Wolf T, Gepstein L, Dror U, Hayam G, Shofti R, Zaretzky A, Uretzky G, Oron U, Ben-Haim S A
Cardiovascular System Laboratory, The Bruce Rappaport Faculty of Medicine, Haifa, Israel.
J Am Coll Cardiol. 2001 May;37(6):1590-7. doi: 10.1016/s0735-1097(01)01209-8.
This study delineates between infarcts varying in transmurality by using endocardial electrophysiologic information obtained during catheter-based mapping.
The degree of infarct transmurality extent has previously been linked to patient prognosis and may have significant impact on therapeutic strategies. Catheter-based endocardial mapping may accurately delineate between infarcts differing in the transmural extent of necrotic tissue.
Electromechanical mapping was performed in 13 dogs four weeks after left anterior descending coronary artery ligation, enabling three-dimensional reconstruction of the left ventricular chamber. A concomitant reduction in bipolar electrogram amplitude (BEA) and local shortening indicated the infarcted region. In addition, impedance, unipolar electrogram amplitude (UEA) and slew rate (SR) were quantified. Subsequently, the hearts were excised, stained with 2,3,5-triphenyltetrazolium chloride and sliced transversely. The mean transmurality of the necrotic tissue in each slice was determined, and infarcts were divided into <30%, 31% to 60% and 61% to 100% transmurality subtypes to be correlated with the corresponding electrical data.
From the three-dimensional reconstructions, a total of 263 endocardial points were entered for correlation with the degree of transmurality (4.6 +/- 2.4 points from each section). All four indices delineated infarcted tissue. However, BEA (1.9 +/- 0.7 mV, 1.4 +/- 0.7 mV, 0.8 +/- 0.4 mV in the three groups respectively, p < 0.05 between each group) proved superior to SR, which could not differentiate between the second (31% to 60%) and third (61% to 100%) transmurality subgroups, and to UEA and impedance, which could not differentiate between the first (<30%) and second transmurality subgroups.
The degree of infarct transmurality extent can be derived from the electrical properties of the endocardium obtained via detailed catheter-based mapping in this animal model.
本研究通过使用基于导管标测期间获得的心内膜电生理信息来区分透壁性不同的梗死灶。
梗死透壁程度先前已与患者预后相关，并且可能对治疗策略有重大影响。基于导管的心内膜标测可准确区分坏死组织透壁程度不同的梗死灶。
在13只犬左前降支冠状动脉结扎4周后进行机电标测，以实现左心室腔的三维重建。双极电图振幅（BEA）和局部缩短的同时降低表明梗死区域。此外，对阻抗、单极电图振幅（UEA）和 slew 率（SR）进行了量化。随后，取出心脏，用2,3,5-氯化三苯基四氮唑染色并横向切片。确定每个切片中坏死组织的平均透壁性，并将梗死灶分为透壁性<30%、31%至60%和61%至100%的亚型，以与相应的电数据相关联。
从三维重建中，总共输入了263个心内膜点以与透壁程度相关（每个切片4.6±2.4个点）。所有四个指标都能描绘出梗死组织。然而，BEA（三组分别为1.9±0.7 mV、1.4±0.7 mV、0.8±0.4 mV，每组之间p<0.05）被证明优于SR，SR无法区分第二（31%至60%）和第三（61%至100%）透壁性亚组，以及UEA和阻抗，它们无法区分第一（<30%）和第二透壁性亚组。
在该动物模型中，梗死透壁程度可通过基于详细导管标测获得的心内膜电特性得出。
