Pavo Noemi, Jakab Andras, Emmert Maximilian Y, Strebinger Georg, Wolint Petra, Zimmermann Matthias, Ankersmit Hendrik Jan, Hoerstrup Simon P, Maurer Gerald, Gyöngyösi Mariann
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
PLoS One. 2014 Nov 19;9(11):e113245. doi: 10.1371/journal.pone.0113245. eCollection 2014.
We compared the accuracy of NOGA endocardial mapping for delineating transmural and non-transmural infarction to the results of cardiac magnetic resonance imaging (cMRI) with late gadolinium enhancement (LE) for guiding intramyocardial reparative substance delivery using data from experimental myocardial infarction studies.
Sixty domestic pigs underwent diagnostic NOGA endocardial mapping and cMRI-LE 60 days after induction of closed-chest reperfused myocardial infarction. The infarct size was determined by LE of cMRI and by delineation of the infarct core on the unipolar voltage polar map. The sizes of the transmural and non-transmural infarctions were calculated from the cMRI transmurality map using signal intensity (SI) cut-offs of>75% and>25% and from NOGA bipolar maps using bipolar voltage cut-off values of <0.8 mV and <1.9 mV. Linear regression analysis and Bland-Altman plots were used to determine correlations and systematic differences between the two images. The overlapping ratios of the transmural and non-transmural infarcted areas were calculated.
Infarct size as determined by 2D NOGA unipolar voltage polar mapping correlated with the 3D cMRI-LE findings (r = 0.504, p<0.001) with a mean difference of 2.82% in the left ventricular (LV) surface between the two images. Polar maps of transmural cMRI and bipolar maps of NOGA showed significant association for determining of the extent of transmural infarction (r = 0.727, p<0.001, overlap ratio of 81.6±11.1%) and non-transmural infarction (r = 0.555, p<0.001, overlap ratio of 70.6±18.5%). NOGA overestimated the transmural scar size (6.81% of the LV surface) but slightly underestimated the size of the non-transmural infarction (-3.04% of the LV surface).
By combining unipolar and bipolar voltage maps, NOGA endocardial mapping is useful for accurate delineation of the targeted zone for intramyocardial therapy and is comparable to cMRI-LE. This may be useful in patients with contraindications for cMRI who require targeted intramyocardial regenerative therapy.
我们利用实验性心肌梗死研究的数据，比较了NOGA心内膜标测在描绘透壁性和非透壁性梗死方面的准确性与心脏磁共振成像（cMRI）联合延迟钆增强（LE）在指导心肌内修复物质递送方面的结果。
60只家猪在闭胸再灌注性心肌梗死诱导60天后接受了诊断性NOGA心内膜标测和cMRI-LE检查。梗死面积通过cMRI的LE以及单极电压极坐标图上梗死核心的描绘来确定。透壁性和非透壁性梗死的面积分别根据cMRI透壁性图使用>75%和>25%的信号强度（SI）截断值，以及根据NOGA双极图使用<0.8 mV和<1.9 mV的双极电压截断值来计算。采用线性回归分析和Bland-Altman图来确定两种图像之间的相关性和系统差异。计算透壁性和非透壁性梗死区域的重叠率。
二维NOGA单极电压极坐标图确定的梗死面积与三维cMRI-LE结果相关（r = 0.504，p<0.001），两张图像之间左心室（LV）表面的平均差异为2.82%。透壁性cMRI的极坐标图和NOGA的双极图在确定透壁性梗死范围方面显示出显著相关性（r = 0.727，p<0.001，重叠率为81.6±11.1%），在确定非透壁性梗死范围方面也显示出显著相关性（r = 0.555，p<0.001，重叠率为70.6±18.5%）。NOGA高估了透壁性瘢痕面积（占LV表面的6.81%），但略微低估了非透壁性梗死面积（占LV表面的-3.04%）。
通过结合单极和双极电压图，NOGA心内膜标测有助于准确描绘心肌内治疗的目标区域，并且与cMRI-LE相当。这对于需要进行靶向心肌内再生治疗但有cMRI禁忌证的患者可能有用。
