Novel Arrhythmogenic Mechanisms Program, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain.
Europace. 2024 Oct 3;26(10). doi: 10.1093/europace/euae244.
There is lack of agreement on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging processing for guiding ventricular tachycardia (VT) ablation. We aim at developing and validating a systematic processing approach on LGE-CMR images to identify VT corridors that contain critical VT isthmus sites.
This is a translational study including 18 pigs with established myocardial infarction and inducible VT undergoing in vivo characterization of the anatomical and functional myocardial substrate associated with VT maintenance. Clinical validation was conducted in a multicentre series of 33 patients with ischaemic cardiomyopathy undergoing VT ablation. Three-dimensional LGE-CMR images were processed using systematic scanning of 15 signal intensity (SI) cut-off ranges to obtain surface visualization of all potential VT corridors. Analysis and comparisons of imaging and electrophysiological data were performed in individuals with full electrophysiological characterization of the isthmus sites of at least one VT morphology. In both the experimental pig model and patients undergoing VT ablation, all the electrophysiologically defined isthmus sites (n = 11 and n = 19, respectively) showed overlapping regions with CMR-based potential VT corridors. Such imaging-based VT corridors were less specific than electrophysiologically guided ablation lesions at critical isthmus sites. However, an optimized strategy using the 7 most relevant SI cut-off ranges among patients showed an increase in specificity compared to using 15 SI cut-off ranges (70 vs. 62%, respectively), without diminishing the capability to detect VT isthmus sites (sensitivity 100%).
Systematic imaging processing of LGE-CMR sequences using several SI cut-off ranges may improve and standardize procedure planning to identify VT isthmus sites.
心脏磁共振晚期钆增强（LGE-CMR）成像处理在指导室性心动过速（VT）消融方面缺乏共识。我们旨在开发和验证一种系统的 LGE-CMR 图像处理方法，以识别包含关键 VT 峡部部位的 VT 走廊。
这是一项转化研究，包括 18 头患有已建立的心肌梗死和可诱导 VT 的猪，进行与 VT 维持相关的解剖和功能心肌基质的体内特征描述。临床验证在 33 名患有缺血性心肌病并接受 VT 消融的多中心系列患者中进行。使用 15 个信号强度（SI）截止范围的系统扫描对三维 LGE-CMR 图像进行处理，以获得所有潜在 VT 走廊的表面可视化。在对至少一种 VT 形态的峡部部位进行完整电生理特征描述的个体中，对成像和电生理数据进行分析和比较。在实验猪模型和接受 VT 消融的患者中，所有电生理定义的峡部部位（分别为 n = 11 和 n = 19）均与基于 CMR 的潜在 VT 走廊存在重叠区域。与基于电生理的关键峡部部位消融病变相比，这种基于影像学的 VT 走廊的特异性较低。然而，在患者中使用最相关的 7 个 SI 截止范围的优化策略与使用 15 个 SI 截止范围相比，特异性提高（分别为 70%和 62%），而不会降低检测 VT 峡部部位的能力（敏感性 100%）。
使用多个 SI 截止范围对 LGE-CMR 序列进行系统成像处理可以改善和标准化程序规划，以识别 VT 峡部部位。
