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The mechanisms underlying infarct extension remain unclear, but myocyte stretching has been suggested as the most likely cause. Using human patient\u2010specific left\u2010ventricular (LV) numerical simulations established from cardiac magnetic resonance imaging (MRI) of myocardial infarction (MI) patients, the correlation between infarct extension and regional mechanics abnormality was investigated by analysing the fibre stress\u2013strain loops (FSSLs). FSSL abnormality was characterised using the directional regional external work (DREW) index, which measures FSSL area and loop direction. Sensitivity studies were also performed to investigate the effect of infarct stiffness on regional myocardial mechanics and potential for infarct extension. We found that infarct extension was correlated to severely abnormal FSSL in the form of counter\u2010clockwise loop at the RZ close to the infarct, as indicated by negative DREW values. In regions demonstrating negative DREW values, we observed substantial fibre stretching in the isovolumic relaxation (IVR) phase accompanied by a reduced rate of systolic shortening. Such stretching in IVR phase in part of the RZ was due to its inability to withstand the high LV pressure that was still present and possibly caused by regional myocardial stiffness inhomogeneity. Further analysis revealed that the occurrence of severely abnormal FSSL due to IVR fibre stretching near the RZ\u2010BZ boundary was due to a large amount of surrounding infarcted tissue, or an excessively stiff IZ.<\/jats:p>","DOI":"10.1002\/cnm.3501","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T12:43:24Z","timestamp":1622465004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The role of regional myocardial topography post\u2010myocardial infarction on infarct extension"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4182-2281","authenticated-orcid":false,"given":"Chen Onn","family":"Leong","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering University of Malaya  Kuala Lumpur 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