Optimal Threshold and Interpatient Variability in Left Atrial Ablation Scar Assessment by Dark-Blood LGE CMR

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2024-10-01 DOI:10.1016/j.jacep.2024.05.017

Geertruida Petronella Bijvoet MD, PhD , Ben J.M. Hermans PhD , Dominik Linz MD, PhD , Justin G.L.M. Luermans MD, PhD , Bart Maesen MD, PhD , Robin Nijveldt MD, PhD , Casper Mihl MD, PhD , Kevin Vernooy MD, PhD , Joachim E. Wildberger MD, PhD , Rob J. Holtackers PhD , Ulrich Schotten MD, PhD , Sevasti-Maria Chaldoupi MD, PhD

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引用次数: 0

Abstract

Background

Dark-blood late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) has better correlation with bipolar voltage (BiV) to define ablation scar in the left atrium (LA) compared to conventional bright-blood LGE CMR.

Objectives

This study sought to determine the optimal signal intensity threshold of dark-blood LGE CMR to identify LA ablation scar.

Methods

In 54 patients scheduled for atrial fibrillation ablation, image intensity ratios (IIRs) were derived from preprocedural dark-blood LGE CMR. In 26 patients without previous ablation, the upper limit of normal was derived from the 95th and 98th percentiles of pooled IIR values. In 28 patients with previous atrial fibrillation ablation, BiV was compared with the corresponding IIR. Receiver-operating characteristics analyses were employed to determine the optimal IIR threshold (ie, the point with the smallest distance to the upper left corner of the receiver-operating characteristics) for LA ablation scar (BiV ≤0.15 mV).

Results

Upper limit of normal corresponded to IIR values 1.16 and 1.21, yielding low sensitivities of 0.32 and 0.09 to detect LA ablation scar. Receiver-operating characteristics analysis of IIR and BiV comparison achieved a median area under the curve of 0.77. Median optimal IIR threshold for LA ablation scar was 1.09, with an average sensitivity of 0.73, specificity of 0.75, and accuracy of 0.71. Median IIR thresholds of 1.00 and 1.10 corresponded to 80% sensitivity and 80% specificity, respectively. There was considerable interpatient variability: optimal IIR thresholds per patient ranged from 1.01 to 1.22.

Conclusions

The optimal IIR threshold to identify LA ablation scar by dark-blood LGE CMR is 1.09. Because of interpatient variability, the investigators recommend using a lower (1.00) and upper (1.10) threshold to prevent over- or underestimation of ablation scar.

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通过暗血 LGE CMR 评估左心房消融瘢痕的最佳阈值和患者间变异性

背景：与传统的亮血 LGE CMR 相比，暗血晚期钆增强（LGE）心脏磁共振（CMR）与双极电压（BiV）在确定左心房（LA）消融瘢痕方面具有更好的相关性：本研究旨在确定暗血 LGE CMR 识别 LA 消融瘢痕的最佳信号强度阈值：方法：在 54 名计划接受心房颤动消融术的患者中，通过术前暗血 LGE CMR 得出图像强度比 (IIR)。在 26 名既往未接受过消融术的患者中，正常值的上限来自于综合 IIR 值的第 95 和第 98 百分位数。在 28 位既往接受过心房颤动消融术的患者中，BiV 与相应的 IIR 进行了比较。采用接收器操作特征分析确定 LA 消融瘢痕的最佳 IIR 阈值（即与接收器操作特征左上角距离最小的点）（BiV ≤0.15 mV）：正常值上限对应的 IIR 值为 1.16 和 1.21，检测 LA 消融瘢痕的灵敏度较低，分别为 0.32 和 0.09。对 IIR 和 BiV 比较进行的接收方操作特征分析得出的中位曲线下面积为 0.77。检测 LA 消融瘢痕的最佳 IIR 阈值中位数为 1.09，平均灵敏度为 0.73，特异度为 0.75，准确度为 0.71。中位 IIR 阈值 1.00 和 1.10 分别对应 80% 的灵敏度和 80% 的特异性。患者之间的差异很大：每位患者的最佳 IIR 阈值从 1.01 到 1.22 不等：结论：通过暗血 LGE CMR 识别 LA 消融瘢痕的最佳 IIR 阈值为 1.09。由于患者之间存在差异，研究者建议使用较低（1.00）和较高（1.10）的阈值，以防止过高或过低估计消融瘢痕。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.