Rickard John, Ingelmo Christopher, Sraow Dan, Wilkoff Bruce L, Grimm Richard A, Schoenhagen Paul, Tchou Patrick J, Desai Milind Y
Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Interv Card Electrophysiol. 2011 Oct;32(1):59-65. doi: 10.1007/s10840-011-9586-9. Epub 2011 May 17.
Optimal left ventricular (LV) lead position is thought to be a major predictor of response in patients undergoing cardiac resynchronization therapy (CRT). While the post-implant posterior-anterior (PA) and lateral chest X-ray (CXR) is commonly used to determine the position of the LV lead, the accuracy to which the CXR can correctly localize the LV lead is unknown.
We collected data on 47 consecutive patients (mean age 64 years, 60% men and LV ejection fraction 23%, 49% ischemic cardiomyopathy) that underwent CRT between 2004 and 2007, who had both a post-implant CXR as well as a contrast-enhanced multi-detector computed tomography (MDCT) of the chest for any reason. The positions of the LV lead on CXR and MDCT were interpreted in a blinded fashion, independent of each other. The accuracy of the CXR in localizing various LV lead positions, with MDCT as the gold standard, was recorded.
On CXR, the LV lead tip position was as follows: basal (4%), mid-ventricular (66%), and apical (30%) and anterior (2%), lateral (34%), and posterior (64%). On MDCT, the LV tip position was: basal (28%), mid-ventricular (60%), and apical (13%) and anterior (13%), lateral (19%), and posterior (68%). Compared to the MDCT gold standard, the percentage of LV lead positions the CXR correctly classified correctly were: 100% basal, 39% mid-ventricular, and 29% apical and 0% anterior, 12% lateral, and 77% posterior. Taking both PA and lateral views into consideration, the LV lead position was misclassified by CXR in 62% cases.
Using MDCT as a gold standard, the routine post-implant CXR performs very modestly in terms of accurate LV lead positioning.
最佳左心室（LV）导联位置被认为是接受心脏再同步治疗（CRT）患者治疗反应的主要预测指标。虽然植入后后前位（PA）和侧位胸部X线片（CXR）常用于确定LV导联的位置，但CXR正确定位LV导联的准确性尚不清楚。
我们收集了2004年至2007年间连续47例接受CRT治疗患者的数据（平均年龄64岁，60%为男性，左心室射血分数23%，49%为缺血性心肌病），这些患者因任何原因均进行了植入后CXR以及胸部对比增强多层螺旋计算机断层扫描（MDCT）。CXR和MDCT上LV导联的位置由互不相关的人员以盲法解读。以MDCT作为金标准，记录CXR定位不同LV导联位置的准确性。
在CXR上，LV导联尖端位置如下：基底部（4%）、心室中部（66%）、心尖部（30%）以及前部（2%）、外侧（34%）、后部（64%）。在MDCT上，LV尖端位置为：基底部（28%）、心室中部（60%）、心尖部（13%）以及前部（13%）、外侧（19%）、后部（68%）。与MDCT金标准相比，CXR正确分类的LV导联位置百分比为：基底部100%、心室中部39%、心尖部29%、前部0%、外侧12%、后部77%。综合考虑PA和侧位片，CXR对LV导联位置的分类错误率为62%。
以MDCT作为金标准，植入后常规CXR在准确LV导联定位方面表现不佳。
