Wiggers Henrik, Bøtker Hans Erik, Søgaard Peter, Kaltoft Anne, Hermansen Flemming, Kim Won Yong, Krusell Lars, Thuesen Leif
Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark.
J Am Coll Cardiol. 2003 Mar 5;41(5):843-8. doi: 10.1016/s0735-1097(02)02961-3.
We compared catheter-based electromechanical mapping (NOGA system, Biosense-Webster, Haifa, Israel) with positron emission tomography (PET) and single photon emission computed tomography (SPECT) for prediction of reversibly dysfunctional myocardium (RDM) and irreversibly dysfunctional myocardium (IDM) in patients with severe left ventricular dysfunction. Furthermore, we established the optimal discriminatory value of NOGA measurements for distinction between RDM and IDM.
The NOGA system can detect viable myocardium but has not been used for prediction of post-revascularization contractile function in patients with ischemic cardiomyopathy.
Twenty patients (19 males, age [mean +/- SD] 60 +/- 16 years, ejection fraction [EF] 29 +/- 6%) underwent viability testing with NOGA and PET or SPECT before revascularization. Left ventricular function was studied at baseline and six months after revascularization.
The EF increased to 34 +/- 13% at six months (p < 0.05 vs. baseline). The 58 RDM and 57 IDM regions differed with regard to unipolar voltage amplitude (UVA) (9.2 +/- 3.9 mV vs. 7.6 +/- 4.0 mV, p < 0.05), normalized UVA (106 +/- 54% vs. 75 +/- 39%, p < 0.05), and tracer uptake (76 +/- 17% vs. 60 +/- 20%, p < 0.05). The NOGA local shortening did not distinguish between RDM and IDM (6.4 +/- 5.8% vs. 5.4 +/- 6.6%). By receiver operating characteristic curve analysis, myocardial tracer uptake had better diagnostic performance than UVA (area under curve [AUC] +/- SE: 0.82 +/- 0.04 vs. 0.63 +/- 0.05, p < 0.05) and normalized UVA (AUC +/- SE: 0.70 +/- 0.05, p < 0.05). Optimal threshold was defined as the value yielding sensitivity = specificity for prediction of RDM. Sensitivity and specificity were 59% at a UVA of 8.4 mV, 65% at a normalized UVA of 83%, and 78% at a tracer uptake of 69%.
The NOGA system may discriminate RDM from IDM with optimal discriminatory values for UVA and normalized UVA of 8.4 mV and 83%, respectively. However, the diagnostic performance does not reach the level obtained by PET and SPECT in patients with severe heart failure.
我们比较了基于导管的机电映射（NOGA系统，以色列海法市百盛-韦伯斯特公司）与正电子发射断层扫描（PET）及单光子发射计算机断层扫描（SPECT）在预测严重左心室功能不全患者可逆性功能不全心肌（RDM）和不可逆性功能不全心肌（IDM）方面的效果。此外，我们确定了NOGA测量值区分RDM和IDM的最佳判别值。
NOGA系统能够检测存活心肌，但尚未用于预测缺血性心肌病患者血管重建术后的收缩功能。
20例患者（19例男性，年龄[均值±标准差]60±16岁，射血分数[EF]29±6%）在血管重建术前接受了NOGA及PET或SPECT的存活心肌检测。在基线期及血管重建术后6个月对左心室功能进行了研究。
6个月时EF升至34±13%（与基线期相比，p<0.05）。58个RDM区域和57个IDM区域在单极电压幅度（UVA）（9.2±3.9mV对7.6±4.0mV，p<0.05）、标准化UVA（106±54%对75±39%，p<0.05）及示踪剂摄取（76±17%对60±20%，p<0.05）方面存在差异。NOGA局部缩短不能区分RDM和IDM（6.4±5.8%对5.4±6.6%）。通过受试者工作特征曲线分析，心肌示踪剂摄取的诊断性能优于UVA（曲线下面积[AUC]±标准误：0.82±0.04对0.63±0.05，p<0.05）和标准化UVA（AUC±标准误：0.70±0.05，p<0.05）。最佳阈值定义为预测RDM时灵敏度=特异度的值。UVA为8.4mV时灵敏度和特异度为59%，标准化UVA为83%时为65%，示踪剂摄取为69%时为78%。
NOGA系统可能分别以UVA为8.4mV和标准化UVA为83%的最佳判别值区分RDM和IDM。然而，在严重心力衰竭患者中，其诊断性能未达到PET和SPECT所达到的水平。
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