Left ventricular MRI segmentations

Hypertrophic cardiomyopathy (HCM) causes sudden cardiac death (SCD) due to
ventricular arrhythmias (VA) manifesting from myocardial fibrosis
proliferation. Current clinical risk stratification criteria inadequately
identify at-risk patients in need of primary prevention of VA. Here, we
use mechanistic computational modeling of the heart to analyze how
HCM-specific remodeling of the heart promotes arrhythmogenesis and to
develop a personalized strategy to forecast risk of VAs in these patients.
We combine contrast-enhanced cardiac magnetic-resonance (CMR) imaging and
T1 mapping data to construct digital replicas of HCM patient hearts that
represent the patient-specific distribution of focal and diffuse fibrosis
and evaluate the substrate propensity to VA. Our analysis indicates that
the presence of diffuse fibrosis, which is rarely assessed in these
patients, increases arrhythmogenic propensity. In forecasting future VA
events in HCM patients, the imaging-based computational heart approach
achieved 84.6%, 76.9%, and 80.1% sensitivity, specificity, and accuracy,
respectively, and significantly outperformed current clinical risk
predictors. This novel VA risk assessment may have the potential to
prevent SCD and help deploy primary prevention appropriately in HCM
patients.