摘要

OBJECTIVES:The aim of this study was to assess acute ablation injuries seen on late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) immediately post-ablation (IPA) and the association with permanent scar 3 months post-ablation (3moPA).
BACKGROUND:Success rates for atrial fibrillation catheter ablation vary significantly, in part because of limited information about the location, extent, and permanence of ablation injury at the time of procedure. Although the amount of scar on LGE MRI months after ablation correlates with procedure outcomes, early imaging predictors of scar remain elusive.
METHODS:Thirty-seven patients presenting for atrial fibrillation ablation underwent high-resolution MRI with a 3-dimensional LGE sequence before ablation, IPA, and 3moPA using a 3-T scanner. The acute left atrial wall injuries on IPA scans were categorized as hyperenhancing (HE) or nonenhancing (NE) and compared with scar 3moPA.
RESULTS:Heterogeneous injuries with HE and NE regions were identified in all patients. Dark NE regions in the left atrial wall on LGE MRI demonstrate findings similar to the "no-reflow" phenomenon. Although the left atrial wall showed similar amounts of HE, NE, and normal tissue IPA (37.7 ± 13%, 34.3 ± 14%, and 28.0 ± 11%, respectively; p = NS), registration of IPA injuries with 3moPA scarring demonstrated that 59.0 ± 19% of scar resulted from NE tissue, 30.6 ± 15% from HE tissue, and 10.4 ± 5% from tissue identified as normal. Paired t-test comparisons were all statistically significant among NE, HE, and normal tissue types (p < 0.001). Arrhythmia recurrence at 1-year follow-up correlated with the degree of wall enhancement 3moPA (p = 0.02).
CONCLUSIONS:Radiofrequency ablation results in heterogeneous injury on LGE MRI with both HE and NE wall lesions. The NE lesions demonstrate no-reflow characteristics and reveal a better predictor of final scar at 3 months. Scar correlates with procedure outcomes, further highlighting the importance of early scar prediction.

译文

目的: 本研究的目的是评估晚期钆增强 (LGE) 磁共振成像 (MRI) 在消融 (IPA) 后立即出现的急性消融损伤以及与消融后 3 个月永久性疤痕 (3 moPA) 的关联。
背景: 心房颤动导管消融的成功率差异很大,部分原因是关于手术时消融损伤的位置、程度和持久性的信息有限。虽然消融后几个月 LGE MRI 上的瘢痕数量与手术结果相关,但瘢痕的早期成像预测因素仍然难以捉摸。
方法: 37 例心房颤动消融患者在消融前接受了具有三维 LGE 序列的高分辨率 MRI,IPA 和使用 3-T 扫描仪的 3mopa。IPA 扫描的急性左心房壁损伤分为高增强 (HE) 或无增强 (NE),并与 scar 3moPA 进行比较。
结果: 所有患者都发现了具有 HE 和 NE 区域的异质损伤。LGE MRI 上左心房壁的暗 NE 区显示类似于 “无复流” 现象的发现。尽管左心房壁显示出相似数量的 HE 、 NE 和正常组织 IPA (分别为 37.7 ± 13% 、 34.3 ± 14% 和 28.0 ± 11%; p = NS), 带有 3mopa 疤痕的 IPA 损伤的登记证明了 59.0 ± 19% 的疤痕是由 NE 组织造成的,30.6 ± 15% 从 HE 组织,和 10.4 ± 5% 从组织鉴定为正常。NE 、 HE 和正常组织类型之间的配对 t检验比较都有统计学意义 (p & lt; 0.001)。随访 1 年时心律失常复发与壁强化程度 3mopa 相关 (p = 0.02)。
结论: 射频消融导致 LGE MRI 上的不均匀损伤,同时伴有 HE 和 NE 壁病变。NE 病变显示无复流特征,并显示 3 个月时最终瘢痕的更好预测因子。瘢痕与手术结果相关,进一步强调早期瘢痕预测的重要性。

No reflow

心血管 心肌灌注 临床研究术语
概述  :  

无复流导致原因在STEMI中,最好理解的原因是血栓与胆固醇碎屑栓塞到远端微血管,但实际上还有很多其它因素参与其中。20世纪70年代就有学者尝试,将狗的冠脉结扎后发现,短时间结扎(<40 min)后解除结扎对下游心肌灌注的影响不大,而长时间结扎(>90 min)后即使解除结扎也会有相当部分的心肌无法恢复灌注,其可能原因是缺血导致微血管内皮损伤肿胀、中性粒细胞阻塞管腔、再灌注损伤与微血管痉挛。由于多种因素共同导致无复流现象的发生,远端血栓与胆固醇栓塞只是其中之一,因此用远端栓塞保护装置来

Reflow 英  [ri'flo]

释义   n. 软熔焊接;页面重排

v. 回熔焊接;重排版

例句   As absorbed water vaporise in reflow, internal cracks and failures may be created.

由于水蒸发吸收的回流,可能会产生内部裂纹和故障。


请扫描右侧二维码,免费查看词汇专业知识背景