Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
JACC Clin Electrophysiol. 2021 Oct;7(10):1243-1253. doi: 10.1016/j.jacep.2021.03.017. Epub 2021 Jun 30.
The goal of this study was to investigate the relationship between cardiac scar on late gadolinium enhancement cardiac resonance imaging (LGE-CMR) and the presence of ventricular tachycardia (VT) ablation target sites within the sinuses of Valsalva (SV).
Patients with idiopathic dilated cardiomyopathy (IDCM) often have scarring involving the basal myocardium, including the SV, allowing targeting of VTs from within the SV.
Forty-three consecutive patients with IDCM underwent a VT ablation procedure with pre-procedure LGE-CMR. Retrospectively, scar characteristics were compared between patients with and without VT target sites in the SV. The ratio between SV-related scarring and the total cardiac scarring was defined as the SV scar index: SV-related scarring/total cardiac scarring.
VT target sites were identified in the SV in 22 (51%) of 43 patients. LGE-CMR identified peri-aortic scarring involving the SV in 34 patients (79%). Scarring extended to the septum in 26 patients, involved the lateral basal wall in 4, and both areas in 13 patients. Scar volume within the SV was larger in patients with SV-VT targets (1.7 ± 0.9 cm vs. 0.7 ± 0.6 cm; p < 0.0001) compared with other patients. A cutoff scar volume identifying SV-VT targets was 1.23 cm in the short-axis view (area under the curve 0.82; sensitivity 0.64; specificity 0.91). The SV scar index was significantly greater in patients who had SV-VT target sites (0.33 ± 0.2 vs. 0.09 ± 0.09; p < 0.0001).
Patients with IDCM undergoing ablation of VT often have peri-aortic scarring visualized on LGE-CMR. Both the presence and the extent of scarring adjacent to the aortic annulus are associated with the presence of VT target sites within the SV.
本研究旨在探讨心脏磁共振延迟钆增强（LGE-CMR）检查中心脏瘢痕与主动脉窦内室性心动过速（VT）消融靶点之间的关系。
特发性扩张型心肌病（IDCM）患者的基底心肌常存在瘢痕，包括主动脉窦，这使得可以在主动脉窦内消融 VT。
43 例 IDCM 患者行 VT 消融术，术前均行 LGE-CMR。回顾性比较 SV 内有无 VT 靶点的患者的瘢痕特征。SV 相关瘢痕与总心脏瘢痕的比值定义为 SV 瘢痕指数：SV 相关瘢痕/总心脏瘢痕。
43 例患者中有 22 例（51%）在 SV 中确定了 VT 靶点。LGE-CMR 识别出 34 例患者的主动脉周围 SV 瘢痕（79%）。26 例患者的瘢痕延伸至室间隔，4 例患者累及外侧基底壁，13 例患者累及上述两个部位。SV 内的瘢痕体积在 SV-VT 靶点患者中较大（1.7±0.9cm 比 0.7±0.6cm；p<0.0001）。SV-VT 靶点的瘢痕体积截断值在短轴位为 1.23cm（曲线下面积 0.82；敏感度 0.64；特异性 0.91）。SV-VT 靶点患者的 SV 瘢痕指数明显较大（0.33±0.2 比 0.09±0.09；p<0.0001）。
行 VT 消融术的 IDCM 患者常存在 LGE-CMR 上可见的主动脉周围瘢痕。主动脉瓣环附近瘢痕的存在和程度均与 SV 内 VT 靶点的存在相关。
