New Adjusted Cutoffs for "Normal" Endocardial Voltages in Patients With Post-Infarct LV Remodeling
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
31648735
DOI
10.1016/j.jacep.2019.07.007
PII: S2405-500X(19)30504-3
Knihovny.cz E-zdroje
- Klíčová slova
- electroanatomic mapping, endocardial voltage, fibrosis, scar, ventricular remodeling,
- MeSH
- elektrofyziologické techniky kardiologické * MeSH
- endokard diagnostické zobrazování fyziologie patofyziologie MeSH
- infarkt myokardu komplikace patofyziologie MeSH
- jizva diagnostické zobrazování etiologie patofyziologie MeSH
- katetrizační ablace MeSH
- komorová tachykardie etiologie patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonance kinematografická MeSH
- magnetická rezonanční tomografie MeSH
- referenční hodnoty MeSH
- remodelace komor fyziologie MeSH
- senioři MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVES: This study sought to determine new reference cutoffs for normal unipolar voltage (UV) and bipolar voltage (BV) that would be adjusted for the LV remodeling. BACKGROUND: The definition of "normal" left ventricular (LV) endocardial voltage in patients with post-infarct scar is still lacking. The reference voltage of the noninfarcted myocardium (NIM) may differ between patients depending on LV structural remodeling and the ensuing interstitial fibrosis. METHODS: Electroanatomic voltage mapping was integrated with isotropic late gadolinium-enhanced cardiac magnetic resonance in 15 patients with nonremodeled LV and 12 patients with remodeled LV (end-systolic volume index >50 ml/m2 with ejection fraction <47% assessed by cardiac magnetic resonance). Reference voltages (fifth percentile values) were determined from pooled NIM segments without late gadolinium enhancement. RESULTS: The cutoffs for normal BV and UV were ≥3.0 and ≥6.7 mV for nonremodeled LV and ≥2.1 and ≥6.4 mV for remodeled LV. Endocardial low-voltage area (LVA) defined by the adjusted cutoffs corresponded better to late gadolinium enhancement-detected scar than did LVA defined by uniform cutoffs. In 15 patients who underwent successful ablation of ventricular tachycardia, the LVA contained >97% of targeted evoked delayed potentials. Insights from whole-heart T1 mapping revealed more fibrotic NIM in patients with remodeled LV compared with nonremodeled LV. CONCLUSIONS: This study found substantial differences in endocardial voltage of NIM in post-infarct patients with remodeled versus nonremodeled LV. The new adjusted cutoffs for "normal" BV and UV enable a patient-tailored approach to electroanatomic voltage mapping of LV.
Department of Cardiology Leiden University Medical Center Leiden the Netherlands
Department of Radiology Leiden University Medical Center Leiden the Netherlands
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