Validation and Opportunities of Electrocardiographic Imaging: From Technical Achievements to Clinical Applications.
Validation and Opportunities of Electrocardiographic Imaging: From Technical Achievements to Clinical Applications.
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DOI：
10.3389/fphys.2018.01305
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发表时间：
2018
影响因子：
4
通讯作者：
Bear L
中科院分区：
文献类型：
--
作者：
Cluitmans M;Brooks DH;MacLeod R;Dössel O;Guillem MS;van Dam PM;Svehlikova J;He B;Sapp J;Wang L;Bear L
心电图成像（ECGI）从密集的体表心电图阵列和患者特定的心脏躯干几何结构重建心脏的电活动。根据其制定方式，ECGI允许重建心脏的激活和恢复序列、早搏或心动过速的起源、折返性心律失常的锚点/热点以及其他感兴趣的电生理量。重要的是，这些量在患者三维心脏的数字化模型中直接和非侵入性地重建，这导致了对ECGI个性化诊断和指导治疗能力的临床兴趣。尽管在过去的几十年里取得了相当大的发展，但ECGI的验证仍具有挑战性。首先，结果在很大程度上取决于实现的选择，这是必要的处理ECGI的不适定性。其次，获得高质量的（侵入性）地面实况数据具有挑战性。在这篇综述中，我们讨论了ECGI验证的现状以及在临床实践中完全采用ECGI所面临的主要挑战。具体而言，显示临床获益对于采用ECGI至关重要。这种益处可能在于患者结果改善、工作流程改善或成本降低。未来的研究应该集中在这些方面，以实现ECGI的广泛采用，但只有在特定应用/病理学的技术挑战得到解决之后。我们提出了技术验证的“最佳”实践，并强调了最近在这一领域组织的合作努力。工程师，基础科学家和医生之间的持续互动对于找到技术成就，病理机制见解和临床益处之间的混合体仍然至关重要，以使这种强大的技术在临床实践中发挥有用的作用。
Electrocardiographic imaging (ECGI) reconstructs the electrical activity of the heart from a dense array of body-surface electrocardiograms and a patient-specific heart-torso geometry. Depending on how it is formulated, ECGI allows the reconstruction of the activation and recovery sequence of the heart, the origin of premature beats or tachycardia, the anchors/hotspots of re-entrant arrhythmias and other electrophysiological quantities of interest. Importantly, these quantities are directly and non-invasively reconstructed in a digitized model of the patient’s three-dimensional heart, which has led to clinical interest in ECGI’s ability to personalize diagnosis and guide therapy. Despite considerable development over the last decades, validation of ECGI is challenging. Firstly, results depend considerably on implementation choices, which are necessary to deal with ECGI’s ill-posed character. Secondly, it is challenging to obtain (invasive) ground truth data of high quality. In this review, we discuss the current status of ECGI validation as well as the major challenges remaining for complete adoption of ECGI in clinical practice. Specifically, showing clinical benefit is essential for the adoption of ECGI. Such benefit may lie in patient outcome improvement, workflow improvement, or cost reduction. Future studies should focus on these aspects to achieve broad adoption of ECGI, but only after the technical challenges have been solved for that specific application/pathology. We propose ‘best’ practices for technical validation and highlight collaborative efforts recently organized in this field. Continued interaction between engineers, basic scientists, and physicians remains essential to find a hybrid between technical achievements, pathological mechanisms insights, and clinical benefit, to evolve this powerful technique toward a useful role in clinical practice.
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影响因子：
8.4
作者：
Andrews, Christopher M.;Srinivasan, Neil T.;Rudy, Yoram
通讯作者：
Rudy, Yoram
影响因子：
3.7
作者：
Berger, Thomas;Pfeifer, Bernhard;Seger, Michael
通讯作者：
Seger, Michael
影响因子：
1.3
作者：
Aras K;Good W;Tate J;Burton B;Brooks D;Coll-Font J;Doessel O;Schulze W;Potyagaylo D;Wang L;van Dam P;MacLeod R
通讯作者：
MacLeod R
影响因子：
5.5
作者：
Bear, Laura R.;Huntjens, Peter R.;Dubois, Remi
通讯作者：
Dubois, Remi
DOI：
10.1016/j.jacep.2016.11.012
发表时间：
2017-03-01
期刊：
JACC. Clinical electrophysiology
影响因子：
--
作者：
Cluitmans, Matthijs J M;Bonizzi, Pietro;Volders, Paul G A
通讯作者：
Volders, Paul G A