非缺血性心肌病且无延迟强化的室性心动过速患者行导管消融时通过心脏磁共振T成像对心肌底物进行特征分析
Myocardial Substrate Characterization by CMR T Mapping in Patients With NICM and No LGE Undergoing Catheter Ablation of VT.
作者信息
Muser Daniele, Nucifora Gaetano, Castro Simon A, Enriquez Andres, Chahal C Anwar A, Magnani Silvia, Kumareswaran Ramanan, Arkles Jeffrey, Supple Gregory, Schaller Robert, Hyman Matthew, Dixit Sanjay, Lin David, Zado Erica S, Tschabrunn Cory, Callans David J, Nazarian Saman, Frankel David S, Marchlinski Francis E, Santangeli Pasquale
机构信息
Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
出版信息
JACC Clin Electrophysiol. 2021 Jul;7(7):831-840. doi: 10.1016/j.jacep.2020.10.002. Epub 2021 Jan 27.
OBJECTIVES
The goal of this study was to characterize the relationship between DF, the electroanatomic mapping (EAM) substrate, and outcomes of catheter ablation of VT in NICM.
BACKGROUND
A substantial proportion of patients with nonischemic dilated cardiomyopathy (NICM) and ventricular tachycardia (VT) do not have scar detectable by cardiac magnetic resonance late gadolinium enhancement (LGE) imaging. In these patients, the significance of diffuse fibrosis (DF) detected with T mapping has not been previously investigated.
METHODS
This study included 51 patients with NICM and VT undergoing catheter ablation (median age 55 years; 77% male subjects) who had no evidence of LGE on pre-procedural cardiac magnetic resonance. Post-contrast T relaxation time determined on the septum was assessed as a surrogate of DF burden. The extent of endocardial low-voltage areas (LVAs) at EAM was correlated with T mapping data.
RESULTS
Bipolar LVAs were present in 22 (43%) patients (median extent 15 cm [8 to 29 cm]) and unipolar LVA in all patients (median extent 48 cm [26 to 120 cm]). A significant inverse correlation was found between T values and both unipolar-LVA (R = 0.64; β = -0.85; p < 0.01) and bipolar-LVA (R = 0.16; β = -1.63; p < 0.01). After a median follow-up of 45 months (22 to 57 months), 2 (4%) patients died, 3 (6%) underwent heart transplantation, and 8 (16%) experienced VT recurrence. Shorter post-contrast T time was associated with an increased risk of VT recurrence (hazard ratio: 1.16; 95% confidence interval: 1.03 to 1.33 per 10 ms decrease; p = 0.02).
CONCLUSIONS
In patients with NICM and no evidence of LGE undergoing catheter ablation of VT, DF estimated by using post-contrast T mapping correlates with the voltage abnormality at EAM and seems to affect post-ablation outcomes.
目的
本研究的目的是描述非缺血性扩张型心肌病（NICM）中弥漫性纤维化（DF）、电解剖标测（EAM）基质与室性心动过速（VT）导管消融结果之间的关系。
背景
相当一部分非缺血性扩张型心肌病（NICM）和室性心动过速（VT）患者在心脏磁共振延迟钆增强（LGE）成像中未检测到瘢痕。在这些患者中，T 标测检测到的弥漫性纤维化（DF）的意义此前尚未得到研究。
方法
本研究纳入了 51 例接受导管消融的 NICM 和 VT 患者（中位年龄 55 岁；77%为男性），这些患者在术前心脏磁共振检查中无 LGE 证据。将在室间隔上测定的对比剂后 T 弛豫时间评估为 DF 负荷的替代指标。EAM 上心内膜低电压区（LVA）的范围与 T 标测数据相关。
结果
22 例（43%）患者存在双极 LVA（中位范围 15 cm [8 至 29 cm]），所有患者均存在单极 LVA（中位范围 48 cm [26 至 120 cm]）。发现 T 值与单极 LVA（R = 0.64；β = -0.85；p < 0.01）和双极 LVA（R = 0.16；β = -1.63；p < 0.01）均呈显著负相关。中位随访 45 个月（22 至 57 个月）后，2 例（4%）患者死亡，3 例（6%）接受心脏移植，8 例（16%）发生 VT 复发。对比剂后 T 时间较短与 VT 复发风险增加相关（风险比：1.16；95%置信区间：每减少 10 ms 为 1.03 至 1.33；p = 0.02）。
结论
在无 LGE 证据且接受 VT 导管消融的 NICM 患者中，使用对比剂后 T 标测估计的 DF 与 EAM 处的电压异常相关，且似乎影响消融后结果。
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