Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies
Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies
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DOI：
10.1161/circulationaha.120.046900
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发表时间：
2020-09-29
期刊：
影响因子：
37.8
通讯作者：
Tondo, Claudio
中科院分区：
文献类型：
--
作者：
Casella, Michela;Dello Russo, Antonio;Tondo, Claudio
背景：电解剖电压标测（EVM）是指导心内膜心肌活检（EMB）的一种有前途的方法。然而，很少有数据支持其可行性和安全性。我们现在报告了接受EVM引导的EMBs的最大患者队列，以显示其诊断率，并将其与心脏磁共振（CMR）引导的方法进行比较。方法：我们纳入了2010年至2019年在我们机构接受EMB的162例连续患者。在EVM和CMR确定的病理区域进行EMB。根据EMB结果评价CMR和EVM识别心肌病理底物的敏感性和特异性。结果：术前CMR显示70%的患者出现晚期钆增强，而EVM显示61%的患者出现低电压区域。右心室（73%）、左心室（19%）或双心室（8%）进行采样。EVM的敏感性与CMR相似（74%对77%），特异性分别为70%和47%。在12例经心肌活检证实的心肌病患者中，EVM确定了CMR评估时未检测到的病理区域。合并EVM和CMR的灵敏度高达95%。EMB分析使我们能够在39%的患者中得出与疑似临床诊断不同的新诊断。并发症发生率较低，主要与血管通路相关，没有患者需要紧急处理。结论：EVM被证明是一个有前途的工具，有针对性的EMB，因为它的敏感性和特异性的识别心肌病理底物。EVM被证明具有与CMR相似的准确性。EVM和CMR共同赋予EMB的阳性预测值为89%。
Background: Electroanatomic voltage mapping (EVM) is a promising modality for guiding endomyocardial biopsies (EMBs). However, few data support its feasibility and safety. We now report the largest cohort of patients undergoing EVM-guided EMBs to show its diagnostic yield and to compare it with a cardiac magnetic resonance (CMR)-guided approach. Methods: We included 162 consecutive patients undergoing EMB at our institution from 2010 to 2019. EMB was performed in pathological areas identified at EVM and CMR. CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated according to EMB results. Results: Preoperative CMR showed late gadolinium enhancement in 70% of the patients, whereas EVM identified areas of low voltage in 61%. Right (73%), left (19%), or both ventricles (8%) underwent sampling. EVM proved to have sensitivity similar to CMR (74% versus 77%), with specificity being 70% and 47%, respectively. In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas that had been undetected at CMR evaluation. Sensitivity of pooled EVM and CMR was as high as 95%. EMB analysis allowed us to reach a new diagnosis, different from the suspected clinical diagnosis, in 39% of patients. The complications rate was low, mostly related to vascular access, with no patients requiring urgent management. Conclusions: EVM proved to be a promising tool for targeted EMB because of its sensitivity and specificity for identification of myocardial pathological substrates. EVM was demonstrated to have accuracy similar to CMR. EVM and CMR together conferred a positive predictive value of 89% on EMB.