Cluitmans Matthijs, Brooks Dana H, MacLeod Rob, Dössel Olaf, Guillem María S, van Dam Peter M, Svehlikova Jana, He Bin, Sapp John, Wang Linwei, Bear Laura
Department of Cardiology, Cardiovascular Research Institute Maastricht Maastricht University, Maastricht, Netherlands.
Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States.
Front Physiol. 2018 Sep 20;9:1305. doi: 10.3389/fphys.2018.01305. eCollection 2018.
Electrocardiographic imaging (ECGI) reconstructs the electrical activity of the heart from a dense array of body-surface electrocardiograms and a patient-specific heart-torso geometry. Depending on how it is formulated, ECGI allows the reconstruction of the activation and recovery sequence of the heart, the origin of premature beats or tachycardia, the anchors/hotspots of re-entrant arrhythmias and other electrophysiological quantities of interest. Importantly, these quantities are directly and non-invasively reconstructed in a digitized model of the patient's three-dimensional heart, which has led to clinical interest in ECGI's ability to personalize diagnosis and guide therapy. Despite considerable development over the last decades, validation of ECGI is challenging. Firstly, results depend considerably on implementation choices, which are necessary to deal with ECGI's ill-posed character. Secondly, it is challenging to obtain (invasive) ground truth data of high quality. In this review, we discuss the current status of ECGI validation as well as the major challenges remaining for complete adoption of ECGI in clinical practice. Specifically, showing clinical benefit is essential for the adoption of ECGI. Such benefit may lie in patient outcome improvement, workflow improvement, or cost reduction. Future studies should focus on these aspects to achieve broad adoption of ECGI, but only after the technical challenges have been solved for that specific application/pathology. We propose 'best' practices for technical validation and highlight collaborative efforts recently organized in this field. Continued interaction between engineers, basic scientists, and physicians remains essential to find a hybrid between technical achievements, pathological mechanisms insights, and clinical benefit, to evolve this powerful technique toward a useful role in clinical practice.
心电图成像（ECGI）通过密集排列的体表心电图和特定患者的心脏-躯干几何模型来重建心脏的电活动。根据其构建方式，ECGI能够重建心脏的激动和恢复序列、早搏或心动过速的起源、折返性心律失常的锚点/热点以及其他感兴趣的电生理参数。重要的是，这些参数是在患者三维心脏的数字化模型中直接且无创地重建的，这引发了临床对ECGI个性化诊断和指导治疗能力的兴趣。尽管在过去几十年中取得了显著进展，但ECGI的验证仍具有挑战性。首先，结果在很大程度上取决于实现选择，这对于处理ECGI的不适定特性是必要的。其次，获取高质量的（有创）地面真值数据具有挑战性。在本综述中，我们讨论了ECGI验证的现状以及在临床实践中全面采用ECGI仍面临的主要挑战。具体而言，证明临床益处对于ECGI的采用至关重要。这种益处可能在于改善患者预后、改进工作流程或降低成本。未来的研究应关注这些方面，以便在解决特定应用/病理学的技术挑战之后实现ECGI的广泛应用。我们提出技术验证的“最佳”实践，并强调该领域最近组织的合作努力。工程师、基础科学家和医生之间持续的互动对于在技术成就、病理机制见解和临床益处之间找到一种平衡至关重要，从而使这项强大的技术在临床实践中发挥有益作用。
