Naohiko Sahara, Yasutoshi Shinoda, Beeletsega Yeneneh, Philip Gideon, Michael F Morris, Praneeth Katrapati, Nathaniel Shatz, Rong Bai, Jake Martinez, Yu Liao, Dalise Yi Shatz, Michael S Zawaneh, Wilber Su, J Peter Weiss, Roderick Tung
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We hypothesized that wall thinning detected with intracardiac echocardiography (ICE) can identify periaortic arrhythmogenic substrate (PAS) in patients with structural heart disease.</p><p><strong>Objectives: </strong>This study sought to validate a new method of identifying PAS using ICE in comparison with electro-anatomic mapping and cardiac magnetic resonance (CMR).</p><p><strong>Methods: </strong>A total of 84 VT ablation patients were analyzed (87% male, median age 72 years [Q1-Q3: 63-75 years], 61% with nonischemic cardiomyopathy) and categorized into 2 groups: PAS+ (n = 29) and PAS- (n = 55) based on voltage-defined scar and deceleration zones. Wall thickness of the basal anterior septum was measured by ICE and CMR at a standardized distance from the left ventricular ostium in diastole by an independent core lab. In 43 patients with CMR, correlation with late gadolinium enhancement (LGE) in the basal anterior septum was also assessed.</p><p><strong>Results: </strong>A significant difference in wall thickness measured at 1 cm from the left ventricular ostium with ICE was observed between PAS+ and PAS- patients (0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm]; P < 0.001). Wall thickness by ICE had higher diagnostic performance than CMR, with only 50% of PAS+ patients exhibiting LGE. At a cutoff of <0.60 cm, the sensitivity and specificity of ICE predicting PAS+ were 58% and 87% (positive predictive value 71%, negative predictive value 80%) in comparison with 50% and 84% (positive predictive value 69%, negative predictive value 70%) with CMR-LGE, respectively.</p><p><strong>Conclusions: </strong>ICE-detected wall thinning may be a novel imaging technique to identify arrhythmogenic periaortic VT substrate in this challenging anatomic region, which often eludes diagnosis with CMR. 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In 43 patients with CMR, correlation with late gadolinium enhancement (LGE) in the basal anterior septum was also assessed.</p><p><strong>Results: </strong>A significant difference in wall thickness measured at 1 cm from the left ventricular ostium with ICE was observed between PAS+ and PAS- patients (0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm]; P < 0.001). Wall thickness by ICE had higher diagnostic performance than CMR, with only 50% of PAS+ patients exhibiting LGE. At a cutoff of <0.60 cm, the sensitivity and specificity of ICE predicting PAS+ were 58% and 87% (positive predictive value 71%, negative predictive value 80%) in comparison with 50% and 84% (positive predictive value 69%, negative predictive value 70%) with CMR-LGE, respectively.</p><p><strong>Conclusions: </strong>ICE-detected wall thinning may be a novel imaging technique to identify arrhythmogenic periaortic VT substrate in this challenging anatomic region, which often eludes diagnosis with CMR. 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引用次数: 0
摘要
背景：腹主动脉周围瘢痕是室性心动过速（VT）消融的一种日益普遍和具有挑战性的基底，目前尚无成熟的成像技术来检测和诊断腹主动脉周围瘢痕。我们假设心内超声心动图（ICE）检测到的壁变薄可以识别结构性心脏病患者的主动脉周围致心律失常底物（PAS）。目的：本研究旨在验证一种使用ICE识别PAS的新方法，并与电解剖测绘和心脏磁共振（CMR）进行比较。方法：对84例VT消融患者进行分析（87%为男性，中位年龄72岁[Q1-Q3: 63-75岁]，61%为非缺血性心肌病），并根据电压定义的疤痕和减速区分为PAS+ (n = 29)和PAS- (n = 55)两组。基底前隔壁厚度由独立的核心实验室在离左室舒张期口的标准距离上通过ICE和CMR测量。在43例CMR患者中，还评估了基底前隔晚期钆增强（LGE）的相关性。结果：PAS+和PAS-患者在距左室口1cm处的ICE壁厚有显著差异（0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm], P < 0.001）。ICE的壁厚比CMR有更高的诊断效能，只有50%的PAS+患者表现出LGE。结论：ice检测壁变薄可能是一种新的成像技术，可以在这一具有挑战性的解剖区域识别致心律失常的主动脉周围VT底物，这通常无法通过CMR诊断。CMR上没有LGE并不排除有流出道VT的患者存在主动脉周围底物。
Intracardiac Echocardiography for the Detection of Arrhythmogenic Periaortic Ventricular Tachycardia Substrate: Multimodality Core Lab Analysis.
Background: There is no established imaging technique to detect and diagnose periaortic scar, an increasingly prevalent and challenging substrate referred for ventricular tachycardia (VT) ablation. We hypothesized that wall thinning detected with intracardiac echocardiography (ICE) can identify periaortic arrhythmogenic substrate (PAS) in patients with structural heart disease.
Objectives: This study sought to validate a new method of identifying PAS using ICE in comparison with electro-anatomic mapping and cardiac magnetic resonance (CMR).
Methods: A total of 84 VT ablation patients were analyzed (87% male, median age 72 years [Q1-Q3: 63-75 years], 61% with nonischemic cardiomyopathy) and categorized into 2 groups: PAS+ (n = 29) and PAS- (n = 55) based on voltage-defined scar and deceleration zones. Wall thickness of the basal anterior septum was measured by ICE and CMR at a standardized distance from the left ventricular ostium in diastole by an independent core lab. In 43 patients with CMR, correlation with late gadolinium enhancement (LGE) in the basal anterior septum was also assessed.
Results: A significant difference in wall thickness measured at 1 cm from the left ventricular ostium with ICE was observed between PAS+ and PAS- patients (0.57 cm [Q1-Q3: 0.51-0.65 cm] vs 0.72 cm [Q1-Q3: 0.65-0.79 cm]; P < 0.001). Wall thickness by ICE had higher diagnostic performance than CMR, with only 50% of PAS+ patients exhibiting LGE. At a cutoff of <0.60 cm, the sensitivity and specificity of ICE predicting PAS+ were 58% and 87% (positive predictive value 71%, negative predictive value 80%) in comparison with 50% and 84% (positive predictive value 69%, negative predictive value 70%) with CMR-LGE, respectively.
Conclusions: ICE-detected wall thinning may be a novel imaging technique to identify arrhythmogenic periaortic VT substrate in this challenging anatomic region, which often eludes diagnosis with CMR. The absence of LGE on CMR does not rule out the presence of periaortic substrate in patients presenting with outflow tract VT.
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.
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