Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: A 2-center study
Automated analysis of atrial late gadolinium enhancement imaging that correlates with endocardial voltage and clinical outcomes: A 2-center study
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DOI：
10.1016/j.hrthm.2013.04.030
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发表时间：
2013-08-01
期刊：
影响因子：
5.5
通讯作者：
Peters, N. S.
中科院分区：
文献类型：
--
作者：
Malcolme-Lawes, L. C.;Juli, C.;Peters, N. S.
背景对于心房瘢痕的晚期钆增强（LGE）心血管磁共振（CMR）评估，以指导房颤（AF）消融的管理和靶向，目的描述一种自动化的心房瘢痕识别方法，LGE的独立定量与共定位的内膜电压和临床结果相关。中心，阵发性房颤肺静脉电隔离前和3个月后（n = 50）。使用自动化软件构建左心房（LA）表面瘢痕标测图，将强度表示为高于血池平均值的标准差（SD）的倍数。21例患者在肺静脉隔离时接受了血管内电压标测（11例重做手术）。结果：LGE水平高于血池平均值3、4和5SD时，双极电压逐渐降低（分别为0.85 +/- 0.33、0.50 +/- 0.22和0.38 +/- 0.28 mV; P = .002、P < .001和P = .048）。消融后AF复发患者的消融前扫描中被归类为瘢痕（即高于血池平均值>3 SD）的心房表面积比例高于无复发患者（6.6% +/- 6.7% vs 3.5% +/-3.0%，P = 0.032）。LA体积>102 mL与LA瘢痕比例显著增加相关（6.4% +/-5.9%vs 3.4% +/- 2.2%; P = 0.007）。结论通过简单客观方法自动量化的LA瘢痕与共定位内分泌电压相关。较大的消融前瘢痕与LA扩张和AF复发相关。
BACKGROUND For late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) assessment of atrial scar to guide management and targeting of ablation in atrial fibrillation (AF), an objective, reproducible method of identifying atrial scar is required.OBJECTIVE To describe an automated method for operator-independent quantification of LGE that correlates with colocated endocardial voltage and clinical outcomes.METHODS LGE CMR imaging was performed at 2 centers, before and 3 months after pulmonary vein isolation for paroxysmal AF (n = 50). A left atrial (LA) surface scar map was constructed by using automated software, expressing intensity as multiples of standard deviation (SD) above blood pool mean. Twenty-one patients underwent endocardial voltage mapping at the time of pulmonary vein isolation (11 were redo procedures). Scar maps and voltage maps were spatially registered to the same magnetic resonance angiography (MRA) segmentation.RESULTS The LGE levels of 3, 4, and 5SDs above blood pool mean were associated with progressively lower bipolar voltages compared to the preceding enhancement level (0.85 +/- 0.33, 0.50 +/- 0.22, and 0.38 +/- 0.28 mV; P = .002, P < .001, and P = .048, respectively). The proportion of atrial surface area classified as scar (ie, >3 SD above blood pool mean) on preablation scans was greater in patients with postablation AF recurrence than those without recurrence (6.6% +/- 6.7% vs 3.5% +/- 3.0%, P = .032). The LA volume >102 mL was associated with a significantly greater proportion of LA scar (6.4% +/- 5.9% vs 3.4% +/- 2.2%; P = .007).CONCLUSIONS LA scar quantified automatically by a simple objective method correlates with colocated endocardial voltage. Greater preablation scar is associated with LA dilatation and AF recurrence.