Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
Department of Pediatric Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
J Cardiovasc Magn Reson. 2022 Dec 12;24(1):70. doi: 10.1186/s12968-022-00904-x.
Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.
CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes.
Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen's kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day.
Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.
肺静脉（PV）狭窄是射频消融治疗心房颤动后罕见但严重的并发症，综合评估形态狭窄分级及其功能后果对于狭窄治疗的相对较窄时间窗口至关重要。本研究旨在确定结合单次心血管磁共振（CMR）成像方案在介入性 PV 狭窄治疗前规划和随访中的临床应用，该方案整合了肺灌注和 PV 血管造影评估。
在介入性 PV 狭窄治疗前及治疗后 1 天和 3 个月，对 32 例连续患者进行了 CMR 检查（电影成像、动态肺灌注、三维 PV 血管造影）。CMR 血管造影上目测评估 PV 狭窄程度；对所有 5 个肺叶进行肺灌注成像的视觉和定量分析。
PV 狭窄的介入治疗急性手术成功率为 90%。视觉评估的肺灌注成像与存在或不存在≥70%的 PV 狭窄之间的一致性几乎是完美的（Cohen 的 kappa，0.96）。ROC 分析表明，定量肺灌注测量对检测≥70%的 PV 狭窄具有很高的鉴别能力（达峰增强时间的 AUC，0.96；灌洗率，0.93；最大增强，0.90）。定量肺灌注分析证明，成功的 PV 再血管化在 1 天后即可归因于非常大的治疗效果。
将 CMR 肺灌注成像整合到 PV 狭窄患者的临床评估中，可以实现有效的围手术期分层，并对再血管化成功进行随访评估。
