Mattson Alexander R, Soto Mario J, Iaizzo Paul A
Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota.
Medtronic, Mounds View, Minnesota.
Clin Anat. 2018 Jul;31(5):661-666. doi: 10.1002/ca.23194. Epub 2018 May 25.
Epicardial electrophysiological procedures rely on dependable interfacing with the myocardial tissue. For example, epicardial pacing systems must generate sustainable chronic pacing capture, while epicardial ablations must effectively deliver energy to the target hyper-excitable myocytes. The human heart has a significant adipose layer which may impede epicardial procedures. The objective of this study was to quantitatively assess the relative location of epicardial adipose on the human heart, to define locations where epicardial therapies might be performed successfully. We studied perfusion-fixed human hearts (n = 105) in multiple isolated planes including: left ventricular margin, diaphragmatic surface, and anterior right ventricle. Relative adipose distribution was quantitatively assessed via planar images, using a custom-generated image analysis algorithm. In these specimens, 76.7 ± 13.8% of the left ventricular margin, 72.7 ± 11.3% of the diaphragmatic surface, and 92.1 ± 8.7% of the anterior right margin were covered with superficial epicardial adipose layers. Percent adipose coverage significantly increased with age (P < 0.001) and history of coronary artery disease (P < 0.05). No significant relationships were identified between relative percent adipose coverage and gender, body weight or height, BMI, history of hypertension, and/or history of congestive heart failure. Additionally, we describe two-dimensional probability distributions of epicardial adipose coverage for each of the three analysis planes. In this study, we detail the quantitative assessment and probabilistic mapping of the distribution of superficial epicardial adipose on the adult human heart. These findings have implications relative to performing epicardial procedures and/or designing procedures or tools to successfully perform such treatments. Clin. Anat. 31:661-666, 2018. © 2018 Wiley Periodicals, Inc.
心外膜电生理手术依赖于与心肌组织的可靠连接。例如，心外膜起搏系统必须实现可持续的慢性起搏夺获，而心外膜消融必须有效地将能量传递至目标兴奋性过高的心肌细胞。人类心脏有一层较厚的脂肪层，这可能会妨碍心外膜手术。本研究的目的是定量评估心外膜脂肪在人心脏上的相对位置，以确定能够成功进行心外膜治疗的位置。我们研究了多个离体平面的灌注固定人心脏（n = 105），包括：左心室边缘、膈面和右心室前壁。使用定制生成的图像分析算法，通过平面图像对相对脂肪分布进行定量评估。在这些标本中，左心室边缘的76.7±13.8%、膈面的72.7±11.3%和右心室前边缘的92.1±8.7%被浅表心外膜脂肪层覆盖。脂肪覆盖百分比随年龄（P < 0.001）和冠状动脉疾病史（P < 0.05）显著增加。在相对脂肪覆盖百分比与性别、体重或身高、BMI、高血压病史和/或充血性心力衰竭病史之间未发现显著相关性。此外，我们描述了三个分析平面中每个平面的心外膜脂肪覆盖的二维概率分布。在本研究中，我们详细阐述了成人心脏浅表心外膜脂肪分布的定量评估和概率图谱。这些发现对于进行心外膜手术和/或设计成功实施此类治疗的手术或工具具有重要意义。《临床解剖学》2018年第31卷：661 - 666页。© 2018威利期刊公司
