Wu Bryan, Atwood Todd, Mundt Arno J, Karunamuni Jennifer, Stark Paul, Hsiao Albert, Han Frederick, Hsu Jonathan C, Hoffmayer Kurt, Raissi Farshad, Birgersdotter-Green Ulrika, Feld Gregory, Krummen David E, Ho Gordon
Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
Division of Medical Physics and Technology, Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California.
Heart Rhythm O2. 2023 Dec 23;5(2):131-136. doi: 10.1016/j.hroo.2023.12.006. eCollection 2024 Feb.
Respiratory motion management strategies are used to minimize the effects of breathing on the precision of stereotactic ablative radiotherapy for ventricular tachycardia, but the extent of cardiac contractile motion of the human heart has not been systematically explored.
We aim to assess the magnitude of cardiac contractile motion between different directions and locations in the heart.
Patients with intracardiac leads or valves who underwent 4-dimensional cardiac computed tomography (CT) prior to a catheter ablation procedure for atrial or ventricular arrhythmias at 2 medical centers were studied retrospectively. The displacement of transvenous right atrial appendage, right ventricular (RV) implantable cardioverter-defibrillator, coronary sinus lead tips, and prosthetic cardiac devices across the cardiac cycle were measured in orthogonal 3-dimensional views on a maximal-intensity projection CT reconstruction.
A total of 31 preablation cardiac 4-dimensional cardiac CT scans were analyzed. The LV lead tip had significantly greater motion compared with the RV lead in the anterior-posterior direction (6.0 ± 2.2 mm vs 3.8 ± 1.7 mm; .01) and superior-inferior direction (4.4 ± 2.9 mm vs 3.5 ± 2.0 mm; .049). The prosthetic aortic valves had the least movement of all fiducials, specifically compared with the RV lead tip in the left-right direction (3.2 ± 1.2 mm vs 6.1 ± 3.8 mm, .04) and the LV lead tip in the anterior-posterior direction (3.8 ± 1.7 mm vs 6.0 ± 2.2 mm, .03).
The degree of cardiac contractile motion varies significantly (1 mm to 15.2 mm) across different locations in the heart. The effect of contractile motion on the precision of radiotherapy should be assessed on a patient-specific basis.
呼吸运动管理策略用于将呼吸对室性心动过速立体定向消融放疗精度的影响降至最低，但尚未对人体心脏的心脏收缩运动程度进行系统研究。
我们旨在评估心脏不同方向和位置之间的心脏收缩运动幅度。
回顾性研究在2个医学中心接受心房或心室心律失常导管消融术前进行四维心脏计算机断层扫描（CT）的有心内导联或瓣膜的患者。在最大强度投影CT重建的正交三维视图中测量整个心动周期中经静脉右心耳、右心室植入式心脏复律除颤器、冠状窦导联尖端和人工心脏装置的位移。
共分析了31例消融术前心脏四维CT扫描。左心室导联尖端在前后方向上的运动明显大于右心室导联（6.0±2.2毫米对3.8±1.7毫米；P<0.01），在上下方向上也是如此（4.4±2.9毫米对3.5±2.0毫米；P=0.049）。人工主动脉瓣在所有基准点中运动最少，特别是在左右方向上与右心室导联尖端相比（3.2±1.2毫米对6.1±3.8毫米，P=0.04），在前后方向上与左心室导联尖端相比（3.8±1.7毫米对6.0±2.2毫米，P=0.03）。
心脏不同位置的心脏收缩运动程度差异显著（1毫米至15.2毫米）。应根据患者个体情况评估收缩运动对放疗精度的影响。
