Atkinson, David

Chan, Rachel

Harmer, Jack

Kozerke, Sebastian

Pushparajah, Kuberan

Razavi, Reza

Stoeck, Christian T.

Toussaint, Nicolas

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41. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trendsin sudden cardiovascular death in young competitive athletes after imple-mentation of a preparticipation screening program. JAMA 2006;296:1593–1601.42. Noheria A, Teodorescu C, Uy-Evanado A, Reinier K, Mariani R, Gunson K, Jui J,Chugh SS. Distinctive profile of sudden cardiac arrest in middle-aged vs. olderadults: a community-based study. Int J Cardiol 2013 May 16, doi:pii:S0167-5273(13)00890-5. 10.1016/j.ijcard.2013.04.207. Published online ahead ofprint.43. Drezner JA. Detect, manage, inform: a paradigm shift in the care of athletes withcardiac disorders? Br J Sports Med 2013;47:4–5.44. Drezner JA, Levine BD, Vetter VL. Reframing the debate: screening athletes toprevent sudden cardiac death. Heart Rhythm 2013;10:454–455.45. Chugh SS. Early identification of risk factors for sudden cardiac death.Nat Rev Cardiol2010;7:318–326.46. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggeringof sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000;343:1355–1361.47. Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiacarrest during vigorous exercise. N Engl J Med 1984;311:874–877.48. CorradoD,BassoC,RizzoliG,SchiavonM,ThieneG.Doessportsactivityenhancetheriskof sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42:1959–1963.CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/eht442Online publish-ahead-of-print 18 October 2013In vivo myofibre architecture in the systemic right ventricleJack Harmer1†*, Kuberan Pushparajah1†, Nicolas Toussaint1, Christian T. Stoeck2, Rachel Chan3,David Atkinson3, Reza Razavi1, and Sebastian Kozerke1,21Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK; 2Institute for Biomedical Engineering, University andETH Zurich, Switzerland; and 3Centre for Medical Imaging, University College London, London, UK* Corresponding author. Division of Imaging Sciences, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK.Tel: +44 207-188 5441; Fax: +44 207 188 5442, Email : jack.harmer@kcl.ac.uk† Equal Contributors.Heart failure in the systemic right ventricle (RV) is acommon pathway in end-stage disease in patientsaffected with congenital heart disease. Usingstate-of-the-art magnetic resonance (MR) diffusionacquisition schemes, we present the first in vivo dif-fusion tensor imaging (DTI) data of the beatingheart acquired in an adult with a systemic RV fol-lowing an atrial switch procedure for transpositionof the great arteries. Magnetic resonance-basedDTI acquisitions provide information about thepredominant direction of structures within eachvoxel of the acquired image. These aggregates,which are often interpreted as fibres, appear as co-herent orientational structures throughout themyocardium. Knowledge of cardiac myocyte archi-tecture has the potential to transform our under-standing of cardiac function and the mechanismsbehind heart failure. Until recently, direct visualiza-tion of myofibre architecture has been limited to exvivo specimens due to cardiac motion. However,recent advances in MRI now allow for robust DTIof the beating heart and can provide in vivo knowl-edge of myofibre architecture. In the data pre-sented here, diffusion tensors are shown acrossmultiple slices and are colour coded to indicatehelix angle (Panels A–E). Full 3D reconstructionsacross the volume of the heart are also shown. Helix angle distributions indicate a predominance of circumferential fibres across theentire healthy LV and in the anterior and inferior segments of the systemic RV. However, in the lateral wall of the systemic RV, helixangles are skewed towards negative values. This indicates a predominance of longitudinal and oblique fibres with a clockwise helix orien-tation and is likely brought about to adaptation of the RV to systemic pressure and load.This work was supported by the UK EPSRC (EP/I018700/1), Adult Congenital Heart Disease Service Guy’s and St Thomas’ NHS foun-dationTrust, and the National Institute for Health Research (NIHR) Biomedical Research Centre atGuy’s and St Thomas’ NHS FoundationTrust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or theDepartment of Health.Published on behalf of the European Society of Cardiology. All rights reserved.& The Author 2013. For permissions please email: journals.permissions@oup.comE. Marijon et al.3640

In vivo myofibre architecture in the systemic right ventricle

In vivo myofibre architecture in the systemic right ventricle

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