Association of septal late gadolinium enhancement on cardiac magnetic resonance with ventricular tachycardia ablation targets in nonischemic cardiomyopathy.
Association of septal late gadolinium enhancement on cardiac magnetic resonance with ventricular tachycardia ablation targets in nonischemic cardiomyopathy.
复制标题
心脏磁共振间隔晚期钆增强与非缺血性心肌病室性心动过速消融目标的关联。
DOI：
10.1111/jce.14777
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发表时间：
2020
影响因子：
2.7
通讯作者：
Nazarian,Saman
中科院分区：
文献类型：
--
作者：
Kuo,Ling;Liang,JacksonJ;Han,Yuchi;Frankel,DavidS;Santangeli,Pasquale;Callans,DavidJ;Zado,EricaS;Marchlinski,FrancisE;Desjardins,Benoit;Nazarian,Saman
非缺血性心肌病（NICM）患者室间隔基质相关性室性心动过速（VT）的消融治疗具有挑战性。我们试图标准化晚钆增强（LGE）心脏磁共振（CMR）的间隔基板的表征，并检查该基板与VT出口和峡部部位的侵入性mapping.MethodsLGE-CMR进行电解剖标测和消融VT在20 NICM患者。使用心肌信号强度Z评分（SI-Z）定量LGE范围和分布。SI-Z阈值与先前验证的电压阈值相关，用于异常组织和致密瘢痕were defined. ResultsLV和RV的双极和单极（电描记图）电压振幅测量值与LGE-CMR成像的SI-Z呈负相关（p< .05）。对于边缘区域，适当识别间隔基质的CMR的SI-Z阈值被确定为大于-0.15，对于致密疤痕，大于0.03。在所有患者中，确定了34个严重室性心动过速部位，SI-Z分布范围为-0.97至0.06。30个（88.2%）关键部位位于致密LGE中，1个（2.9%）位于边缘区，3个（8.9%）位于健康组织中，但在LGE的7 mm范围内。值得注意的是，临界室性心动过速的网站都位于基底隔靠近瓣膜（距离主动脉瓣：17.5 ± 31.2毫米，二尖瓣：21.2 ± 8.7毫米）在nonsarcoidosis cases.ConclusionsCritical网站的间隔室性心动过速在NICM患者主要是在CMR定义的密集疤痕时，使用标准化的信号强度阈值。
BackgroundAblation of septal substrate‐associated ventricular tachycardia (VT) in patients with nonischemic cardiomyopathy (NICM) is challenging. We sought to standardize the characterization of septal substrates on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and to examine the association of that substrate with VT exit and isthmus sites on invasive mapping.MethodsLGE‐CMR was performed before electroanatomic mapping and ablation for VT in 20 NICM patients. LGE extent and distribution were quantified using myocardial signal‐intensityZscores (SI‐Z). The SI‐Z thresholds correlating to previously validated voltage thresholds, for abnormal tissue and dense scar were defined.ResultsBipolar and unipolar (electrogram) voltage amplitude measurements from the LV and RV were negatively associated with SI‐Z from LGE‐CMR imaging (p< .05). SI‐Z thresholds for appropriate CMR identification of septal substrates were determined to be greater than −.15 for border zone and greater than .03 for a dense scar. Among all patients, 34 critical VT sites were identified with SI‐Z distribution in the range of −.97 to .06. Thirty (88.2%) critical sites were located in the dense LGE, 1 (2.9%) in the border zone, and 3 (8.9%) in healthy tissue but within 7 mm of LGE. Of note, critical VT sites were all located at the basal septum close to valves (distance to aortic valve: 17.5 ± 31.2 mm, mitral valve: 21.2 ± 8.7 mm) in nonsarcoidosis cases.ConclusionsCritical sites of septal VT in NICM patients are predominantly in the CMR defined dense scar when using standardized signal‐intensity thresholds.