Cardiac magnetic resonance imaging using wideband sequences in patients with nonconditional cardiac implanted electronic devices.
Cardiac magnetic resonance imaging using wideband sequences in patients with nonconditional cardiac implanted electronic devices.
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DOI：
10.1016/j.hrthm.2017.10.003
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发表时间：
2018-03
期刊：
影响因子：
5.5
通讯作者：
Boyle NG
中科院分区：
文献类型：
--
作者：
Do DH;Eyvazian V;Bayoneta AJ;Hu P;Finn JP;Bradfield JS;Shivkumar K;Boyle NG
磁共振成像(MRI)在没有条件心脏可植入电子设备(CIED)的患者中进行是安全的，但在这类患者中，特别是心脏磁共振成像(CMR)的经验有限。评估CMR在非MRI条件CIED中的安全性以及使用宽带序列对图像的可解释性。我们在111名患者(平均年龄59±14岁，12个起搏器，73个植入型心律转复除颤器，29个双室除颤器)上进行了114次连续的CMR研究，使用宽带脉冲序列进行晚期Gd增强(LGE)成像。遵循了设备管理和患者监控的标准化协议。患者在CMR后立即和临床随访时评估主要的临床不良事件和设备参数的变化。共成功完成111项CMR研究。在依赖患者中，没有患者死亡、新的心律失常、即刻发生器或导线故障、电重置或起搏捕获失败。治疗后右房、右室和左室导联阻抗显著降低，中位数分别为−7Ω(IQR−20至0Ω)(p<；0.0001)、0Ω(IQR−19至0Ω)(p=0.0001)和−10Ω(IQR−30至0Ω)(p=0.023)。这些变化分别持续到中位数差值−18.5Ω(智商−41至−66Ω)(p=0.007)、−19Ω(智商−44至−7Ω)(p=0.006)和−30Ω(智商−130至0Ω)(p=0.003)。97项研究(87%)没有限制解释的伪影。在使用标准化方案的非MRI条件下的CIED中，可以安全地进行CMR。使用宽带脉冲序列进行LGE成像可获得不受伪影影响的高研究率。
Magnetic resonance imaging (MRI) has been performed safely in patients without MRI-conditional cardiac implantable electronic devices (CIED), but experience specifically with cardiac magnetic resonance imaging (CMR) is limited in this patient population. Evaluate the safety of CMR in non-MRI-conditional CIED and the interpretability of images using wideband sequences. We performed 114 consecutive CMR studies in 111 patients (mean age 59±14 years with 12 pacemakers, 73 implantable cardioverter defibrillators, 29 biventricular defibrillators) utilizing a wideband pulse sequence for late gadolinium enhancement (LGE) imaging. A standardized protocol for device management and patient monitoring was followed. Patients were evaluated for major clinical adverse events and device parameter changes immediately after CMR and at clinical follow-up. A total of 111 CMR studies were completed successfully. There were no patient deaths, new arrhythmias, immediate generator or lead failures, electrical resets, or pacing capture failures in dependent patients. Right atrial, right ventricular, and left ventricular lead impedances were significantly lower post-CMR, median difference −7Ω (IQR −20 to 0Ω) (p<0.0001), 0Ω (IQR −19 to 0Ω) (p=0.0001), and −10Ω (IQR −30 to 0Ω) (p=0.023), respectively. These changes persisted through follow-up with median difference −18.5Ω (IQR −41 to −66Ω) (p=0.007) and −19Ω (IQR −44 to −7Ω) (p=0.006), and −30Ω (IQR −130 to 0Ω) (p = 0.003), respectively. Ninety-seven (87%) studies had no artifact limiting interpretation. CMR can be performed safely in non-MRI-conditional CIEDs using a standardized protocol. Use of a wideband pulse sequence for LGE imaging yields a high rate of studies unaffected by artifact.
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