MUSIC: Cardiac Imaging, Modelling and Visualisation Software for Diagnosis and Therapy

International audienceThe tremendous advancement of cardiac imaging methods, the substantial progress in predictive modelling, along with the amount of new investigative multimodalities, challenge the current technologies in the cardiology field. Innovative, robust and multimodal tools need to be created in order to fuse imaging data (e.g., MR, CT) with mapped electrical activity and to integrate those into 3D biophysical models. In the past years, several cross-platform toolkits have been developed to provide image analysis tools to help build such software. The aim of this study is to introduce a novel multimodality software platform dedicated to cardiovascular diagnosis and therapy guidance: MUSIC. This platform was created to improve the image-guided cardiovascular interventional procedures and is a robust platform for AI/Deep Learning, image analysis and modelling in a newly created consortium with international hospitals. It also helps our researchers develop new techniques and have a better understanding of the cardiac tissue properties and physiological signals. Thus, this extraction of quantitative information from medical data leads to more repeatable and reliable medical diagnoses

GenIDA: an international participatory database to gain knowledge on health issues related to genetic forms of neurodevelopmental disorders

International audienceIntellectual disability with or without manifestations of autism and/or epilepsy affects 1–2% of the population, and it is estimated that more than 30–50% of these cases have a single genetic cause. More than 1000 genes and recurrent chromosomal abnormalities are involved in these genetic forms of neurodevelopmental disorders, which often remain insufficiently described in terms of clinical spectrum, associated medical problems, etc., due to their rarity and the often-limited number of patients’ phenotypes reported. GenIDA is an international online participatory database that aims to better characterise the clinical manifestations and natural histories of these rare diseases. Clinical information is reported by parents of affected individuals using a structured questionnaire exploring physical parameters, cognitive and behavioural aspects, the presence or absence of neurological disorders or problems affecting major physiological functions, as well as autonomy and quality of life. This strengthens the implication in research of the concerned families. GenIDA aims to construct international cohorts of significant size of individuals affected by a given condition. As of July 2022, GenIDA counts some 1545 documented patient records from over 60 nationalities and collaborates with clinicians and researchers around the world who have access to the anonymized data collected to generate new, medically meaningful information to improve patient care. We present the GenIDA database here, together with an overview of the possibilities it offers to affected individuals, their families, and professionals in charge of the management of genetic forms of neurodevelopmental disorders. Finally, case studies of cohorts will illustrate the usefulness of GenIDA

Que m'arrive-t-il ?

En posant la question des rapports entre événement et littérature, on engage un dialogue à plusieurs voix entre les différentes époques de la production littéraire et entre les divers territoires de la critique. Il s'agit également d'échanger avec les disciplines des sciences humaines dont le voisinage est aujourd'hui nécessaire, polémique et complémentaire – avec ces disciplines qui envisagent le rapport de l'homme à l'histoire, au temps humain et aux représentations qui y donnent accès

Impact of Spacing and Orientation on the Scar Threshold With a High-Density Grid Catheter

International audienceBACKGROUND: Multipolar catheters are increasingly used for highdensity mapping. However, the threshold to define scar areas has not been well described for each configuration. We sought to elucidate the impact of bipolar spacing and orientation on the optimal threshold to match magnetic resonance imaging-defined scar. METHOD: The HD-Grid catheter uniquely allows for different spatially stable bipolar configurations to be tested. We analyzed the electrograms with settings of HD-16 (3 mm spacing in both along and across bipoles) and HD-32 (1 mm spacing in along bipoles and 3 mm spacing in across bipoles) and determined the optimal cutoff for scar detection in 6 infarcted sheep. RESULTS: From 456 total acquisition sites (mean 76±12 per case), 14 750 points with the HD-16 and 32286 points with the HD-32 configuration for bipolar electrograms were analyzed. For bipolar voltages, the optimal cutoff value to detect the magnetic resonance imaging-defined scar based on the Youden's Index, and the area under the receiver operating characteristic curve (AUROC) differed depending on the spacing and orientation of bipoles; across 0.84 mV (AUROC, 0.920; 95% CI, 0.911-0.928), along 0.76 mV (AUROC, 0.903; 95% CI, 0.893-0.912), northeast direction 0.95 mV (AUROC, 0.923; 95% CI, 0.913-0.932), and southeast direction, 0.87 mV (AUROC, 0.906; 95% CI, 0.895-0.917) in HD-16; and across 0.83 mV (AUROC, 0.917; 95% CI, 0.911-0.924), along 0.46 mV (AUROC, 0.890; 95% CI, 0.883-0.897), northeast direction 0.89 mV (AUROC, 0.923; 95% CI, 0.917-0.929), and southeast direction 0.83 mV (AUROC, 0.913; 95% CI, 0.906-0.920) in HD-32. Significant differences in AUROC were seen between HD-16 along versus across (P=0.002), HD-16 northeast direction versus southeast direction (P=0.01), HD-32 northeast direction versus southeast direction (P<0.0001), and HD-16 along versus HD-32 along (P=0.006). The AUROC was significantly larger (P<0.01) when only the best points on each given site were selected for analysis, compared with when all points were used. CONCLUSIONS: Spacing and orientation of bipoles impacts the accuracy of scar detection. Optimal threshold specific to each bipolar configuration should be determined. Selecting one best voltage point among multiple points projected on the same surface is also critical on the Ensite-system to increase the accuracy of scar-mapping

Detailed Analysis of the Relation Between Bipolar Electrode Spacing and Far- and Near-Field Electrograms

International audienceOBJECTIVESThis study sought to evaluate the relation between bipolar electrode spacing and far- and near-fieldelectrograms.BACKGROUNDThe detailed effects of bipolar spacing on electrograms (EGMs) is not well described.METHODSWith a HD-Grid catheter, EGMs from different bipole pairs could be created in each acquisition. This studyanalyzed the effect of bipolar spacing on EGMs in 7 infarcted sheep. A segment was defined as a 2-mm center-to-centerbipole. In total, 4,768 segments (2,020 healthy, 1,542 scar, and 1,206 in border areas, as defined by magnetic resonanceimaging [MRI]) were covered with an electrode pair of spacing of 2 mm (Bi-2), 4 mm (Bi-4), and 8 mm (Bi-8).RESULTSA total of 3,591 segments in Bi-2 were free from local abnormal ventricular activities (LAVAs); 1,630 segmentswere within the MRI-defined scar and/or border area. Among them, 172 (10.6%) segments in Bi-4 and 219 (13.4%)segments in Bi-8 showed LAVAs. In contrast, LAVAs were identified in 1,177 segments in Bi-2; 1,118 segments were withinthe MRI-defined scar and/or border area. Among them, LAVAs were missed in 161 (14.4%) segments in Bi-4 and in 409(36.6%) segments in Bi-8. In segments with LAVAs, median far-field voltage increased from 0.09 mV (25th to 75thpercentile: 0.06 to 0.14 mV) in Bi-2, to 0.16 mV (25th to 75th percentile: 0.10 to 0.24 mV) in Bi-4, and to 0.28 mV (25thto 75th percentile: 0.20 to 0.42 mV) in Bi-8 (p<0.0001). Median near-field voltage increased from 0.14 mV (25th to75th percentile: 0.08 to 0.25 mV) in Bi-2, to 0.21 mV (25th to 75th percentile: 0.12 to 0.35 mV) in Bi-4, and to 0.32 mV(25th to 75th percentile: 0.17 to 0.48 mV) in Bi-8 (p<0.0001). The median near-/far-field voltage ratio decreased from1.67 in Bi-2, to 1.43 in Bi-4, and 1.23 in Bi-8 (p<0.0001).CONCLUSIONSCloser spacing better discriminates surviving tissue from dead scar area. Although far-field voltagesystematically increases with spacing, near-field voltages were more variable, depending on local surviving muscularbundles. Near-field EGMs are more easily observed with smaller spacing, largely due to the reduction of the far-field effect.(J Am Coll Cardiol EP 2019;5:66–77) © 2019 by the American College of Cardiology Foundation