Bertsche Dagmar, Metze Patrick, Luo Erfei, Dahme Tillman, Gonska Birgid, Rottbauer Wolfgang, Vernikouskaya Ina, Rasche Volker, Schneider Leonhard M
Department of Internal Medicine II, Ulm University Medical Center, Ulm, Germany.
Front Cardiovasc Med. 2023 Jun 23;10:1132626. doi: 10.3389/fcvm.2023.1132626. eCollection 2023.
Percutaneous closure of the left atrial appendage (LAA) facilitates stroke prevention in patients with atrial fibrillation. Optimal device selection and positioning are often challenging due to highly variable LAA shape and dimension and thus require accurate assessment of the respective anatomy. Transesophageal echocardiography (TEE) and x-ray fluoroscopy (XR) represent the gold standard imaging techniques. However, device underestimation has frequently been observed. Assessment based on 3-dimensional computer tomography (CTA) has been reported as more accurate but increases radiation and contrast agent burden. In this study, the use of non-contrast-enhanced cardiac magnetic resonance imaging (CMR) to support preprocedural planning for LAA closure (LAAc) was investigated.
CMR was performed in thirteen patients prior to LAAc. Based on the 3-dimensional CMR image data, the dimensions of the LAA were quantified and optimal C-arm angulations were determined and compared to periprocedural data. Quantitative figures used for evaluation of the technique comprised the maximum diameter, the diameter derived from perimeter and the area of the landing zone of the LAA.
Perimeter- and area-based diameters derived from preprocedural CMR showed excellent congruency compared to those measured periprocedurally by XR, whereas the respective maximum diameter resulted in significant overestimation ( < 0.05). Compared to TEE assessment, CMR-derived diameters resulted in significantly larger dimensions ( < 0.05). The deviation of the maximum diameter to the diameters measured by XR and TEE correlated well with the ovality of the LAA. C-arm angulations used during the procedures were in agreement with those determined by CMR in case of circular LAA.
This small pilot study demonstrates the potential of non-contrast-enhanced CMR to support preprocedural planning of LAAc. Diameter measurements based on LAA area and perimeter correlated well with the actual device selection parameters. CMR-derived determination of landing zones facilitated accurate C-arm angulation for optimal device positioning.
经皮左心耳封堵术有助于预防心房颤动患者发生中风。由于左心耳的形状和尺寸高度可变，最佳器械的选择和定位往往具有挑战性，因此需要准确评估相应的解剖结构。经食管超声心动图（TEE）和X线透视（XR）是金标准成像技术。然而，器械低估的情况经常出现。据报道，基于三维计算机断层扫描（CTA）的评估更为准确，但会增加辐射和造影剂负担。在本研究中，探讨了使用非增强心脏磁共振成像（CMR）来支持左心耳封堵术（LAAc）的术前规划。
在13例患者进行LAAc术前进行CMR检查。基于三维CMR图像数据，对左心耳的尺寸进行量化，并确定最佳C形臂角度，并与围手术期数据进行比较。用于评估该技术的定量指标包括左心耳的最大直径、由周长得出的直径以及着陆区面积。
与术中通过XR测量的直径相比，术前CMR得出的基于周长和面积的直径具有极好的一致性，而相应的最大直径则被显著高估（<0.05）。与TEE评估相比，CMR得出的直径明显更大（<0.05）。最大直径与XR和TEE测量的直径之间的偏差与左心耳的椭圆度密切相关。在圆形左心耳的情况下，术中使用的C形臂角度与CMR确定的角度一致。
这项小型试点研究证明了非增强CMR在支持LAAc术前规划方面的潜力。基于左心耳面积和周长的直径测量与实际器械选择参数密切相关。通过CMR确定着陆区有助于准确的C形臂角度调整，以实现最佳器械定位。
