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Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium
Christian Vahlhaus1, Hans Jürgen Bruns, Jörg Stypmann
1Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. Vahlhaus@uni-muenster.de
Insights
Direct epicardial mapping accurately predicts recovery of ischemic left ventricular (LV) dysfunction. This method identifies viable myocardium, guiding treatment decisions for patients with coronary artery disease (CAD).
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Myocardial Viability Assessment
Background:
- Left ventricular (LV) dysfunction in ischemic myocardium poses a significant clinical challenge.
- Accurate prediction of myocardial recovery is crucial for guiding revascularization strategies in patients with coronary artery disease (CAD).
Purpose of the Study:
- To investigate the hypothesis that direct epicardial bipolar mapping can predict the recovery of LV dysfunction in ischemic myocardium.
- To assess the utility of epicardial mapping in determining myocardial viability.
Main Methods:
- Simultaneous recording of bipolar epicardial electrograms using a ventricular jacket array in 34 CAD patients undergoing revascularization.
- Assessment of segmental myocardial function via transthoracic echocardiography before and after coronary artery bypass grafting (CABG).
- Classification of dysfunctional segments as viable or non-viable based on wall motion score improvement post-CABG.
Main Results:
- Bipolar voltage was significantly lower in non-viable compared to viable myocardium (P<0.001).
- ROC-curve analysis demonstrated that bipolar voltage at a cut-off of 5.9mV predicted myocardial viability with 83% sensitivity and 83% specificity (AUC=0.92).
Conclusions:
- Direct epicardial mapping is a reliable method for predicting the recovery of chronically ischemic dysfunctional myocardium.
- Epicardial mapping effectively proves the presence of myocardial viability, informing clinical management.
Aims:
This study investigated the hypothesis that direct epicardial bipolar mapping is able to predict the recovery of left ventricular (LV) dysfunction in ischaemic myocardium.
Methods And Results:
In 34 patients with CAD, a maximum of 102 bipolar epicardial electrograms per patient (n=3468 electrograms) were simultaneously recorded with a ventricular jacket array intraoperatively immediately prior to revascularization. Only LV electrograms with good myocardial contact (n=1813, 52+/-14 per patient, mean+/-SD) were analyzed. In accordance to the position of each electrode, segmental myocardial function was assessed by transthoracic echocardiography before and 7+/-2 months (mean+/-SD; range 3-10 months) after CABG using a wall motion score. Preoperatively dysfunctional segments (n=700) were classified as viable (improvement in wall motion score of at least 20% following CABG, n=424) or non-viable (no improvement, n=276). Bipolar voltage was significantly lower in non-viable when compared to viable myocardium (P<0.001, ANOVA) At a cut-off value of 5.9mV, ROC-curve analysis for bipolar voltage (to discriminate between viable and non-viable myocardium) revealed a sensitivity of 83% at a specificity of 83% (area under the ROC-curve of 0.92+/-0.01, mean+/-SE).
Conclusions:
Direct epicardial mapping is able to predict the recovery of chronically ischaemic dysfunctional myocardium and thereby proves the presence of myocardial viability.
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