Cardiovascular magnetic resonance imaging of scar development following pulmonary vein isolation: a prospective study.
Cardiovascular magnetic resonance imaging of scar development following pulmonary vein isolation: a prospective study.
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DOI：
10.1371/journal.pone.0104844
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Josephson ME
中科院分区：
文献类型：
--
作者：
Hsing J;Peters DC;Knowles BR;Manning WJ;Josephson ME
心血管磁共振（MR）可对肺静脉隔离（通过消融）后的早期（24小时）水肿和损伤以及随后的瘢痕形成进行无创评估。我们假设消融术后24小时，心血管MR将表现出消融术引起的水肿和损伤模式，严重程度与随后的瘢痕相关。15例房颤患者在肺静脉隔离前、消融后24小时（N = 11）和消融后30天（N = 7）接受了心血管MR，采用T2加权（T2W）和晚期钆增强（LGE）成像。 观察各时间点左房壁厚度、水肿强化率及LGE强化情况。在24小时时测量LGE和水肿增强的范围，并评估损伤的周向存在，包括与30天时的LGE增强进行比较。消融后24小时左心房壁厚度增加（10.7±4.1 mm vs. PVI前7.0±1.8 mm，p<0.05）。24小时T2W增强显示水肿增强比增加（消融后为1.5±0.4，消融前为0.9±0.2，p<0.001）。24小时水肿和LGE体积与30天LGE体积相关（分别为R= 0.76，p = 0.04和R = 0.74，p =0.09）。 使用16节段模型进行评估，24小时T2W预测30天LGE的敏感性、特异性和准确性分别为82%、63%和79%。24-小时LGE的敏感性、特异性和准确性分别为91%、47%和84%。消融后早期心血管MR显示左心房壁增厚和水肿增加，发现与30天LGE瘢痕相关。
Cardiovascular magnetic resonance (MR) provides non-invasive assessment of early (24-hour) edema and injury following pulmonary vein isolation (by ablation) and subsequent scar formation. We hypothesize that 24-hours after ablation, cardiovascular MR would demonstrate a pattern of edema and injury due to ablation and the severity would correlate with subsequent scar. Fifteen atrial fibrillation patients underwent cardiovascular MR prior to pulmonary vein isolation, 24-hours post (N = 11) and 30-days post (N = 7) ablation, with T2-weighted (T2W) and late gadolinium enhancement (LGE) imaging. Left atrial wall thickness, edema enhancement ratio and LGE enhancement were assessed at each time point. Volumes of LGE and edema enhancement were measured, and the circumferential presence of injury was assessed at 24-hours, including comparison with LGE enhancement at 30 days. Left atrial wall thickness was increased 24-hours post-ablation (10.7±4.1 mm vs. 7.0±1.8 mm pre-PVI, p<0.05). T2W enhancement at 24-hours showed increased edema enhancement ratio (1.5±0.4 for post-ablation, vs. 0.9±0.2 pre-ablation, p<0.001). Edema and LGE volumes at 24-hours were correlated with 30-day LGE volume (R = 0.76, p = 0.04, and R = 0.74, p = 0.09, respectively). Using a 16 segment model for assessment, 24-hour T2W had sensitivity, specificity, and accuracy of 82%, 63%, and 79% respectively, for predicting 30-day LGE. 24-hour LGE had sensitivity, specificity, and accuracy of 91%, 47%, and 84%. Increased left atrial wall thickening and edema were characterized on cardiovascular MR early post-ablation, and found to correlate with 30-day LGE scar.
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