应用经皮冠状动脉介入治疗（PTCA）导丝记录的冠状动脉内电图实时评估左心室功能障碍患者的存活心肌：与延迟增强磁共振成像的比较。

Real-time assessment of myocardial viability in the catheterization laboratory using the intracoronary electrograms recorded by the PTCA guidewire in patients with left ventricular dysfunction: comparison with delayed-enhancement magnetic resonance imaging.

机构信息

Cardiologia Interventistica, Ospedale di Busto Arsizio, Busto Arsizio, Italy.

出版信息

JACC Cardiovasc Interv. 2014 Sep;7(9):988-96. doi: 10.1016/j.jcin.2014.04.009. Epub 2014 Aug 13.

DOI:10.1016/j.jcin.2014.04.009

PMID:25129666

Abstract

OBJECTIVES

This study aimed to determine whether the intracoronary electrograms (IC-EGMs) recorded using a standard percutaneous coronary intervention guidewire could provide myocardial viability information.

BACKGROUND

The revascularization of dysfunctional but viable myocardium may confer prognostic benefits compared with medical therapy in patients with post-ischemic heart failure. However, knowledge of myocardial viability is often unavailable at the time of the procedure.

METHODS

The peak-to-peak voltage of 317 IC-EGMs recordings from 25 patients with a previous myocardial infarction and systolic dysfunction were matched with corresponding delayed-enhancement magnetic resonance imaging sites using a 17-segment model of the left ventricle.

RESULTS

Sixty-seven recordings were obtained from segments classified as complete scar on delayed-enhancement magnetic resonance imaging (group A), 162 from partially viable segments (group B), and 88 from fully viable segments (group C). Three high-pass (HP) filters (0.5, 30, and 100 Hz) were applied to the signals to modulate their spatial resolution. For all filters, the peak-to-peak voltage significantly decreased from group C to group B to group A (p < 0.001 for all comparisons). When receiver-operating characteristic analysis was used to compare nonviable (group A) with viable (group B + C) segments, the optimal discriminating voltages were 4.6, 2.2, and 0.78 mV for, respectively, HP-0.5, HP-30, and HP-100 filters, with a sensitivity of 92%, 94%, and 99% and a specificity of 70%, 79%, and 69%.

CONCLUSIONS

The amplitude of the IC-EGMs discriminates viable from nonviable left ventricular segments. Because this technique is simple and inexpensive and provides real-time results, it is potentially useful to aid decision making in the catheterization laboratory.

摘要

目的

本研究旨在确定使用标准经皮冠状动脉介入导丝记录的冠状动脉内电图（IC-EGM）是否能提供心肌存活信息。

背景

与药物治疗相比，缺血性心力衰竭患者的功能障碍但存活的心肌再血管化可能带来预后益处。然而，在手术时往往无法获得心肌存活的知识。

方法

将 25 例既往心肌梗死和收缩功能障碍患者的 317 个 IC-EGM 记录的峰峰值电压与左心室 17 节段模型相对应的延迟增强磁共振成像部位相匹配。

结果

67 个记录来自在延迟增强磁共振成像上被归类为完全瘢痕的节段（组 A），162 个来自部分存活节段（组 B），88 个来自完全存活节段（组 C）。将三个高通（HP）滤波器（0.5、30 和 100 Hz）应用于信号以调节其空间分辨率。对于所有滤波器，从组 C 到组 B 再到组 A 的峰峰值电压均显著降低（所有比较均 p < 0.001）。当使用接收者操作特征分析比较非存活（组 A）与存活（组 B+C）节段时，最佳区分电压分别为 4.6、2.2 和 0.78 mV，适用于 HP-0.5、HP-30 和 HP-100 滤波器，其灵敏度分别为 92%、94%和 99%，特异性分别为 70%、79%和 69%。