Kornowski R, Hong M K, Gepstein L, Goldstein S, Ellahham S, Ben-Haim S A, Leon M B
From Washington Hospital Center, Washington, DC, USA.
Circulation. 1998 Sep 15;98(11):1116-24. doi: 10.1161/01.cir.98.11.1116.
A catheter-based left ventricular (LV) endocardial mapping procedure using electromagnetic field energy for positioning of the catheter tip was designed to acquire simultaneous measurements of endocardial voltage potentials and myocardial contractility. We investigated such a mapping system to distinguish between infarcted and normal myocardium in an animal infarction model and in patients with coronary artery disease.
Measurements of LV endocardial unipolar (UP) and bipolar (BP) voltages and local endocardial shortening were derived from dogs at baseline (n=12), at 24 hours (n=6), and at 3 weeks (n=6) after occlusion of the left anterior descending coronary artery. Also, 12 patients with prior myocardial infarction (MI) and 12 control patients underwent the LV endocardial mapping study for assessment of electromechanical function in infarcted versus healthy myocardial regions. In the canine model, a significant decrease in voltage potentials was noted in the MI zone at 24 hours (UP, 42. 8+/-9.6 to 29.1+/-12.2 mV, P=0.007; BP, 11.6+/-2.3 to 4.9+/-1.2 mV, P<0.0001) and at 3 weeks (UP, 41.0+/-8.9 to 13.9+/-3.9 mV, P<0.0001; BP, 11.2+/-2.8 to 2.4+/-0.4 mV, P<0.0001). No change in voltage was noted in zones remote from MI. In patients with prior MI, the average voltage was 7.2+/-2.7 mV (UP)/1.4+/-0.7 mV (BP) in MI regions, 17.8+/-4.6 mV (UP)/4.5+/-1.1 mV (BP) in healthy zones remote from MI, and 19.7+/-4.4 mV (UP)/5.8+/-1.0 mV (BP) in control patients without prior MI (P<0.001 for MI values versus remote zones or control patients). In the canine model and patients, local endocardial shortening was significantly impaired in MI zones compared with controls.
These preliminary data suggest that infarcted myocardium could be accurately diagnosed and distinguished from healthy myocardium by a reduction in both electrical voltage and mechanical activity. Such a diagnostic electromechanical mapping study might be clinically useful for accurate assessment of myocardial function and viability.
设计了一种基于导管的左心室（LV）心内膜标测程序，利用电磁场能量定位导管尖端，以同时获取心内膜电压电位和心肌收缩力的测量值。我们研究了这样一种标测系统，以在动物梗死模型和冠心病患者中区分梗死心肌和正常心肌。
在左前降支冠状动脉闭塞后基线（n = 12）、24小时（n = 6）和3周（n = 6）时，从犬类获取左心室心内膜单极（UP）和双极（BP）电压以及局部心内膜缩短的测量值。此外，12例既往有心肌梗死（MI）的患者和12例对照患者接受了左心室心内膜标测研究，以评估梗死心肌区域与健康心肌区域的机电功能。在犬类模型中，梗死区域在24小时时电压电位显著降低（UP，从42.8±9.6 mV降至29.1±12.2 mV，P = 0.007；BP，从11.6±2.3 mV降至4.9±1.2 mV，P<0.0001），在3周时也显著降低（UP，从41.0±8.9 mV降至13.9±3.9 mV，P<0.0001；BP，从11.2±2.8 mV降至2.4±0.4 mV，P<0.0001）。远离梗死区域的区域电压无变化。在既往有心肌梗死的患者中，梗死区域的平均电压为7.2±2.7 mV（UP）/1.4±0.7 mV（BP），远离梗死区域的健康区域为17.8±4.6 mV（UP）/4.5±1.1 mV（BP），无既往心肌梗死的对照患者为19.7±4.4 mV（UP）/5.8±1.0 mV（BP）（梗死区域的值与远离梗死区域或对照患者相比，P<0.001）。在犬类模型和患者中，梗死区域的局部心内膜缩短与对照组相比显著受损。
这些初步数据表明，梗死心肌可通过电压和机械活动的降低准确诊断并与健康心肌区分开来。这样一种诊断性的机电标测研究可能在临床上有助于准确评估心肌功能和存活性。
