使用晚期加多增强-磁共振成像,电图电压和导电速度的心房基板局部化的差异:在患有持续心房的患者中使用一致的解剖参考框架进行的一组研究
Deborah Nairn1, Martin Eichenlaub2,3, Björn Müller-Edenborn2,3
1Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, Karlsruhe 76131, Germany.
概括
在持续性心房动 (AF) 患者中,对心房心肌病 (ACM) 的成像技术进行比较,揭示了病理基质检测的显著差异. 对于LGE-MRI,一种新的优化图像强度值 (EOIIT) 提高了ACM的诊断准确性.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 电子生理学 电子生理学
背景情况:
- 心房心肌病 (ACM) 与电解剖学电压映射,导电速度 (CV) 映射和晚期加多增强 (LGE) 磁共振成像 (MRI) 相关.
- 这些确定ACM的方法之间的可比性和诊断一致性仍然不清楚,需要进一步调查.
研究的目的:
- 为了比较LGE-MRI和电解剖绘图之间的病理基质的程度和位置.
- 开发和验证LGE-MRI用于识别ACM的新估计优化图像强度值 (EOIIT).
- 评估这些模式对持续性心房动 (AF) 肺静脉隔离 (PVI) 后节律结果的预测价值.
主要方法:
- 三十六名经过过切除的持久性AF患者接受了LGE-MRI和高清电解剖绘图.
- 使用低压基板 (LVS),缓慢导电区域 (<0.2 m/s) 和LGE (UTAH,IIR>1.20和新型EOIIT方法) 评估了病态基板.
- 接收器操作特征分析确定了与LVS最佳匹配的LGE值,将ACM定义为LVS范围≥5%的左心室 (LA) 表面在<0.5mV时.
主要成果:
- 病理基质检测的显著变化 (P < 0.001) 在各种模式中观察到,LGE方法检测到较大的心房表面积与LVS和缓慢导电相比.
- 新的EOIIT方法在ACM诊断中显示了LGE-MRI和LVS之间更好的一致性 (83%的灵敏度,79%的特异性,AUC:0.89),优于UTAH和IIR方法.
- 基质检测中的差异在后左心室中最为明显,无论使用哪种LGE检测方法.
结论:
- 在LVS,心血管映射和左心室的LGE-MRI之间存在病理基质检测的不一致性.
- EOIIT的方法提高了基于LGE-MRI的ACM诊断与去除前AF患者的LVS的一致性,尽管差异仍然存在,特别是在后壁上.
- 所有研究的方法都有可能预测PVI后持续性AF患者的节律结果.
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