Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. mariann.gyongyosi@ meduniwien.ac.at
Nat Rev Cardiol. 2011 May 17;8(7):393-404. doi: 10.1038/nrcardio.2011.64.
The three-dimensional NOGA(®) (Biologics Delivery Systems, a Johnson & Johnson company, Irwindale, CA, USA) electromechanical mapping system simultaneously registers the electrical and mechanical activities of the left ventricle, enabling online assessment of myocardial viability. The system distinguishes between viable, nonviable, stunned, and hibernating myocardium and can assess wall motion. The evaluation of the electrophysiological state of the tissue by NOGA(®) mapping has been validated by comparing the electroanatomical voltage and local linear shortening maps obtained with this technique with several noninvasive diagnostic tests. Bipolar signal analysis and determination of the existence and degree of transmural infarctions are also possible with NOGA(®). Immediately after percutaneous coronary intervention, an increased electromechanical discordance between voltage and local linear shortening maps indicates procedure-induced stunning that is caused by repetitive ischemia or microvascular compromise. Catheter-based direct intramyocardial injection of cells or gene constructs by NOGA(®) reduces the likelihood of systemic toxicity of the injected substance, resulting in minimal washout, limited exposure of nontarget organs, and precise localization to ischemic and peri-ischemic myocardial regions in patients with chronic myocardial ischemia. In addition, direct intramyocardial injection enables the treatment of chronic myocardial infarction by provoking a chemotactic signal at the injection-injury site that contributes to cell engraftment. By measuring the electrical activation pattern in delayed-motion areas, NOGA(®) might also be useful to predict response to cardiac resynchronization therapy.
三维诺加（®）（生物制剂输送系统，强生公司，欧文代尔，加利福尼亚州，美国）机电映射系统同时记录左心室的电和机械活动，使在线评估心肌活力。该系统区分存活、非存活、顿抑和冬眠心肌，并能评估壁运动。诺加（®）映射对组织电生理状态的评估已通过将该技术获得的电解剖电压和局部线性缩短图与几种非侵入性诊断测试进行比较得到验证。诺加（®）还可以进行双极信号分析和确定存在及透壁梗死的程度。经皮冠状动脉介入治疗后，电压和局部线性缩短图之间的机电不协调增加表明程序引起的顿抑，这是由反复缺血或微血管损伤引起的。诺加（®）通过导管直接向心肌内注射细胞或基因构建体，可降低注射物质全身毒性的可能性，从而导致最小的冲洗、非靶器官暴露有限，以及在慢性心肌缺血患者的缺血和缺血周边心肌区域的精确定位。此外，直接向心肌内注射通过在注射损伤部位引发趋化信号，有助于细胞移植，从而治疗慢性心肌梗死。通过测量延迟运动区域的电激活模式，诺加（®）也可能有助于预测对心脏再同步治疗的反应。
