Cardiol J. 2013;20(1):68-77. doi: 10.5603/CJ.2013.0011.
Peri-infarct border zone (BZ) as quantified by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) has been proposed as a risk stratification tool, and is associated with increased mortality. BZ has been measured by various methods in the literature. We assessed which BZ analysis best predicts inducible arrhythmia during electrophysiological study (EPS).
LGE was performed in 47 patients with coronary artery disease referred for EPS to assess for ventricular tachycardia (VT). LGE data was analyzed for BZ quantification by 3 previously published methods. Method I (BZ-I) used pixels 2-3 standard deviations over the mean of normal tissue, expressed as % of left ventricular mass, Method II (BZ-II, as described by Yan) and Method III (BZ-III, as described by Schmidt). EPS results were classified as negative (non-inducible) or positive (monomorphic VT - MVT).
There were 47 subjects-age 61.7 years, 72% male. During EPS, 20 patients were non-inducible and 18 had induced MVT. Ejection fraction was not significantly different between non-inducible patients and those with MVT (34.1% vs. 28.5%, p = 0.13). BZ-I was significantly different (1.4% vs. 2.6%, p = 0.001), but not BZ-II (7.9% vs. 6.9%, p = 0.68) or BZ-III (2.7 g vs. 2.1 g, p = 0.88). Multivariate analysis demonstrated that only BZ-I was an independent predictor of EPS outcome after controling for infarct size (OR 1.97 per % change, 95% CI 1.04-3.73, p = 0.04).
This study demonstrates significant variability between the published methods for measuring BZ. Also, BZ-I is a stronger predictor of inducible MVT during EPS than ejection fraction and infarct size. BZ may be another LGE marker of elevated risk of arrhythmia.
心脏磁共振成像（MRI）上的晚期钆增强（LGE）所量化的梗死周边区（BZ）已被提出作为一种风险分层工具，与死亡率增加相关。BZ 在文献中已通过各种方法进行测量。我们评估了哪种 BZ 分析最能预测电生理研究（EPS）期间的诱发性心律失常。
对 47 例因冠状动脉疾病就诊行 EPS 以评估室性心动过速（VT）的患者进行 LGE。使用 3 种先前发表的方法对 LGE 数据进行 BZ 量化分析。方法 I（BZ-I）使用正常组织平均值 2-3 个标准差的像素，以左心室质量的百分比表示；方法 II（Yan 描述的 BZ-II）和方法 III（Schmidt 描述的 BZ-III）。EPS 结果分为阴性（非诱发性）或阳性（单形性 VT-MVT）。
共 47 例患者，年龄 61.7 岁，72%为男性。在 EPS 期间，20 例患者非诱发性，18 例患者诱导出 MVT。非诱发性患者与 MVT 患者的射血分数无显著差异（34.1% vs. 28.5%，p=0.13）。BZ-I 有显著差异（1.4% vs. 2.6%，p=0.001），但 BZ-II（7.9% vs. 6.9%，p=0.68）或 BZ-III（2.7 g vs. 2.1 g，p=0.88）则无差异。多变量分析表明，在校正梗死面积后，只有 BZ-I 是 EPS 结果的独立预测因子（每 %变化的 OR 为 1.97，95%CI 为 1.04-3.73，p=0.04）。
本研究表明，用于测量 BZ 的已发表方法之间存在显著差异。此外，BZ-I 是预测 EPS 期间可诱发性 MVT 的比射血分数和梗死面积更强的预测因子。BZ 可能是心律失常风险升高的另一个 LGE 标志物。
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