von Bary Christian, Deneke Thomas, Arentz Thomas, Schade Anja, Lehrmann Heiko, Schwab-Malek Susanne, Fredersdorf Sabine, Baldaranov Dobri, Maier Lars, Schlachetzki Felix
Department of Cardiology, Rotkreuzklinikum München, Munich, Germany.
Department of Internal Medicine II, University of Regensburg, Regensburg, Germany.
J Ultrasound Med. 2018 May;37(5):1091-1101. doi: 10.1002/jum.14447. Epub 2017 Oct 16.
Microembolic signal detection by transcranial Doppler ultrasonography may be considered a surrogate for cerebral events during invasive cardiac procedures. However, the impact of the microembolic signal count during pulmonary vein isolation on the clinical outcome is not well evaluated. We investigated the effect of the microembolic signal count on the occurrence of new silent cerebral embolism measured by diffusion-weighted imaging (DWI)-magnetic resonance imaging (MRI), changes in neuropsychological testing, and the occurrence of clinical events during long-term follow-up after pulmonary vein isolation.
Pulmonary vein isolation was performed in 41 patients. The total microembolic signal burden (classified into "solid," "gaseous," and "equivocal") and sustained thromboembolic showers of greater than 30 seconds were recorded. Diffusion-weighted imaging-MRI and neuropsychological testing were performed before and after pulmonary vein isolation to assess for silent cerebral embolism and neuropsychological sequelae. Long-term follow-up was performed by telephone to assess for stroke/transient ischemic attack.
A total of 68,729 microembolic signals (14,893 solid, 11,909 gaseous, and 41,927 equivocal) with an average of 1676 signals per patient and 42 thromboembolic showers were recorded. No correlation between the microembolic signal/thromboembolic shower count and the occurrence of new DWI lesions or neuropsychological capability was found. After a mean follow-up ± SD of 49 ± 4 months, 1 patient had an overt transient ischemic event, which was not associated with a high microembolic signal count.
In this multicenter study, we found no impact of the intraprocedural microembolic symbol/thromboembolic shower count on the occurrence of new DWI lesions, neuropsychological capability, or overt neurologic deficits after pulmonary vein isolation. Thus, not only the microembolic signal count but also procedural/individual factors may contribute to commensurable clinical damage, which may challenge this method as a valid biomarker during pulmonary vein isolation.
经颅多普勒超声检测微栓塞信号可被视为侵入性心脏手术期间脑事件的替代指标。然而，肺静脉隔离期间微栓塞信号计数对临床结局的影响尚未得到充分评估。我们研究了微栓塞信号计数对通过扩散加权成像（DWI）-磁共振成像（MRI）测量的新发无症状脑栓塞的发生、神经心理学测试变化以及肺静脉隔离后长期随访期间临床事件发生的影响。
对41例患者进行肺静脉隔离。记录总的微栓塞信号负荷（分为“固体”、“气体”和“可疑”）以及持续超过30秒的血栓栓塞性阵雨。在肺静脉隔离前后进行扩散加权成像-MRI和神经心理学测试，以评估无症状脑栓塞和神经心理学后遗症。通过电话进行长期随访，以评估中风/短暂性脑缺血发作。
共记录到68729个微栓塞信号（14893个固体信号、11909个气体信号和41927个可疑信号），平均每位患者1676个信号，以及42次血栓栓塞性阵雨。未发现微栓塞信号/血栓栓塞性阵雨计数与新发DWI病变的发生或神经心理学能力之间存在相关性。在平均随访49±4个月后，1例患者发生明显的短暂性缺血事件，这与高微栓塞信号计数无关。
在这项多中心研究中，我们发现术中微栓塞信号/血栓栓塞性阵雨计数对肺静脉隔离后新发DWI病变的发生、神经心理学能力或明显神经功能缺损没有影响。因此，不仅微栓塞信号计数，而且手术/个体因素可能导致相当的临床损害，这可能挑战该方法作为肺静脉隔离期间有效生物标志物的地位。
