Noninvasive electrocardiographic imaging of chronic myocardial infarct scar.
Noninvasive electrocardiographic imaging of chronic myocardial infarct scar.
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DOI：
10.1016/j.jelectrocard.2015.08.035
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发表时间：
2015-11
影响因子：
1.3
通讯作者：
Sapp JL
中科院分区：
文献类型：
--
作者：
Horáček BM;Wang L;Dawoud F;Xu J;Sapp JL
心肌梗死（MI）瘢痕是室性心动过速（VT）的基础，准确描绘梗死瘢痕有助于识别折返环路，从而有助于导管消融。室性心动过速基质表征的最新进展之一是通过无创心电图成像在心室壁内进行体积描绘。本文比较了，在四个特定的情况下，心外膜和体积逆解，使用磁共振成像（MRI）与后期钆增强作为金标准。对于在格拉斯哥西部医院就诊的慢性心肌梗死患者，采集了延迟增强MRI和120导联体表电位标测（BSPM）数据，随后将4例选定病例作为2007年心脏病学挑战生理网络/计算机的一部分提供给更广泛的社区。这些数据用于对心外膜电描记图执行患者特定的逆解，并应用基于形态学的标准来描绘心外膜表面上的梗死瘢痕。后来，罗切斯特小组通过一种新的逆解重建壁内跨膜电位来分析相同的数据，以三维方式描绘梗死瘢痕。三个具体的逆解算法的性能比较在这里，使用分数的基础上推荐的美国心脏协会的17段心室分割方案。在用于比较的所有评分中，将梗死瘢痕描绘为跨膜动作电位的三维（3D）壁内分布的非侵入性方法优于在心外膜表面上提供瘢痕描绘的估计。特别是，梗塞疤痕的程度（其相对于总心室质量的百分比质量）通过3D估计更准确地呈现。此外，瘢痕边界的体积再现提供了更好的线索，潜在的目标，导管消融。心电图逆解提供心室肌动作电位的跨壁分布是一种有前途的工具，无创描绘的范围和位置的慢性MI疤痕。需要进一步验证更大的数据集与详细的金标准数据，以确认本研究中报告的观察结果。
Myocardial infarction (MI) scar constitutes a substrate for ventricular tachycardia (VT), and an accurate delineation of infarct scar may help to identify reentrant circuits and thus facilitate catheter ablation. One of the recent advancements in characterization of a VT substrate is its volumetric delineation within the ventricular wall by noninvasive electrocardiographic imaging. This paper compares, in four specific cases, epicardial and volumetric inverse solutions, using magnetic resonance imaging (MRI) with late gadolinium enhancement as a gold standard. For patients with chronic MI, who presented at Glasgow Western Infirmary, delayed-enhancement MRI and 120-lead body surface potential mapping (BSPM) data were acquired and 4 selected cases were later made available to a wider community as part of the 2007 PhysioNet/Computers in Cardiology Challenge. These data were used to perform patient-specific inverse solutions for epicardial electrograms and morphology-based criteria were applied to delineate infarct scar on the epicardial surface. Later, the Rochester group analyzed the same data by means of a novel inverse solution for reconstructing intramural transmembrane potentials, to delineate infarct scar in three dimensions. Comparison of the performance of three specific inverse-solution algorithms is presented here, using scores based on the 17-segment ventricular division scheme recommended by the American Heart Association. The noninvasive methods delineating infarct scar as three-dimensional (3D) intramural distribution of transmembrane action potentials outperform estimates providing scar delineation on the epicardial surface in all scores used for comparison. In particular, the extent of infarct scar (its percentage mass relative to the total ventricular mass) is rendered more accurately by the 3D estimate. Moreover, the volumetric rendition of scar border provides better clues to potential targets for catheter ablation. Electrocardiographic inverse solution providing transmural distribution of ventricular action potentials is a promising tool for noninvasively delineating the extent and location of chronic MI scar. Further validation on a larger data set with detailed gold-standard data is needed to confirm observations reported in this study.