Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
JACC Clin Electrophysiol. 2019 Oct;5(10):1158-1167. doi: 10.1016/j.jacep.2019.06.017. Epub 2019 Aug 28.
This study sought to evaluate the association between contrast-enhanced multidetector computed tomography (CE-MDCT) attenuation and local epicardial conduction speed (ECS) and electrographic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and ventricular tachycardia (VT).
CE-MDCT is a widely available and fast imaging technology with high spatial resolution that is less prone to defibrillator generator-related safety issues and image artifacts. However, the association between hypoattenuation on MDCT and VT substrates in ARVC remains unknown.
Patients with ARVC who underwent CE-MDCT followed by endocardial (n = 30) and epicardial (n = 21) electroanatomical mapping (EAM) and VT ablation were prospectively enrolled. Right ventricular (RV) mid-myocardial attenuation was calculated from 3-dimensional MDCT images and registered to EAM. Local ECS was calculated by averaging the ECS between each point and 5 adjacent points with concordant wave front direction.
A total of 17,311 epicardial and 5,204 endocardial points were included. In multivariable regression analysis clustered by patient, RV myocardial attenuation was associated with epicardial bipolar voltage amplitude (2.5% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), with endocardial unipolar voltage amplitude (0.9% decrease in amplitude per 10 HU decrease in attenuation; p < 0.001), and with ECS (0.4% decrease in ECS per 10 HU decrease in attenuation; p = 0.001).
CE-MDCT attenuation distribution is associated with regional ECS and electrographic amplitude in ARVC. Regions with low attenuation likely reflect fibro-fatty involvement in the RV and may serve as important VT substrates in patients with ARVC who are undergoing VT ablation.
本研究旨在评估对比增强多排螺旋 CT（CE-MDCT）衰减与心律失常性右室心肌病（ARVC）伴室性心动过速（VT）患者的局部心外膜传导速度（ECS）和电图异常之间的关系。
CE-MDCT 是一种广泛应用的、快速成像技术，具有较高的空间分辨率，较少出现除颤器发生器相关安全问题和图像伪影。然而，ARVC 中 MDCT 低衰减与 VT 底物之间的关系尚不清楚。
前瞻性纳入了接受 CE-MDCT 检查后行心内膜（n=30）和心外膜（n=21）电解剖标测（EAM）和 VT 消融的 ARVC 患者。从 3 维 MDCT 图像计算右心室（RV）中层心肌衰减值，并与 EAM 进行配准。通过计算每个点与 5 个相邻点的 ECS 平均值来计算局部 ECS，这 5 个相邻点的波前方向相同。
共纳入 17311 个心外膜点和 5204 个心内膜点。多变量回归分析聚类按患者分组，RV 心肌衰减与心外膜双极电压幅度（衰减每降低 10HU，幅度降低 2.5%；p<0.001）、心内膜单极电压幅度（衰减每降低 10HU，幅度降低 0.9%；p<0.001）和 ECS（衰减每降低 10HU，ECS 降低 0.4%；p=0.001）相关。
CE-MDCT 衰减分布与 ARVC 中局部 ECS 和电图幅度相关。低衰减区域可能反映 RV 中的纤维脂肪浸润，并且可能作为 ARVC 患者在行 VT 消融时的重要 VT 底物。
