Agreement between gadolinium-enhanced cardiac magnetic resonance and electro-anatomical maps in patients with non-ischaemic dilated cardiomyopathy and ventricular arrhythmias

EP Europace ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1392-1399
Author(s):  
Federica Torri ◽  
Csilla Czimbalmos ◽  
Livio Bertagnolli ◽  
Sabrina Oebel ◽  
Andreas Bollmann ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Ventricular Arrhythmias ◽  
Low Voltage ◽  
Gadolinium Enhancement ◽  
Lge Cmr ◽  
Good Agreement

Abstract Aims We sought to investigate the overlap between late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and electro-anatomical maps (EAM) of patients with non-ischaemic dilated cardiomyopathy (NIDCM) and how it relates with the outcomes after catheter ablation of ventricular arrhythmias (VA). Methods and results We identified 50 patients with NIDCM who received CMR and ablation for VA. Late gadolinium enhancement was detected in 16 (32%) patients, mostly in those presenting with sustained ventricular tachycardia (VT): 15 patients. Low-voltage areas (<1.5 mV) were observed in 23 (46%) cases; in 7 (14%) cases without evidence of LGE. Using a threshold of 1.5 mV, a good and partially good agreement between the bipolar EAM and LGE-CMR was observed in only 4 (8%) and 9 (18%) patients, respectively. With further adjustments of EAM to match the LGE, we defined new cut-off limits of median 1.5 and 5 mV for bipolar and unipolar maps, respectively. Most VT exits (12 out of 16 patients) were found in areas with LGE. VT exits were found in segments without LGE in two patients with VT recurrence as well as in two patients without recurrence, P = 0.77. In patients with VT recurrence, the LGE volume was significantly larger than in those without recurrence: 12% ± 5.8% vs. 6.9% ± 3.4%; P = 0.049. Conclusions In NIDCM, the agreement between LGE and bipolar EAM was fairly poor but can be improved with adjustment of the thresholds for EAM according to the amount of LGE. The outcomes were related to the volume of LGE.

Arrhythmogenic substrate detection in chronic ischaemic patients undergoing ventricular tachycardia ablation using multidetector cardiac computed tomography: compared evaluation with cardiac magnetic resonance

EP Europace ◽  
2020 ◽  
Author(s):  
Beatriz Jáuregui ◽  
David Soto-Iglesias ◽  
Giulio Zucchelli ◽  
Diego Penela ◽  
Augusto Ordóñez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Cardiac Computed Tomography ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Arrhythmogenic Substrate ◽  
Lge Cmr

Abstract Aims Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterizing ischaemic scars, detecting heterogeneous tissue channels (HTCs) which constitute the arrhythmogenic substrate (AS). Late gadolinium enhancement cardiac magnetic resonance also improves the arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation. However, its availability may be limited. We sought to evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying HTCs detected by LGE-CMR in ischaemic patients undergoing VT substrate ablation. Methods and results Thirty ischaemic patients undergoing both LGE-CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to LGE-CMR or MDCT analysis, characterized the presence of CMR and computed tomography (CT) channels, respectively. Cardiac magnetic resonance channels were classified as endocardial (layers &lt; 50%), epicardial (layers ≥ 50%), or transmural. Cardiac magnetic resonance- vs. CT-channel concordance was considered when showing the same orientation and American Heart Association (AHA) segment. Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction was 35 ± 10%. All patients had CMR channels (n = 76), whereas only 26/30 (86.7%) had CT channels (n = 91). Global sensitivity (Se) and positive predictive values for detecting CMR channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR channels (Se 80.5%) and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial myocardial infarction (MI), MDCT was unable to identify the AS. Conclusions Compared to LGE-CMR, myocardial wall thickness assessment using MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI, showing modest sensitivity identifying HTCs but a better performance in patients with transmural scars.

P1016Correlation between cardiac magnetic resonance-late gadolinium enhancement and electro-anatomical map for right atrium

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Gunturiz Beltran ◽  
R Borras-Amoraga ◽  
F Alarcon ◽  
P Garre ◽  
R Figueras ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Right Atrium ◽  
Healthy Tissue ◽  
Gadolinium Enhancement ◽  
Fibrotic Tissue ◽  
Bipolar Voltage ◽  
The Right ◽  
Lge Cmr

Abstract Funding Acknowledgements none Background  Electroanatomical map (EAM) detects areas of low voltage as a surrogated marker of fibrosis areas, being the reference technique for its detection. Cardiac magnetic resonance with Late Gadolinium enhancement (CMR-LGE) allows non-invasive detection of atrial fibrotic areas. CMR-LGE studies have focused on the left atrium since now. Purpose We need to validate this test to extend its use to the right atrium (RA), since it is involved in the arrhythmogenic substrate of several arrhythmias, and probably also in atrial fibrillation (AF). Methods  Prospective observational study. Fifteen patients undergoing a first AF ablation procedure were included. All patients had a pre-procedural LGE-CMR performed. The blood pool-normalized intensity signal (image intensity ratio-IIR) was calculated for the right atrial wall, and values projected in a shell. IIR values validated for the left atrium were used to identify dense and intermediate fibrosis, and healthy tissue (&gt;1.32, 1.2-1.32, &lt;1.2, respectively). During the procedure but before ablation, a point-by-point high density EA bipolar voltage map of RA was obtained with a multipolar catheter. Standard voltage thresholds of 0,1 mV and 0,5 mV were used to characterize fibrotic and healthy tissue in EAM. For each RA, the EAM was projected into the IIR shell, and the correlation between bipolar voltage and normalized IIR values for each shell point was quantified. Then, we also obtained its concordance (categorical variables) according to the label automatically assigned by EAM/CMR with the pre-set thresholds: healthy tissue/ intermediate fibrosis/dense fibrosis. Results  A total of 8,830 points were obtained, mean per patient 588 (± 509) points. A global weak negative correlation was found between the EA bipolar voltage map (EAM) and IIR (CMR) (r= -0.16, p &lt; 0.0001)(figure). LGE-CMR identified more healthy tissue than EAM (81.0% vs 60.6% respectively), then CMR underestimated the fibrotic tissue in RA. Finally, we analyzed the concordance and we obtained that the degree of accuracy between both measurements was 55.7%. Conclusion  There was an inverse correlation between the bipolar voltage EAM and IIR (CMR) of low grade but with statistical significance. CMR underestimated fibrotic tissue in RA with respect to its identification by EAM. Abstract Figure. Correlation between bipolar voltage-IIR

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