Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333ZA Leiden, The Netherlands.
LKEB-Division of Image Processing, Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
Eur Heart J. 2018 Aug 14;39(31):2867-2875. doi: 10.1093/eurheartj/ehy168.
Electroanatomical voltage mapping (EAVM) is an important diagnostic tool for fibrosis identification and risk stratification in non-ischaemic cardiomyopathy (NICM); currently, distinct cut-offs are applied. We aimed to evaluate the performance of EAVM to detect fibrosis by integration with whole heart histology and to identify the fibrosis pattern in NICM patients with ventricular tachycardias (VTs).
Eight patients with NICM and VT underwent EAVM prior to death or heart transplantation. EAVM data was projected onto slices of the entire heart. Pattern, architecture, and amount of fibrosis were assessed in transmural biopsies corresponding to EAVM sites. Fibrosis pattern in NICM biopsies (n = 507) was highly variable and not limited to mid-wall/sub-epicardium. Fibrosis architecture was rarely compact, but typically patchy and/or diffuse. In NICM, biopsies without abnormal fibrosis unipolar voltage (UV) and bipolar voltage (BV) showed a linear association with wall thickness (WT). The amount of viable myocardium showed a linear association with both UV and BV. Accordingly, any cut-off to delineate fibrosis performed poorly. An equation was generated calculating the amount of fibrosis at any location, given WT and UV or BV.
Considering the linear relationships between WT, amount of fibrosis and both UV and BV, the search for any distinct voltage cut-off to identify fibrosis in NICM is futile. The amount of fibrosis can be calculated, if WT and voltages are known. Fibrosis pattern and architecture are different from ischaemic cardiomyopathy and findings on ischaemic substrates may not be applicable to NICM.
电解剖电压测绘（EAVM）是识别非缺血性心肌病（NICM）纤维化和风险分层的重要诊断工具；目前，应用了不同的截断值。我们旨在通过整合全心组织学评估 EAVM 检测纤维化的性能，并确定伴有室性心动过速（VTs）的 NICM 患者的纤维化模式。
8 例 NICM 合并 VT 的患者在死亡或心脏移植前行 EAVM。EAVM 数据被投影到整个心脏的切片上。在与 EAVM 部位相对应的穿透性活检中评估纤维化的模式、结构和数量。NICM 活检（n=507）中的纤维化模式变化多样，不限于中壁/心外膜。纤维化结构很少是致密的，但通常是斑片状和/或弥漫性的。在 NICM 中，无异常纤维化的单极电压（UV）和双极电压（BV）活检与壁厚度（WT）呈线性相关。存活心肌的数量与 UV 和 BV 均呈线性相关。因此，任何用于界定纤维化的截断值都表现不佳。生成了一个方程，用于计算在任何位置的纤维化量，给定 WT 和 UV 或 BV。
考虑到 WT、纤维化量以及 UV 和 BV 之间的线性关系，寻找任何明确的电压截断值来识别 NICM 中的纤维化都是徒劳的。如果知道 WT 和电压，则可以计算纤维化的量。纤维化模式和结构与缺血性心肌病不同，缺血性基质上的发现可能不适用于 NICM。
