the population ages and life expectancy increases, this trend is not likely to change. Myocardial infarction (MI)-induced adverse left ventricular (LV) remodeling is responsible for nearly 70% of heart failure cases. The adverse remodeling process involves an extension of the border zone (BZ) adjacent to an MI, which is normally perfused but shows myofiber contractile dysfunction. To improve patient-specific modeling of cardiac mechanics, we sought to create a finite element model of the human LV with BZ and MI morphologies integrated directly from delayed-enhancement magnetic resonance (DE-MR) images. Instead of separating the LV into discrete regions (e.g., the MI, BZ, and remote regions) with each having a homogeneous myocardial material property, we assumed a functional relation between the DE-MR image pixel intensity and myocardial stiffness and contractility—we considered a linear variation of material properties as a function of DE-MR image pixel intensity, which is known to improve the accuracy of the model's response. The finite element model was then calibrated using measurements obtained from the same patient—namely, 3D strain measurements—using complementary spatial modulation of magnetization magnetic resonance (CSPAMM-MR) images. This led to an average circumferential strain error of 8.9% across all American Heart Association (AHA) segments. We demonstrate the utility of our method for quantifying smooth regional variations in myocardial contractility using cardiac DE-MR and CSPAMM-MR images acquired from a 78-yr-old woman who experienced an MI approximately 1 yr prior. We found a remote myocardial diastolic stiffness of C0¯=0.102kPa, and a remote myocardial contractility of Tmax¯=146.9kPa, which are both in the range of previously published normal human values. Moreover, we found a normalized pixel intensity range of 30% for the BZ, which is consistent with the literature. Based on these regional myocardial material properties, we used our finite element model to compute patient-specific diastolic and systolic LV myofiber stress distributions, which cannot be measured directly. One of the main driving forces for adverse LV remodeling is assumed to be an abnormally high level of ventricular wall stress, and many existing and new treatments for heart failure fundamentally attempt to normalize LV wall stress. Thus, our noninvasive method for estimating smooth regional variations in myocardial contractility should be valuable for optimizing new surgical or medical strategies to limit the chronic evolution from infarction to heart failure.

References

References
1.
Guccione
,
J. M.
,
Moonly
,
S. M.
,
Moustakidis
,
P.
,
Costa
,
K. D.
,
Moulton
,
M. J.
,
Ratcliffe
,
M. B.
, and
Pasque
,
M. K.
,
2001
, “
Mechanism Underlying Mechanical Dysfunction in the Border Zone of Left Ventricular Aneurysm: A Finite Element Model Study
,”
Ann. Thorac. Surg.
,
71
(
2
), pp.
654
662
.10.1016/S0003-4975(00)02338-9
2.
Jackson
,
B. M.
,
Gorman
,
J. H.
,
Moainie
,
S. L.
,
Guy
,
T. S.
,
Narula
,
N.
,
Narula
,
J.
,
St. John-Sutton
,
M. G.
,
Edmunds
,
L. H.
, and
Gorman
,
R. C.
,
2002
, “
Extension of Borderzone Myocardium in Postinfarction Dilated Cardiomyopathy
,”
J. Am. Coll. Cardiol.
,
40
(
6
), pp.
1160
1167
.10.1016/S0735-1097(02)02121-6
3.
Wenk
,
J. F.
,
Klepach
,
D.
,
Lee
,
L. C.
,
Zhang
,
Z.
,
Ge
,
L.
,
Tseng
,
E. E.
,
Martin
,
A.
,
Kozerke
,
S.
,
Gorman
,
J. H.
,
Gorman
,
R. C.
, and
Guccione
,
J. M.
,
2012
, “
First Evidence of Depressed Contractility in the Border Zone of a Human Myocardial Infarction
,”
Ann. Thorac. Surg.
,
93
(
4
), pp.
1188
1193
.10.1016/j.athoracsur.2011.12.066
4.
Lee
,
L. C.
,
Wenk
,
J. F.
,
Klepach
,
D.
,
Zhang
,
Z.
,
Saloner
,
D.
,
Wallace
,
A. W.
,
Ge
,
L.
,
Ratcliffe
,
M. B.
, and
Guccione
,
J. M.
,
2011
, “
A Novel Method for Quantifying In-Vivo Regional Left Ventricular Myocardial Contractility in the Border Zone of a Myocardial Infarction
,”
ASME J. Biomech. Eng.
,
133
(
9
), p.
094506
.10.1115/1.4004995
5.
Shimkunas
,
R.
,
Makwana
,
O.
,
Spaulding
,
K.
,
Bazargan
,
M.
,
Khazalpour
,
M.
,
Takaba
,
K.
,
Soleimani
,
M.
,
Myagmar
,
B.-E.
,
Lovett
,
D. H.
,
Simpson
,
P. C.
,
Ratcliffe
,
M. B.
, and
Baker
,
A. J.
,
2014
, “
Myofilament Dysfunction Contributes to Impaired Myocardial Contraction in the Infarct Border Zone
,”
Am. J. Physiol.: Heart Circ. Physiol.
,
307
(
8
), pp.
H1150
H1158
.10.1152/ajpheart.00463.2014
6.
Shimkunas
,
R.
,
Zhang
,
Z.
,
Wenk
,
J. F.
,
Soleimani
,
M.
,
Khazalpour
,
M.
,
Acevedo-Bolton
,
G.
,
Wang
,
G.
,
Saloner
,
D.
,
Mishra
,
R.
,
Wallace
,
A. W.
,
Ge
,
L.
,
Baker
,
A. J.
,
Guccione
,
J. M.
, and
Ratcliffe
,
M. B.
,
2013
, “
Left Ventricular Myocardial Contractility is Depressed in the Borderzone After Posterolateral Myocardial Infarction
,”
Ann. Thorac. Surg.
,
95
(
5
), pp.
1619
1625
.10.1016/j.athoracsur.2013.02.005
7.
Lee
,
L. C.
,
Wall
,
S. T.
,
Genet
,
M.
,
Hinson
,
A.
, and
Guccione
,
J. M.
,
2014
, “
Bioinjection Treatment: Effects of Post-Injection Residual Stress on Left Ventricular Wall Stress
,”
J. Biomech.
,
47
(
12
), pp.
3115
3119
.10.1016/j.jbiomech.2014.06.026
8.
Lee
,
L. C.
,
Ge
,
L.
,
Zhang
,
Z.
,
Pease
,
M.
,
Nikolic
,
S. D.
,
Mishra
,
R.
,
Ratcliffe
,
M. B.
, and
Guccione
,
J. M.
,
2014
, “
Patient-Specific Finite Element Modeling of the Cardiokinetix Parachute Device: Effects on Left Ventricular Wall Stress and Function
,”
Med. Biol. Eng. Comput.
52
(6), pp.
557
566
.10.1007/s11517-014-1159-5
9.
Kim
,
R. J.
,
Fieno
,
D. S.
,
Parrish
,
T. B.
,
Harris
,
K.
,
Chen
,
E.-L.
,
Simonetti
,
O.
,
Bundy
,
J.
,
Finn
,
J. P.
,
Klocke
,
F. J.
, and
Judd
,
R. M.
,
1999
, “
Relationship of MRI Delayed Contrast Enhancement to Irreversible Injury, Infarct Age, and Contractile Function
,”
Circulation
,
100
(
19
), pp.
1992
2002
.10.1161/01.CIR.100.19.1992
10.
Choi
,
K. M.
,
Kim
,
R. J.
,
Gubernikoff
,
G.
,
Vargas
,
J. D.
,
Parker
,
M.
, and
Judd
,
R. M.
,
2001
, “
Transmural Extent of Acute Myocardial Infarction Predicts Long-Term Improvement in Contractile Function
,”
Circulation
,
104
(
10
), pp.
1101
1107
.10.1161/hc3501.096798
11.
Wu
,
E.
,
Judd
,
R. M.
,
Vargas
,
J. D.
,
Klocke
,
F. J.
,
Bonow
,
R. O.
, and
Kim
,
R. J.
,
2001
, “
Visualisation of Presence, Location, and Transmural Extent of Healed Q-Wave and Non-Q-Wave Myocardial Infarction
,”
Lancet
,
357
(
9249
), pp.
21
28
.10.1016/S0140-6736(00)03567-4
12.
Sun
,
K.
,
Stander
,
N.
,
Jhun
,
C.-S.
,
Zhang
,
Z.
,
Suzuki
,
T.
,
Wang
,
G.-Y.
,
Saeed
,
M.
,
Wallace
,
A. W.
,
Tseng
,
E. E.
,
Baker
,
A. J.
,
Saloner
,
D. A.
,
Einstein
,
D. R.
,
Ratcliffe
,
M. B.
, and
Guccione
,
J. M.
,
2009
, “
A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm
,”
ASME J. Biomech. Eng.
,
131
(
11
), p.
111001
.
13.
Wenk
,
J. F.
,
Sun
,
K.
,
Zhang
,
Z.
,
Soleimani
,
M.
,
Ge
,
L.
,
Saloner
,
D. A.
,
Wallace
,
A. W.
,
Ratcliffe
,
M. B.
, and
Guccione
,
J. M.
,
2011
, “
Regional Left Ventricular Myocardial Contractility and Stress in a Finite Element Model of Posterobasal Myocardial Infarction
,”
ASME J. Biomech. Eng.
,
133
(
4
), p.
044501
.10.1115/1.4003438
14.
Genet
,
M.
,
Lee
,
L. C.
,
Nguyen
,
R.
,
Haraldsson
,
H.
,
Acevedo-Bolton
,
G.
,
Zhang
,
Z.
,
Ge
,
L.
,
Ordovas
,
K.
,
Kozerke
,
S.
, and
Guccione
,
J. M.
,
2014
, “
Distribution of Normal Human Left Ventricular Myofiber Stress at End-Diastole and End-Systole—A Target for in Silico Studies of Cardiac Procedures
,”
J. Appl. Physiol.
,
117
, pp.
142
152
.10.1152/japplphysiol.00255.2014
15.
Sagawa
,
K.
,
1978
, “
The Ventricular Pressure-Volume Diagram Revisited
,”
Circ. Res.
,
43
(
5
), pp.
677
687
.10.1161/01.RES.43.5.677
16.
Holzapfel
,
G. A.
,
2000
,
Nonlinear Solid Mechanics: A Continuum Approach for Engineering
,
Wiley
, Chichester, UK, p.
470
.
17.
Fung
,
Y. C.
,
1993
, Biomechanics: Mechanical Properties of Living Tissues,
Springer-Verlag
,
New York
.10.1007/978-1-4757-2257-4
18.
Guccione
,
J. M.
,
McCulloch
,
A. D.
, and
Waldman
,
L. K.
,
1991
, “
Passive Material Properties of Intact Ventricular Myocardium Determined From a Cylindrical Model
,”
ASME J. Biomech. Eng.
,
113
(
1
), pp.
42
55
.10.1115/1.2894084
19.
Ateshian
,
G. A.
, and
Costa
,
K. D.
,
2009
, “
A Frame-Invariant Formulation of Fung Elasticity
,”
J. Biomech.
,
42
(
6
), pp.
781
785
.10.1016/j.jbiomech.2009.01.015
20.
Guccione
,
J. M.
, and
McCulloch
,
A. D.
,
1993
, “
Mechanics of Active Contraction in Cardiac Muscle: Part I—Constitutive Relations for Fiber Stress That Describe Deactivation
,”
ASME J. Biomech. Eng.
,
115
(
1
), pp.
72
81
.10.1115/1.2894084
21.
Guccione
,
J. M.
,
Waldman
,
L. K.
, and
McCulloch
,
A. D.
,
1993
, “
Mechanics of Active Contraction in Cardiac Muscle: Part II—Cylindrical Models of the Systolic Left Ventricle
,”
ASME J. Biomech. Eng.
,
115
(
1
), pp.
82
90
.10.1115/1.2895474
22.
Osman
,
N. F.
,
Kerwin
,
W. S.
,
McVeigh
,
E. R.
, and
Prince
,
J. L.
,
1999
, “
Cardiac Motion Tracking Using CINE Harmonic Phase (HARP) Magnetic Resonance Imaging
,”
Magn. Reson. Med.
,
42
(
6
), pp.
1048
1060
.10.1002/(SICI)1522-2594(199912)42:6<1048::AID-MRM9>3.0.CO;2-M
23.
Ryf
,
S.
,
Tsao
,
J.
,
Schwitter
,
J.
,
Stuessi
,
A.
, and
Boesiger
,
P.
,
2004
, “
Peak-Combination HARP: A Method to Correct for Phase Errors in HARP
,”
J. Magn. Reson. Imaging
,
20
, pp.
874
880
.10.1002/jmri.20186
24.
Christensen
,
G. E.
,
Rabbitt
,
R. D.
, and
Miller
,
M. I.
,
1996
, “
Deformable Templates Using Large Deformation Kinematics
,”
IEEE Trans. Image Process.
,
5
(
10
), pp.
1435
1447
.10.1109/83.536892
25.
Tanaka
,
Y.
,
Genet
,
M.
,
Lee
,
L. C.
,
Martin
,
A. J.
,
Sievers
,
R.
, and
Gerstenfeld
,
E. P.
,
2015
, “
Utility of High-Resolution Electroanatomic Mapping of the Left Ventricle Using a Multispline Basket Catheter in a Swine Model of Chronic Myocardial Infarction
,”
Heart Rhythm
,
12
(
1
), pp.
144
154
.10.1016/j.hrthm.2014.08.036
26.
Sun
,
K.
,
Zhang
,
Z.
,
Suzuki
,
T.
,
Wenk
,
J. F.
,
Stander
,
N.
,
Einstein
,
D. R.
,
Saloner
,
D. A.
,
Wallace
,
A. W.
,
Guccione
,
J. M.
, and
Ratcliffe
,
M. B.
,
2010
, “
Dor Procedure for Dyskinetic Anteroapical Myocardial Infarction Fails to Improve Contractility in the Border Zone
,”
J. Thorac. Cardiovasc. Surg.
,
140
(
1
), pp.
233
239
.10.1016/j.jtcvs.2009.11.055
27.
Jones
,
R. H.
,
Velazquez
,
E. J.
,
Michler
,
R. E.
,
Sopko
,
G.
,
Oh
,
J. K.
,
O'Connor
,
C. M.
,
Hill
,
J. A.
,
Menicanti
,
L.
,
Sadowski
,
Z.
,
Desvigne-Nickens
,
P.
,
Rouleau
,
J.-L.
, and
Lee
,
K. L.
,
2009
, “
Coronary Bypass Surgery With or Without Surgical Ventricular Reconstruction
,”
N. Engl. J. Med.
,
360
(
17
), pp.
1705
1717
.10.1056/NEJMoa0900559
28.
Walker
,
J. C.
,
Ratcliffe
,
M. B.
,
Zhang
,
P.
,
Wallace
,
A. W.
,
Fata
,
B.
,
Hsu
,
E. W.
,
Saloner
,
D. A.
, and
Guccione
,
J. M.
,
2005
, “
MRI-Based Finite-Element Analysis of Left Ventricular Aneurysm
,”
Am. J. Physiol.: Heart Circ. Physiol.
,
289
(
2
), pp.
H692
H700
.10.1152/ajpheart.01226.2004
29.
Karim
,
R.
,
Housden
,
R. J.
,
Balasubramaniam
,
M.
,
Chen
,
Z.
,
Perry
,
D.
,
Uddin
,
A.
,
Al-Beyatti
,
Y.
,
Palkhi
,
E.
,
Acheampong
,
P.
,
Obom
,
S.
,
Hennemuth
,
A.
,
Lu
,
Y.
,
Bai
,
W.
,
Shi
,
W.
,
Gao
,
Y.
,
Peitgen
,
H.-O.
,
Radau
,
P.
,
Razavi
,
R.
,
Tannenbaum
,
A.
,
Rueckert
,
D.
,
Cates
,
J.
,
Schaeffter
,
T.
,
Peters
,
D.
,
MacLeod
,
R.
, and
Rhode
,
K. S.
,
2013
, “
Evaluation of Current Algorithms for Segmentation of Scar Tissue From Late Gadolinium Enhancement Cardiovascular Magnetic Resonance of the Left Atrium: An Open-Access Grand Challenge
,”
J. Cardiovasc. Magn. Reson.
,
15
(105), pp.
1
7
.10.1186/1532-429X-15-105
30.
Lee
,
L. C.
,
Genet
,
M.
,
Tanaka
,
Y.
,
Guccione
,
J. M.
,
Martin
,
A. J.
,
Ordovas
,
K.
,
Sievers
,
R.
, and
Gerstenfeld
,
E. P.
,
2014
, “
Comparison of Methodologies for Scar Delineation Using Delayed-Enhancement MRI in a Swine Model of Chronic Infarction
,”
Heart Rhythm Society Meeting
, pp.
PO05
PO131
.http://ondemand.hrsonline.org/common/presentation-detail.aspx/15/23/1392/10554
31.
Kramer
,
C. M.
,
Rogers
,
W. J.
,
Mankad
,
S.
,
Theobald
,
T. M.
,
Pakstis
,
D. L.
, and
Hu
,
Y.-L.
,
2000
, “
Contractile Reserve and Contrast Uptake Pattern by Magnetic Resonance Imaging and Functional Recovery After Reperfused Myocardial Infarction
,”
J. Am. Coll. Cardiol.
,
36
(
6
), pp.
1835
1840
.10.1016/S0735-1097(00)00945-1
32.
Toussaint
,
N.
,
Stoeck
,
C. T.
,
Sermesant
,
M.
,
Schaeffter
,
T.
,
Kozerke
,
S.
, and
Batchelor
,
P. G.
,
2013
, “
In Vivo Human Cardiac Fibre Architecture Estimation Using Shape-Based Diffusion Tensor Processing
,”
Med. Image Anal.
,
17
(8), pp.
1243
1255
.10.1016/j.media.2013.02.008
33.
Harmer
,
J.
,
Pushparajah
,
K.
,
Toussaint
,
N.
,
Stoeck
,
C. T.
,
Chan
,
R. W.
,
Atkinson
,
D.
,
Razavi
,
R.
, and
Kozerke
,
S.
,
2013
, “
In Vivo Myofibre Architecture in the Systemic Right Ventricle
,”
Eur. Heart J.
,
34
(
47
), p.
3640
.10.1093/eurheartj/eht442
You do not currently have access to this content.