Investigators Use Personalized Modeling to Diagnose Hypertrophic Cardiomyopathy

By Jonathan Springston, Editor, Relias Media

A group of engineers recently tested a novel approach to identifying arrhythmias, diagnosing hypertrophic cardiomyopathy (HCM), and identifying candidates for defibrillators.

An irregular heartbeat could be a sign a patient is living with a serious condition, such as HCM, which damages heart muscles and is the leading cause of sudden cardiac death. Primary prevention calls for implanting a cardioverter defibrillator, a risky procedure.

"There are ways to predict which patients are at risk of developing heart arrhythmias and who might benefit from a defibrillator, but these methods are not accurate," said Ryan O'Hara, a study author and doctoral candidate in the Johns Hopkins Department of Biomedical Engineering. "We wanted to develop a more accurate and personalized approach for predicting abnormal heart rhythms in patients with hypertrophic cardiomyopathy."

O’Hara and colleagues blended post-contrast T1 mapping and contrast-enhanced cardiac MRI with late gadolinium enhancement to create 3D digital models of HCM patients’ hearts. Doing so allowed researchers to see the unique characteristics of each patient’s heart, including diffuse fibrosis, which the authors noted “is rarely assessed in these patients [and] increases arrhythmogenic propensity.”

“In forecasting future [ventricular arrhythmia] 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,” the authors explained.

Although the study population was small (n = 26), the authors believe “the technology developed here charts a new direction in the use of biophysically detailed heart modeling in the prognosis of rhythm disorders.” Patients who need a defibrillator might be able to receive one sooner; those who do not might avoid undergoing dangerous surgery.

In the February 2022 issue of Clinical Cardiology Alert, editor Michael H. Crawford, MD, wrote about a pharmacological treatment for obstructive HCM that could be promising. The results of a clinical trial showed mavacamten, a cardiac myosin inhibitor, alleviated symptoms, expanded exercise capacity, and reduced left ventricular outflow tract obstruction in patients with this condition. “Most patients probably would prefer a pill to invasive septal reduction therapies,” Crawford observed.