Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation.
Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation.
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DOI：
10.1161/circulationaha.108.811877
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发表时间：
2009-04-07
期刊：
影响因子：
37.8
通讯作者：
Marrouche NF
中科院分区：
文献类型：
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作者：
Oakes RS;Badger TJ;Kholmovski EG;Akoum N;Burgon NS;Fish EN;Blauer JJ;Rao SN;DiBella EV;Segerson NM;Daccarett M;Windfelder J;McGann CJ;Parker D;MacLeod RS;Marrouche NF
心房颤动（AF）与弥漫性左心房（LA）纤维化和内膜电压降低相关。这些变化是AF严重程度的指标，似乎是治疗结果的预测因子。在这项研究中，我们报告了延迟增强MRI（DE-MRI）在射频消融术前检测异常心房组织和预测手术结果方面的实用性。81名接受肺静脉窦隔离（PVAI）治疗AF的患者在消融前接受了LA的3D DE-MRI。还对6名健康志愿者进行了扫描。手动分割DE-MRI图像以隔离LA，并使用定制软件量化延迟增强的空间范围，然后将其与PVAI手术的电解剖标测图中的低电压区域进行比较。在PVAI后至少6个月评估患者的AF复发，平均随访时间为9.6 ± 3.7个月（范围= 6 - 19个月）。根据消融前增强程度，43例患者被归类为轻度增强（平均增强= 8.0% ± 4.2%），30例为中度增强（平均增强= 21.3% ± 5.8%），8例为广泛增强（平均增强= 50.1% ± 15.4%）。房颤复发率：轻度强化6例（14.0%），中度强化13例（43.3%），广泛强化6例（75%）（P <0.001）。DE-MRI提供了一种评估AF患者左心房心肌组织的非侵入性方法，并可能提供对疾病进展的了解。消融前DE-MRI有望预测房颤消融的应答者，并可提供总体疾病进展的指标。
Atrial fibrillation (AF) is associated with diffuse left atrial (LA) fibrosis and a reduction in endocardial voltage. These changes are indicators of AF severity and appear to be predictors of treatment outcome. In this study we report the utility of delayed enhancement MRI (DE-MRI) in detecting abnormal atrial tissue prior to radiofrequency ablation and in predicting procedural outcome. Eighty-one patients presenting for pulmonary vein antrum isolation (PVAI) for treatment of AF underwent 3D DE-MRI of the LA prior to the ablation. Six healthy volunteers were also scanned. DE-MRI images were manually segmented to isolate the LA and custom software was implemented to quantify the spatial extent of delayed enhancement, which was then compared to the regions of low voltage from electroanatomical maps from the PVAI procedure. Patients were assessed for AF recurrence at least six months following PVAI with average follow-up of 9.6 ± 3.7 months (range = 6 to 19 months). Based on the extent of pre-ablation enhancement, 43 patients were classified as having minimal enhancement (average enhancement = 8.0% ± 4.2%), 30 as moderate (enhancement = 21.3% ± 5.8%), and 8 as extensive (enhancement = 50.1% ± 15.4%). The rate of AF recurrence was 6 patients (14.0%) with minimal enhancement, 13 (43.3%) with moderate and 6 (75%) patients with extensive enhancement (p <0.001). DE-MRI provides a non-invasive means of assessing LA myocardial tissue in patients suffering from AF and might provide insight into the progress of the disease. Pre-ablation DE-MRI holds promise to predict responders to AF ablation and may provide a metric of overall disease progression.