Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy.
Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy.
复制标题
心脏计算机断层扫描的综合使用在心脏重新同步疗法中指导左心室铅放置。
DOI：
10.1016/j.hrthm.2017.04.041
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发表时间：
2017-09
期刊：
影响因子：
5.5
通讯作者：
Rinaldi CA
中科院分区：
文献类型：
--
作者：
Behar JM;Rajani R;Pourmorteza A;Preston R;Razeghi O;Niederer S;Adhya S;Claridge S;Jackson T;Sieniewicz B;Gould J;Carr-White G;Razavi R;McVeigh E;Rinaldi CA
最佳电极导线定位是心脏起搏治疗（CRT）反应的重要决定因素。本研究的目的是通过靶向晚期机械激活区域并避免心肌瘢痕，评价心脏计算机断层扫描（CT）选择用于左心室（LV）电极导线置入的最佳心外膜静脉。18例使用现有起搏系统进行CRT升级的患者接受了植入前心电图门控心脏CT，以通过推导内膜雕刻区（SQUEEZ）算法的拉伸量化器来评估壁厚、灌注不足、晚期机械激活和心肌瘢痕区域。将心脏静脉解剖结构映射到个性化的美国心脏协会（AHA）靶心图，以确定最佳静脉目标，并使用LV压力导丝将其与每个冠状静脉目标的急性血流动力学反应（AHR）进行比较。15个数据集是可评价的。与最佳可实现AHR相比，CT-SQUEEZ衍生目标产生的平均AHR相似（20.4% ± 13.7% vs 24.9% ± 11.1%; P = 0.36）。SQUEEZ引导在92%的靶节段中产生了阳性AHR，CT-SQUEEZ靶静脉中的起搏产生了比非靶节段更高的临床应答率（90% vs 60%）。术前CT-SQUEEZ衍生的靶点选择可能是预测接受CRT升级的患者中LV电极导线放置的最佳静脉部位的有价值工具。
Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response. The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar. Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized American Heart Association (AHA) bull’s-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire. Fifteen data sets were evaluable. CT-SQUEEZ–derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%). Preprocedural CT-SQUEEZ–derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.
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