各种对比剂增强磁共振成像方法与高清电压和激活标测在心房心肌病检测中的比较。

Comparison of various late gadolinium enhancement magnetic resonance imaging methods with high-definition voltage and activation mapping for detection of atrial cardiomyopathy.

机构信息

Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany.

Adas 3D Medical SL, 08036 Barcelona, Spain.

出版信息

Europace. 2022 Jul 21;24(7):1102-1111. doi: 10.1093/europace/euac010.

DOI:10.1093/europace/euac010

PMID:35298612

Abstract

AIMS

Atrial cardiomyopathy (ACM) is associated with increased arrhythmia recurrence rates after pulmonary vein isolation (PVI). We compare the most common left atrial (LA) late gadolinium enhancement magnetic resonance imaging (LGE-MRI)-methods [Utah-method and image intensity ratio (IIR)-methods] and endocardial voltage mapping for ACM-detection and outcome prediction after PVI for atrial fibrillation (AF).

METHODS AND RESULTS

In this prospective observational study, 37 ablation-naive patients (66 ± 9 years, 84% male) with persistent AF underwent LA-LGE-MRI and high-definition voltage and activation mapping (2129 ± 484 sites) in sinus rhythm prior to PVI. The MRI-post-processing-analyses were performed by two independent expert laboratories. Arrhythmia recurrence was recorded within 12 months following PVI. The global ACM-extent was highly variable: median LA low-voltage substrate (LA-LVS) was 12.9% at <1.0 mV and 2.7% at <0.5 mV; median LA-LGE-extent using the Utah-method was 18.3% and 0.03-93.1% using the IIR-methods. The LA activation time was significantly correlated with LA-LVS (r = 0.76 at <0.5 mV and r = 0.82 at <1.0 mV, both P < 0.0001), but not with LA-LGE-extent. The highest regional matching between LA-LVS <0.5 mV and LA-LGE was found for the anterior wall in 57% of patients using the Utah-method and in 59% using IIR 1.20. The corresponding values for the posterior wall were 19% and 38%, respectively. Arrhythmia recurrence occurred in 15(41%) patients. Freedom from arrhythmia was significantly lower in those with LA-LVS ≥2 cm2 at 0.5 mV but not in those with LGE ≥20% (Utah-stages III and IV): 43% vs. 81%, P = 0.009 and 50% vs. 67%, P = 0.338, respectively.

CONCLUSION

Comparison of the most common LA-LGE-MRI methods and endocardial voltage mapping revealed large discrepancies in global and regional ACM-extent.

摘要

目的

心房心肌病（ACM）与肺静脉隔离（PVI）后心律失常复发率增加有关。我们比较了最常见的左心房（LA）晚期钆增强磁共振成像（LGE-MRI）方法[犹他州方法和图像强度比（IIR）方法]和心内膜电压图，用于检测 ACM 并预测 PVI 治疗心房颤动（AF）后的结果。

方法和结果

在这项前瞻性观察研究中，37 名未经消融的患者（66±9 岁，84%为男性）在 PVI 前处于窦性心律，接受了 LA-LGE-MRI 和高清晰度电压和激活图（2129±484 个部位）。MRI 后处理分析由两个独立的专家实验室进行。在 PVI 后 12 个月内记录心律失常复发情况。整体 ACM 范围变化很大：LA 低电压基质（LA-LVS）中位数<1.0 mV 为 12.9%，<0.5 mV 为 2.7%；使用犹他州方法的 LA-LGE 范围中位数为 18.3%，使用 IIR 方法的中位数为 0.03-93.1%。LA 激活时间与 LA-LVS 显著相关（<0.5 mV 时 r = 0.76，<1.0 mV 时 r = 0.82，均 P<0.0001），但与 LA-LGE 范围无关。使用犹他州方法，57%的患者在前壁发现 LA-LVS<0.5 mV 和 LA-LGE 之间具有最高的区域匹配，而 IIR 1.20 为 59%。后壁的相应值分别为 19%和 38%。15 名（41%）患者出现心律失常复发。LA-LVS≥2 cm2 at 0.5 mV 的患者心律失常无复发率明显低于 LA-LGE≥20%（犹他州 III 和 IV 期）的患者：43%比 81%，P=0.009 和 50%比 67%，P=0.338。