Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Department of Diagnostic Radiology, Yokohama City University, Yokohama, Japan.
Int J Cardiovasc Imaging. 2021 Aug;37(8):2535-2543. doi: 10.1007/s10554-021-02219-x. Epub 2021 Mar 16.
Absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after catheter ablation (CA) for atrial fibrillation (AF) with non-ischemic dilated cardiomyopathy (NIDCM). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify severity of myocardial fibrosis. The aim of this study was to assess the incremental value of ECV over LGE-MRI for the improvement of LVEF(∆EF) after CA in NIDCM patients. A total of thirty-two patients with NIDCM and AF (mean age 67.4 ± 9.3 years; 29 (91%) male) were retrospectively studied. Using a 1.5 T MR scanner and 32 channel cardiac coils, LGE-MRI, pre- and post-T1 mapping images of LV wall at mid-ventricular level (modified look-locker inversion recovery sequence) were acquired. All patients successfully underwent CA for AF, and the improvement of LVEF after CA were evaluated by echocardiography. All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 35.1 ± 9.7% before CA and 52.2 ± 10.2% after CA (p < 0.001), resulting an increase of 17.4 ± 12.6%. Significant correlation was found between ∆LVEF and % LGE (r = - 0.49, p = 0.004), ∆LVEF and extracellular volume fraction (ECV) (r = - 0.47, p = 0.010). Area under the receiver operating characteristics curve (AUC) of combination of %LGE and ECV for predicting improvement of LVEF > 10% was substantially higher than that of %LGE alone (AUC: 0.830 vs 0.602). In NIDCM patients with AF, ECV had incremental value over %LGE for predicting improvement of EF by CA, suggesting that the assessment of diffuse interstitial fibrosis may be important to forecast the response of CA.
晚期钆增强（LGE）磁共振成像（MRI）无心肌纤维化与非缺血性扩张型心肌病（NIDCM）合并心房颤动（AF）患者导管消融（CA）后左心室收缩功能改善相关。T1 映射的细胞外容积分数（ECV）已成为量化心肌纤维化严重程度的一种非侵入性手段。本研究旨在评估 ECV 相对于 LGE-MRI 在预测 NIDCM 患者 CA 后左心室射血分数（LVEF）改善方面的附加价值。共回顾性研究了 32 名 NIDCM 合并 AF 的患者（平均年龄 67.4±9.3 岁；29 名[91%]男性）。使用 1.5T 磁共振扫描仪和 32 通道心脏线圈，在 LV 中部水平获得 LGE-MRI 和 LV 壁的预 T1 映射图像（改良 Look-Locker 反转恢复序列）。所有患者均成功接受 AF 的 CA，通过超声心动图评估 CA 后 LVEF 的改善。CA 后所有患者均恢复窦性心律，此时进行超声心动图检查。CA 前 LVEF 平均为 35.1±9.7%，CA 后为 52.2±10.2%（p<0.001），增加了 17.4±12.6%。发现 ∆LVEF 与 %LGE（r=-0.49，p=0.004）和 ∆LVEF 与细胞外容积分数（ECV）（r=-0.47，p=0.010）之间存在显著相关性。%LGE 和 ECV 联合预测 LVEF 改善>10%的受试者工作特征曲线（ROC）曲线下面积（AUC）明显高于单独使用 %LGE 的 AUC（AUC：0.830 对 0.602）。在合并 AF 的 NIDCM 患者中，ECV 对预测 CA 后 EF 的改善具有比 %LGE 更高的附加价值，提示弥漫性间质纤维化的评估可能对预测 CA 的反应很重要。
