优化心肌瘢痕检测的心血管磁共振对心脏植入式电子设备患者的临床影响。
Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices.
机构信息
Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institutes for Cardiovascular Science, University College London, London, UK.
National Institutes of Health, Bethesda, USA.
出版信息
Int J Cardiol. 2019 Mar 15;279:72-78. doi: 10.1016/j.ijcard.2019.01.005. Epub 2019 Jan 4.
BACKGROUND
Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs.
METHODS
136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts.
RESULTS
CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences.
CONCLUSION
The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.
背景
使用钆延迟增强心血管磁共振（LGE CMR）评估心肌瘢痕在心脏植入式电子设备（CIED）患者中通常是必要的，但金属伪影会降低图像质量。我们评估了针对 CIED 患者采用依赖设备的金属伪影减少策略的 LGE CMR 的临床影响。
方法
在 2 年内，对 133 例连续的 CIED 患者（年龄 56±19 岁，69%为男性）进行了 136 次 CMR 检查（22%为植入式环路记录器 [ILR]，40%为永久性起搏器 [PPM]，38%为植入式心脏除颤器 [ICD]；42%为非 MRI 兼容），没有并发症。LGE 成像针对 CIED 进行了调整，使用宽带序列用于左侧 PPM 和 ICD，使用常规序列用于 ILR 和右侧 PPM，对节段性伪影进行评分。诊断效用和对临床管理的影响由专家共识进行评分。
结果
CMR 提供了 22 例（16%）意外诊断，并改变了 113 例（83%）患者的治疗方案。92 例（68%）患者存在心肌瘢痕，另外 13 例患者存在其他异常。使用常规 LGE，43 例（32%）研究结果不可诊断（79%的除颤器），而宽带 LGE 成像则为 0%。与使用常规 LGE 序列的结果相比，宽带 LGE 结果改变了另外 39 例（75%）除颤器患者和 10 例（19%）起搏器患者的临床管理。
结论
在 CIED 患者中使用优化的 LGE 序列进行 CMR 检查的临床获益很高，且没有明显的临床风险。需要采用依赖设备的 LGE 成像策略，特别是在 ICD 患者中使用宽带 LGE，以实现临床效用。
Zotero 插件