Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), C/Villarroel N° 170, Barcelona, Spain.
Department of Cardiology, Morriston Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK.
Europace. 2019 May 1;21(5):724-731. doi: 10.1093/europace/euy314.
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may define left atrial (LA) anatomy and structural remodelling, and facilitate atrial fibrillation (AF) ablation. We aimed to assess the intra- and inter-observer reproducibility and agreement of LGE-CMR parameters with direct application to AF ablation techniques.
One experienced and one non-experienced observer performed complete LGE-CMR data analysis twice, on different days, in 40 randomly selected LGE-CMR examinations [20 performed before ablation (pre-ablation) and 20 performed 3 months after ablation (post-ablation)]. Four additional observers (two experienced and two non-experienced) performed complete LGE-CMR data analysis in a subgroup of 30 patients (15 pre-ablation and 15 post-ablation). All LGE-CMR were performed in sinus rhythm. Intra- and inter-observer reproducibility of LA volume, LA area, and sphericity index (SI) was high: coefficient of variation <10% and intraclass correlation coefficient >0.71. Geometric congruency of repeated reconstruction of LA shape was high: maximal error <5 mm for intra-observer and <8 mm for inter-observer. The precision of scar location increased with extent of scar, and was high (Dice coefficient >0.75) when the scar area was >5 cm2 for a single observer and >15 cm2 for multiple observers. Non-experienced observers performed equally well to experienced observers.
Late gadolinium enhancement cardiac magnetic resonance measurements of LA area, volume, and SI were reproducible, and geometric congruency of LA shape was high. Location of scar was precise for scar areas >5 cm2 for single observers and >15 cm2 for multiple observers, regardless of the observers' experience. These results may serve as a reference for future studies on the role for substrate-based AF ablation procedures.
钆延迟增强心脏磁共振（LGE-CMR）可定义左心房（LA）解剖结构和重构，并有助于房颤（AF）消融。我们旨在评估 LGE-CMR 参数的观察者内和观察者间可重复性和一致性，并直接应用于 AF 消融技术。
一位有经验的观察者和一位无经验的观察者分别在不同的两天对 40 例随机选择的 LGE-CMR 检查进行了两次完整的 LGE-CMR 数据分析[20 例在消融前（消融前）进行，20 例在消融后 3 个月（消融后）进行]。另外四位观察者（两位有经验的，两位无经验的）对 30 例患者的亚组进行了完整的 LGE-CMR 数据分析（15 例消融前，15 例消融后）。所有 LGE-CMR 均在窦性心律下进行。LA 容积、LA 面积和球形指数（SI）的观察者内和观察者间可重复性较高：变异系数<10%，组内相关系数>0.71。LA 形状的重复重建的几何一致性较高：观察者内最大误差<5mm，观察者间最大误差<8mm。随着瘢痕面积的增加，瘢痕位置的精度增加，当单个观察者的瘢痕面积>5cm2 且多个观察者的瘢痕面积>15cm2 时，准确性较高（Dice 系数>0.75）。无经验的观察者与有经验的观察者表现相当。
LA 面积、容积和 SI 的 LGE-CMR 测量具有可重复性，LA 形状的几何一致性较高。对于单个观察者的瘢痕面积>5cm2 且多个观察者的瘢痕面积>15cm2 的瘢痕，其位置具有较高的准确性，与观察者的经验无关。这些结果可以为未来基于基质的 AF 消融程序的作用研究提供参考。
