Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
Int J Cardiol. 2013 Sep 30;168(2):1472-8. doi: 10.1016/j.ijcard.2012.12.052. Epub 2013 Jan 23.
If specific organized substrates of ventricular-fibrillation (VF) are identified, they may provide important-information for prevention of sudden-cardiac-death. To identify specific organized substrates of VF, we compared 320-slice CT heart images in non-ischemic VF subjects with non-ischemic sustained and non-sustained ventricular-tachycardia (VT) subjects.
Retrospective analysis of a total of 103 subjects who had VF (17 subjects; age, 59 ± 16 years), sustained VT (20 subjects; 62 ± 19 years), or non-sustained VT (66 subjects; 60 ± 15 years) underwent 320-slice CT (Aquilion one).
After excluding 26 ischemic subjects with >50% stenosis in any coronary arteries on CT, myocardial infarction, or coronary vasospastic angina, a total of 77 non-ischemic subjects (12 VF subjects; age, 58 ± 18 years), (13 sustained VT subjects; 55 ± 20 years) or (52 non-sustained VT subjects; 58 ± 15 years) were analyzed. On CT, myocardial abnormal-late-enhancement was significantly more frequent in the VF group (75%, all myocardial abnormal-late-enhancement in left-ventricle) than in the sustained VT group (31%) and the non-sustained VT group (35%) (both P<0.01). Myocardial fatty change was significantly more frequent in the sustained VT group (54%) than in the VF group (17%) and the non-sustained VT group (12%) (both P<0.01). Final diagnoses of the non-ischemic VF and sustained groups included four subjects in each case with normal cardiac structure on transthoracic echocardiogram; the former included two subjects who had abnormal-late-enhancement on CT without specific ECG findings.
Myocardial abnormal-late-enhancement and fatty change on CT may be substrates of VF or sustained VT in non-ischemic subjects. 320-slice CT can evaluate both coronary arteries and myocardium.
如果能明确心室颤动（VF）的特定有组织的基质，这可能为预防心源性猝死提供重要信息。为了明确 VF 的特定有组织基质，我们比较了非缺血性 VF 患者、非缺血性持续性和非持续性室性心动过速（VT）患者的 320 层 CT 心脏图像。
回顾性分析了 103 例 VF（17 例，年龄 59±16 岁）、持续性 VT（20 例，年龄 62±19 岁）或非持续性 VT（66 例，年龄 60±15 岁）患者的 320 层 CT（Aquilion one）图像。
排除 26 例 CT 显示任何冠状动脉狭窄>50%、心肌梗死或冠状动脉痉挛性心绞痛的缺血性患者后，共分析了 77 例非缺血性患者（12 例 VF 患者，年龄 58±18 岁；13 例持续性 VT 患者，年龄 55±20 岁；52 例非持续性 VT 患者，年龄 58±15 岁）。CT 显示，VF 组（75%，所有左心室心肌延迟强化异常）异常延迟强化的发生率明显高于持续性 VT 组（31%）和非持续性 VT 组（35%）（均 P<0.01）。持续性 VT 组（54%）心肌脂肪变化的发生率明显高于 VF 组（17%）和非持续性 VT 组（12%）（均 P<0.01）。非缺血性 VF 和持续性 VT 组的最终诊断包括各 4 例经胸超声心动图显示心脏结构正常的患者；前者包括 2 例 CT 显示异常延迟强化但无特定心电图表现的患者。
CT 显示的心肌延迟强化和脂肪变化可能是非缺血性患者 VF 或持续性 VT 的基质。320 层 CT 可以同时评估冠状动脉和心肌。
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