通过心内膜电解剖标测评估心肌存活：与代谢成像及冠状动脉血运重建后的功能恢复情况比较

Myocardial viability assessment by endocardial electroanatomic mapping: comparison with metabolic imaging and functional recovery after coronary revascularization.

作者信息

Koch K C, vom Dahl J, Wenderdel M, Nowak B, Schaefer W M, Sasse A, Stellbrink C, Buell U, Hanrath P

机构信息

Medizinische Klinik I, Department of Cardiology, Aachen, Germany.

出版信息

J Am Coll Cardiol. 2001 Jul;38(1):91-8. doi: 10.1016/s0735-1097(01)01314-6.

DOI:10.1016/s0735-1097(01)01314-6

PMID:11451302

Abstract

OBJECTIVES

The objective of this study was to compare electroanatomic mapping for the assessment of myocardial viability with nuclear metabolic imaging using positron emission computed tomography (PET) and with data on functional recovery after successful myocardial revascularization.

BACKGROUND

Animal experiments and first clinical studies suggested that electroanatomic endocardial mapping identifies the presence and absence of myocardial viability.

METHODS

Forty-six patients with prior (> or =2 weeks) myocardial infarction underwent fluorine-18 fluorodeoxyglucose (FDG) PET and Tc-99m sestamibi single-photon emission computed tomography (SPECT) before mapping and percutaneous coronary revascularization. The left ventricular endocardium was mapped and divided into 12 regions, which were assigned to corresponding nuclear regions. Functional recovery using the centerline method was assessed in 25 patients with a follow-up angiography.

RESULTS

Regional unipolar electrogram amplitude was 11.0 mV +/- 3.6 mV in regions with normal perfusion, 9.0 mV +/- 2.8 mV in regions with reduced perfusion and preserved FDG-uptake and 6.5 mV +/- 2.6 mV in scar regions (p < 0.001 for all comparisons). At a threshold amplitude of 7.5 mV, the sensitivity and specificity for detecting viable (by PET/SPECT) myocardium were 77% and 75%, respectively. In infarct areas with electrogram amplitudes >7.5 mV, improvement of regional wall motion (RWM) from -2.4 SD/chord +/- 1.0 SD/chord to -1.5 SD/chord +/- 1.1 SD/chord (p < 0.01) was observed, whereas, in infarct areas with amplitudes <7.5 mV, RWM remained unchanged at follow-up (-2.3 SD/chord +/- 0.7 SD/chord to -2.4 SD/chord +/- 0.7 SD/chord).

CONCLUSIONS

These data suggest that the regional unipolar electrogram amplitude is a marker for myocardial viability and that electroanatomic mapping can be used for viability assessment in the catheterization laboratory.

摘要

目的

本研究的目的是比较用于评估心肌存活性的电解剖标测与使用正电子发射计算机断层扫描（PET）的核代谢成像以及心肌血运重建成功后的功能恢复数据。

背景

动物实验和首批临床研究提示，电解剖心内膜标测可识别心肌存活性的有无。

方法

46例既往（≥2周）心肌梗死患者在标测和经皮冠状动脉血运重建前接受了氟-18氟脱氧葡萄糖（FDG）PET和锝-99m甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）。对左心室心内膜进行标测并分为12个区域，这些区域对应于相应的核素区域。采用中心线法对25例患者进行随访血管造影，评估其功能恢复情况。

结果

灌注正常区域的局部单极电图振幅为11.0 mV±3.6 mV，灌注减低但FDG摄取保留区域为9.0 mV±2.8 mV，瘢痕区域为6.5 mV±2.6 mV（所有比较p<0.001）。在阈值振幅为7.5 mV时，检测存活（通过PET/SPECT）心肌的敏感性和特异性分别为77%和75%。在电图振幅>7.5 mV的梗死区域，观察到局部室壁运动（RWM）从-2.4 SD/弦±1.0 SD/弦改善至-1.5 SD/弦±1.1 SD/弦（p<0.01），而在振幅<7.5 mV的梗死区域，随访时RWM保持不变（-2.3 SD/弦±0.7 SD/弦至-2.4 SD/弦±0.7 SD/弦）。