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(Circulation Research. 2006;98:125.)
© 2006 American Heart Association, Inc.

Integrative Physiology

Evidence of Structural Remodeling in the Dyssynchronous Failing Heart

Patrick A. Helm, Laurent Younes, Mirza F. Beg, Daniel B. Ennis, Christophe Leclercq, Owen P. Faris, Elliot McVeigh, David Kass, Michael I. Miller, Raimond L. Winslow

From the Centers for Cardiovascular Bioinformatics & Modeling (P.A.H., R.L.W.) and Imaging Science (L.Y., M.I.M.) and Division of Cardiology (C.L., D.K.), Johns Hopkins University, Baltimore, Md; Engineering Science (M.F.B.), Simon Fraser University, Burnaby, British Columbia, Canada; and Laboratory of Cardiac Energetics (D.B.E., O.P.F., E.M.), National Heart Lung Blood Institute, National Institutes of Health, Bethesda, Md.

Correspondence to Patrick Helm, 202 Clark Hall, Johns Hopkins University, 3400 N Charles St, Baltimore MD 21218. E-mail phelm{at}bme.jhu.edu

Ventricular remodeling of both geometry and fiber structure is a prominent feature of several cardiac pathologies. Advances in MRI and analytical methods now make it possible to measure changes of cardiac geometry, fiber, and sheet orientation at high spatial resolution. In this report, we use diffusion tensor imaging to measure the geometry, fiber, and sheet architecture of eight normal and five dyssynchronous failing canine hearts, which were explanted and fixed in an unloaded state. We apply novel computational methods to identify statistically significant changes of cardiac anatomic structure in the failing and control heart populations. The results demonstrate significant regional differences in geometric remodeling in the dyssynchronous failing heart versus control. Ventricular chamber dilatation and reduction in wall thickness in septal and some posterior and anterior regions are observed. Primary fiber orientation showed no significant change. However, this result coupled with the local wall thinning in the septum implies an altered transmural fiber gradient. Further, we observe that orientation of laminar sheets become more vertical in the early-activated septum, with no significant change of sheet orientation in the late-activated lateral wall. Measured changes in both fiber gradient and sheet structure will affect both the heterogeneity of passive myocardial properties as well as electrical activation of the ventricles.

Key Words: cardiac remodeling • computational anatomy • fiber architecture • dyssynchrony

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