{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T06:18:19Z","timestamp":1762409899637,"version":"3.41.2"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000222","name":"Heart and Stroke Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000222","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy. The instillation of fluid into the peritoneum provides an opportunity to deliver moderate hypothermia as primary prevention against cardiovascular events. We aimed to to investigate both cardiac perfusion consequences (overall blood flow and detailed assessment of perfusion heterogeneity) and subsequently simulate the associated arrhythmic risk for patients undergoing peritoneal dialysis (PD) induced TH.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Patients underwent high resolution myocardial perfusion scanning using high resolution 256 slice CT scanning, at rest and with adenosine stress. The first visit using the patient's usual PD regimen, on the second visit the same regime was utilized but with cooled peritoneal dialysate at 32\u00b0C. Myocardial blood flow (MBF) was quantified from generated perfusion maps, reconstructed in 3D. MBF heterogeneity was assessed by fractal dimension (FD) measurement on the 3D left ventricular reconstruction. Arrhythmogenicity was quantified from a sophisticated computational simulation using a multi-scale human 3D ventricle wedge electrophysiological computational model.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> We studied 7 PD patients, mean age of 60 \u00b1 7 and mean vintage dialysis of 23.6 \u00b1 17.6 months. There were no significant different in overall segmental MBF between normothermic condition (NT) and TH. MBF heterogeneity was significantly decreased (\u221214%, <jats:italic>p<\/jats:italic> = 0.03) at rest and after stress (\u221214%, <jats:italic>p<\/jats:italic> = 0.03) when cooling was applied. Computational simulation showed that TH allowed a normalization of action potential, QT duration and T wave.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> TH-PD results in moderate hypothermia leading to a reduction in perfusion heterogeneity and simulated risk of non-terminating malignant ventricular arrhythmias.<\/jats:p>","DOI":"10.3389\/fmed.2021.700824","type":"journal-article","created":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T05:33:13Z","timestamp":1627623193000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Therapeutic Hypothermia Reduces Peritoneal Dialysis Induced Myocardial Blood Flow Heterogeneity and Arrhythmia"],"prefix":"10.3389","volume":"8","author":[{"given":"Sanjay R.","family":"Kharche","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandrine","family":"Lemoine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanya","family":"Tamasi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Hur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"So","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher W.","family":"McIntyre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1681\/ASN.2011060607","article-title":"Global trends in rates of peritoneal dialysis","volume":"23","author":"Jain","year":"2012","journal-title":"J Am Soc Nephrol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/sdi.12752","article-title":"Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: why isn't it better than hemodialysis?","volume":"32","author":"Selby","year":"2019","journal-title":"Semin Dial."},{"key":"B3","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1111\/j.1540-8159.2007.00651.x","article-title":"Poor prognosis for patients with chronic kidney disease despite ICD therapy for the primary prevention of sudden death","volume":"30","author":"Cuculich","year":"2007","journal-title":"Pacing Clin Electrophysiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1111\/j.1540-8167.2008.01258.x","article-title":"Benefit of primary prevention implantable cardioverter-defibrillators in the setting of chronic kidney disease: a decision model analysis","volume":"19","author":"Amin","year":"2008","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1536\/ihj.16-357","article-title":"Do implantable cardioverter defibrillators reduce mortality in patients with chronic kidney disease at all stages?","volume":"58","author":"Fu","year":"2017","journal-title":"Int Heart J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"388","DOI":"10.3747\/pdi.2014.00278","article-title":"ISPD cardiovascular and metabolic guidelines in adult peritoneal dialysis patients part II - 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