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首页> 外文期刊>Journal of cardiovascular electrophysiology >Imaging of scar in patients with ventricular arrhythmias of right ventricular origin: cardiac magnetic resonance versus electroanatomic mapping.
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Imaging of scar in patients with ventricular arrhythmias of right ventricular origin: cardiac magnetic resonance versus electroanatomic mapping.

机译：右室起源的室性心律失常患者的瘢痕影像：心脏磁共振与电解剖图。

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INTRODUCTION: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has been shown to reliably detect scars corresponding to different cardiomyopathic substrates. We compared LGE with EAM for the detection of scar in patients with arrhythmias of RV origin. METHODS AND RESULTS: Thirty-one patients with RV arrhythmias and biopsy-proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM-guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false-positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 +/- 16.5% vs 7.9 +/- 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar >/=20% of the RV area was the best cut-off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars <20% of RV area. CONCLUSIONS: LGE is significantly less sensitive than EAM in identifying RV cardiomyopathic substrates. Absence of LGE does not rule out the presence of small scars, and EAM with biopsy should be considered to increase the diagnostic yield.
机译：简介：心脏磁共振检查中晚期late增强（LGE）的评估通常用于检测患有右心室（RV）心律不齐的患者的瘢痕。近来，已显示出电解剖标测图（EAM）能够可靠地检测对应于不同心肌病基质的疤痕。我们将LGE与EAM进行了比较，以检测RV源性心律失常患者的瘢痕。方法和结果：31例RV心律失常​​和活检证实的结构性心脏病（18 ARVC和13心肌炎），以及5例特发性RV流出道心律不齐的患者接受了LGE分析和EAM，并通过EAM指导的心内膜活检证实了疤痕。 EAM疤痕存在于23名（64％）患者（均患有结构性心脏病）中，而LGE仅存在12名（33％）。在2例中，EAM对基底周壁区域的小疤痕提供了假阳性诊断。 LGE在48％的患者中正确诊断出EAM疤痕，从而产生较高的阳性（92％）但较低的阴性（50％）预测值。 LGE的分布与EAM疤痕的分布显着相关（自由壁P <0.001，流出道P = 0.003，后/下壁P = 0.023）。 LGE的存在反映了EAM疤痕的扩展程度更高（RV区域为34.4 +/- 16.5％vs 7.9 +/- 10.1％，P <0.001）。在接受者工作特征（ROC）分析中，疤痕扩展> / = RV区域的20％是检测LGE的最佳临界值（敏感性83％，特异性92％）。值得注意的是，LGE漏诊了11例EAM疤痕小于RV面积20％的患者中的10例（91％）。结论：LGE在鉴定RV心肌病底物方面比EAM敏感。没有LGE并不能排除小疤痕的存在，应考虑活检进行EAM以增加诊断率。

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