Valles-Colomer Anna, Rubio Forcada Barbara, Soto-Iglesias David, Planes Xavi, Trueba Ramón, Teres Cheryl, Penela Diego, Berruezo Antonio, Serra Luis, Figueras I Ventura Rosa M
Adas3D Medical, Barcelona, Catalonia, Spain.
Heart Institute, Teknon Medical Center, Barcelona, Catalonia, Spain.
J Interv Card Electrophysiol. 2023 Aug;66(5):1045-1055. doi: 10.1007/s10840-023-01472-5. Epub 2023 Feb 20.
Adapting the ablation index (AI) to the left atrial wall thickness (LAWT) derived from computed tomography angiography (CTA) allows for a personalized approach that showed to improve PVI safety and outcomes.
Three observers with different degrees of experience performed complete LAWT analysis of CTA for 30 patients and repeated the analysis for 10 of these patients. Intra- and inter-observer reproducibility of these segmentations was assessed.
Geometric congruence of repeated reconstruction of LA endocardial surface showed that 99.4% of points in the 3D reconstructed mesh were within < 1 mm distance for the intra-observer variability and 95.1% for the inter-observer. For the LA epicardial surface, an 82.4% of points were within < 1 mm for intra-observer and a 77.7% for inter-observer. A 1.99% of points were further than 2 mm for the intra-observer and a 4.1% for the inter-observer. Colour agreement between LAWT maps showed that a 95.5% and a 92.9% intra- and inter-observer respectively presented the same colour or a change to the colour immediately above or below. The ablation index (AI), which was adapted to this LAWT colour maps to perform a personalized pulmonary vein isolation (PVI), showed an average difference in the derived AI lower than 25 units in all cases. For all analyses, the concordance increased with user-experience.
Geometric congruence of LA shape was high, for both endocardial and epicardial segmentations. LAWT measurements were reproducible, increasing with user experience. This translated into a negligible impact in the target AI.
根据计算机断层血管造影（CTA）得出的左心房壁厚度（LAWT）调整消融指数（AI），可实现个性化治疗方案，这已被证明能提高肺静脉隔离（PVI）的安全性及治疗效果。
三名经验程度不同的观察者对30例患者的CTA进行完整的LAWT分析，并对其中10例患者重复分析。评估这些分割的观察者内及观察者间的可重复性。
左心房心内膜表面重复重建的几何一致性显示，在三维重建网格中，观察者内变异性有99.4%的点距离在<1mm内，观察者间为95.1%。对于左心房心外膜表面，观察者内有82.4%的点距离在<1mm内，观察者间为77.7%。观察者内有1.99%的点距离超过2mm，观察者间为4.1%。LAWT图之间的颜色一致性显示，观察者内和观察者间分别有95.5%和92.9%呈现相同颜色或变为紧邻的上一种或下一种颜色。根据此LAWT颜色图调整的消融指数（AI）用于进行个性化肺静脉隔离（PVI），在所有病例中得出的AI平均差异低于25个单位。对于所有分析，一致性随用户经验增加。
左心房形状的几何一致性很高，无论是心内膜还是心外膜分割。LAWT测量具有可重复性，且随用户经验增加。这对目标AI的影响可忽略不计。
