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基于不同参考标准对心房颤动患者左心房晚期钆增强定量方法的评估

Evaluation of quantification methods for left arial late gadolinium enhancement based on different references in patients with atrial fibrillation.

作者信息

Hwang Sung Ho, Oh Yu-Whan, Lee Dae In, Shim Jaemin, Park Sang-Weon, Kim Young-Hoon

机构信息

Department of Radiology, Korea University Medical Center, Seoul, Republic of Korea.

出版信息

Int J Cardiovasc Imaging. 2015 Jun;31 Suppl 1:91-101. doi: 10.1007/s10554-014-0563-0. Epub 2014 Nov 4.

Abstract

By using late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging, we compared left atrial late gadolinium enhancement (LA-LGE) quantification methods based on different references to characterize the left atrial wall in patients with atrial fibrillation (AF). Thirty-eight patients who underwent three-dimensional LGE-CMR imaging before catheter ablation for AF were classified into three groups depending on their clinical AF type: (1) paroxysmal AF (PAF; n = 12); (2) persistent AF (PeAF; n = 16); and (3) recurrent AF after catheter ablation (RAF; n = 10). To quantify LA-LGE on LGE-CMR imaging, we used the thresholds of 2 standard deviations (2-SD), 3-SD, 4-SD, 5-SD, or 6-SD above the mean signal from the unenhanced left ventricular myocardium, and we used the full width at half maximum (FWHM) technique, which was based on the maximum signal from the mitral valve with high signal intensity. The 6-SD threshold and FWHM techniques were statistically reproducible with an intraclass correlation coefficient >0.7. On applying the FWHM technique, the normalized LA-LGE volume by LA wall area showed a significant difference between the RAF, PeAF, and PAF groups (0.22 ± 0.04, 0.16 ± 0.06, and 0.09 ± 0.03 mL/cm(2), respectively) (P < 0.05). Furthermore, most of the fibrotic scarring and low-voltage tissue on the electroanatomic map corresponded well with the extent of LA-LGE. The FWHM technique based on the mitral valve can provide a reproducible quantification of LA-LGE related to AF in the thin LA wall.

摘要

通过使用延迟钆增强心脏磁共振成像(LGE-CMR),我们比较了基于不同参考值的左心房延迟钆增强(LA-LGE)量化方法,以对心房颤动(AF)患者的左心房壁进行特征描述。38例在导管消融治疗AF前接受三维LGE-CMR成像的患者,根据其临床AF类型分为三组:(1)阵发性AF(PAF;n = 12);(2)持续性AF(PeAF;n = 16);(3)导管消融术后复发性AF(RAF;n = 10)。为了在LGE-CMR成像上量化LA-LGE,我们使用了比未增强左心室心肌平均信号高2个标准差(2-SD)、3-SD、4-SD、5-SD或6-SD的阈值,并且使用了半高宽(FWHM)技术,该技术基于二尖瓣高信号强度的最大信号。6-SD阈值和FWHM技术具有统计学可重复性,组内相关系数>0.7。应用FWHM技术时,按左心房壁面积归一化的LA-LGE体积在RAF、PeAF和PAF组之间存在显著差异(分别为0.22±0.04、0.16±0.06和0.09±0.03 mL/cm²)(P<0.05)。此外,电解剖图上的大多数纤维化瘢痕和低电压组织与LA-LGE的范围高度吻合。基于二尖瓣的FWHM技术能够对薄左心房壁中与AF相关的LA-LGE进行可重复量化。

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