Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan.
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
Physiol Rep. 2021 Nov;9(22):e15123. doi: 10.14814/phy2.15123.
Atrial fibrillation (AF) patients without coronary artery stenosis often show clinical evidence of ischemia. However myocardial perfusion in AF patients has been poorly studied. The purposes of this study were to investigate altered hyperemic myocardial blood flow (MBF) in patients with AF compared with risk-matched controls in sinus rhythm (SR), and to evaluate hyperemic MBF before and after catheter ablation using dynamic CT perfusion.
Hyperemic MBF was quantified in 87 patients with AF (44 paroxysmal, 43 persistent) scheduled for catheter ablation using dynamic CT perfusion, and compared with hyperemic MBF in 87 risk-matched controls in SR. Follow-up CT after ablation was performed in 49 AF patients.
Prior to ablation, hyperemic MBF of patients in AF during the CT (1.29 ± 0.34 ml/mg/min) was significantly lower than in patients in SR (1.49 ± 0.26 ml/g/min, p = 0.002) or matched controls (1.65 ± 0.32 ml/g/min, p < 0.001); no significant difference was seen between patients in SR during the CT and matched controls (vs. 1.50 ± 0.31 ml/g/min, p = 0.815). In patients in AF during the pre-ablation CT (n = 24), hyperemic MBF significantly increased after ablation from 1.30 ± 0.35 to 1.53 ± 0.17 ml/g/min (p = 0.004); whereas in patients in SR during the pre-ablation CT (n = 25), hyperemic MBF did not change significantly after ablation (from 1.46 ± 0.26 to 1.49 ± 0.27 ml/g/min, p = 0.499).
In the current study using stress perfusion CT, hyperemic MBF in patients with AF during pre-ablation CT was significantly lower than that in risk-matched controls, and improved significantly after restoration of SR by catheter ablation, indicating that MBF abnormalities in AF patients are caused primarily by AF itself.
无冠状动脉狭窄的房颤（AF）患者常出现缺血的临床证据。然而，AF 患者的心肌灌注情况研究甚少。本研究旨在通过动态 CT 灌注研究，比较 AF 患者与窦性心律（SR）中风险匹配的对照组之间充血性心肌血流（MBF）的改变，并评估导管消融前后的充血性 MBF。
采用动态 CT 灌注法对 87 例拟行导管消融的 AF 患者（阵发性 44 例，持续性 43 例）进行充血性 MBF 定量分析，并与 SR 中 87 例风险匹配的对照组进行比较。49 例 AF 患者在消融后进行了 CT 随访。
在消融前，AF 患者在 CT 期间的充血性 MBF（1.29±0.34ml/mg/min）明显低于 SR 期间的患者（1.49±0.26ml/g/min，p=0.002）或匹配的对照组（1.65±0.32ml/g/min，p<0.001）；SR 期间 CT 期间的患者与匹配的对照组之间无显著差异（与 1.50±0.31ml/g/min，p=0.815）。在消融前 CT 期间的 AF 患者（n=24）中，充血性 MBF 在消融后从 1.30±0.35 显著增加到 1.53±0.17ml/g/min（p=0.004）；而在消融前 CT 期间的 SR 患者（n=25）中，充血性 MBF 在消融后没有显著变化（从 1.46±0.26 增加到 1.49±0.27ml/g/min，p=0.499）。
在本研究中，使用应激灌注 CT，在消融前 CT 期间的 AF 患者的充血性 MBF 明显低于风险匹配的对照组，并且在导管消融恢复 SR 后显著改善，表明 AF 患者的 MBF 异常主要是由 AF 本身引起的。
