Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy

Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.The Centro Nacional de Investigaciones Cardiovasculares (CNIC) is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovación and the ProCNIC Foundation (Madrid, Spain). The CNIC and the Barcelona Supercomputing Center (BSC, Barcelona, Spain) are Severo Ochoa Centers of Excellence (SEV-2015-0505 and SEV-2011-0067, respectively). This study was also supported by grants from the Fondo Europeo de Desarrollo Regional (CB16/11/00458), the Ministerio de Ciencia e Innovación (PID2019-109329RB-I00) and the Heart Rhythm Association of the Spanish Society of Cardiology (ARC). The study was also part of a Master Research Agreement between CNIC and Philips Healthcare. The study was partially supported by the Fundación Interhospitalaria para la Investigación Cardiovascular (FIC, Madrid, Spain) and the Fundación Eugenio Rodríguez Pascual (Madrid, Spain). J.A.-S. is funded by the CompBioMed2 project grant agreement 823712, H2020-EU.1.4.1.3 European Union’s Horizon 2020 research and innovation program, the SILICOFCM project, grant agreement 777204, H2020-EU.3.1.5 and by a Ramón y Cajal fellowship (RYC-2017-22532), MINECO, Spain. L.K.G was funded by the Fundación Carolina-BBVA. Grant TEC2017-82408-R is also acknowledged.Peer Reviewed"Article signat per 25 autors/es: Susana Merino-Caviedes, Lilian K. Gutierrez, José Manuel Alfonso-Almazán, Santiago Sanz-Estébanez, Lucilio Cordero-Grande, Jorge G. Quintanilla, Javier Sánchez-González, Manuel Marina-Breysse, Carlos Galán-Arriola, Daniel Enríquez-Vázquez, Carlos Torres, Gonzalo Pizarro, Borja Ibáñez, Rafael Peinado, Jose Luis Merino, Julián Pérez-Villacastín, José Jalife, Mariña López-Yunta, Mariano Vázquez, Jazmín Aguado-Sierra, Juan José González-Ferrer, Nicasio Pérez-Castellano, Marcos Martín-Fernández, Carlos Alberola-López & David Filgueiras-Rama"Postprint (published version