心脏磁共振成像的区域性应变与多模态瘢痕评估中的晚期钆增强相比，可提高心律失常性右心室心肌病患者右心室瘢痕的检出率。
Regional Strain by Cardiac Magnetic Resonance Imaging Improves Detection of Right Ventricular Scar Compared With Late Gadolinium Enhancement on a Multimodality Scar Evaluation in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.
机构信息
Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.).
Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (M.A.G., I.K., S.Z.).
出版信息
Circ Cardiovasc Imaging. 2018 Sep;11(9):e007546. doi: 10.1161/CIRCIMAGING.118.007546.
BACKGROUND
Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy characterized by fibrofatty replacement of right ventricular myocardium resulting in reentrant ventricular tachycardia (VT). Cardiac magnetic resonance imaging (CMR) can noninvasively measure regional abnormalities using tissue-tracking strain as well as late gadolinium enhancement (LGE). In this study, we examine arrhythmogenic substrate using regional CMR strain, LGE, and electroanatomic mapping (EAM) in arrhythmogenic right ventricular cardiomyopathy patients presenting for VT ablation.
METHODS AND RESULTS
Twenty-one patients underwent right ventricular endocardial EAM, whereas 17 underwent epicardial EAM, to detect dense scar (<0.5 mV) as well as CMR study within 12 months. Quantitative regional strain analysis was performed in all 21 patients, although the presence of LGE was visually examined in 17 patients. Strain was lower in segments with dense scar on endocardial and epicardial EAM (-9.7±4.1 versus -7.3±4.0, and -9.8±2.8 versus -7.6±3.8; P<0.05), in segments with LGE scar (-9.9±4.4 versus -6.0±3.6; P=0.001), and at VT culprit sites (-7.4±3.7 versus -10.1±4.1; P<0.001), compared with the rest of right ventricular. On patient-clustered analysis, a unit increase in strain was associated with 21% and 18% decreased odds of scar on endocardial and epicardial EAM, respectively, 17% decreased odds of colocalizing VT culprit site, and 43% decreased odds of scar on LGE-CMR ( P<0.05 for all). LGE and EAM demonstrated poor agreement with κ=0.18 (endocardial, n=17) and κ=0.06 (epicardial, n=13). Only 8 (15%) VT termination sites exhibited LGE.
CONCLUSIONS
Regional myocardial strain on cine CMR improves detection of arrhythmogenic VT substrate compared with LGE. This may enhance diagnostic accuracy of CMR in arrhythmogenic right ventricular cardiomyopathy without the need for invasive procedures and facilitate the planning of VT ablation procedures.
背景
致心律失常性右室心肌病是一种遗传性心肌病，其特征为右心室心肌的纤维脂肪替代，导致折返性室性心动过速（VT）。心脏磁共振成像（CMR）可使用组织追踪应变以及延迟钆增强（LGE）无创性地测量区域性异常。在这项研究中，我们检查了致心律失常性右室心肌病患者因 VT 消融而进行的右室心内膜 EAM 和心外膜 EAM 时，使用区域性 CMR 应变、LGE 和电解剖图（EAM）检测心律失常基质。
方法和结果
21 例患者行右室心内膜 EAM，17 例行心外膜 EAM，以检测致密瘢痕（<0.5 mV），并在 12 个月内进行 CMR 研究。21 例患者均进行了定量区域性应变分析，尽管 17 例患者进行了 LGE 视觉检查。心内膜和心外膜 EAM 上致密瘢痕节段的应变较低（-9.7±4.1 比-7.3±4.0，-9.8±2.8 比-7.6±3.8；P<0.05），LGE 瘢痕节段的应变较低（-9.9±4.4 比-6.0±3.6；P=0.001），VT 致病灶节段的应变较低（-7.4±3.7 比-10.1±4.1；P<0.001），与右室其余部分相比。在患者聚类分析中，应变每增加 1 单位，心内膜和心外膜 EAM 上瘢痕的几率分别降低 21%和 18%，共同的 VT 致病灶的几率降低 17%，LGE-CMR 上瘢痕的几率降低 43%（P<0.05 均）。LGE 和 EAM 的一致性较差，κ=0.18（心内膜，n=17）和 κ=0.06（心外膜，n=13）。只有 8（15%）个 VT 终止部位有 LGE。
结论
电影 CMR 的区域性心肌应变提高了致心律失常性 VT 基质的检测，与 LGE 相比。这可能会提高致心律失常性右室心肌病的 CMR 诊断准确性，而无需进行有创性检查，并有助于 VT 消融程序的规划。
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