Scar Tissue Characterization to Predict Arrhythmia Recurrence in Patients Undergoing Ventricular Tachycardia Ablation: Cardiac Computed Tomography Compared with Cardiac Magnetic Resonance

Oskar Galuszka,Samuel Baldinger,Thomas Kueffer,Antonio Madaffari,Gregor Thalmann,Martina Boscolo, Christoph Greg,Hildegard Tanner,Laurent Roten,Tobias Reichlin

Journal of Hepatology（2024）SCI 1区

Inselspital Univ Hosp Bern

Cited 0|Views12

Abstract

Abstract Background The role of imaging in evaluating patients undergoing ventricular tachycardia (VT) ablation is crucial for planning, procedural success, and clinical outcomes. In daily practice, cardiac computed tomography (CCT) assessing wall thinning and late iodine uptake (LI) and cardiac magnetic resonance (CMR) assessing late-gadolinium enhancement (LGE) are most commonly implemented. However, data comparing the two imaging modalities for scar tissue characterization is scarce. Aims To compare the performance of both imaging modalities for scar tissue characterization in ischemic (ICM) and non-ischemic (NICM) patients undergoing VT ablation and predict procedural outcomes. Methods In a retrospective analysis, consecutive patients undergoing both CCT and LGE-CMR before scheduled VT ablation were included. The presence and extent of scar was assessed by means of each imaging modality using dedicated softwares (MUSIC and ADAS). To compare scar distribution and agreement between the two modalities, a scar classification scheme was used for all 17 AHA segments: 0 points (no scar present), 1 point (scar <50% of total segment area), 2 points (scar representing 50-99% of total segment area) or 3 points (scar present in 100% of the segment area).<scar<100%)><scar<100%> Results 36 patients (67±10 years; 97% male; LVEF 39±10%; 72% ischemic) undergoing CCT and LGE-CMR before scheduled VT ablation were included. In the ICM group, mean detected scar burden was higher than in the NICM group on LGE-CMR (total volume: 62.3±32.9g vs. 32.8±9.5g, p<0.001), using wall thinning model (WT)(mean scar area 69.0±45.6 cm2 vs. 23.4±23.6cm2, p=0.005) as well as LI (dense scar area: 39.2±28.1 cm2 vs. 11.0±6.3 cm2 , p=0.005). The absolute score difference per segment and patient between CCT and LGE-CMR was calculated and summed for all patients divided by the number of patients. Differences were more pronounced for NICM compared to ICM and LGE-CMR showed better concordance to LI than WT in both NICMP and ICM (Figure). Total procedure time was 205±68 min (ablation time 28±16 min; fluoroscopy time 15 ± 12 min). During a follow-up period of 19±7 months, 87 sustained VT episodes in 12 patients (33%) were documented. Three patients (8%) underwent a second VT ablation and one patient (3%) died during follow-up. In ICM, total scar volume on LGE-CMR and scar area on LI showed numerically higher predictive value for VT recurrence than total scar area by means of WT (AUC: LGE 0.76, LI 0.78 and WT 0.65 respectively), while in NICM scar characterization by means of WT yielded higher performance to predict VT recurrence than LI or LGE-CMR (AUC: LGE 0.67, LI 0.58, WT 0.83 respectively). Conclusions In patients undergoing VT ablation, both LGE-CMR and CCT are valuable for scar tissue characterization. Late iodine uptake on CCT showed a high concordance with LGE-CMR in both NICM and ICM.</scar<100%></scar<100%)>

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【要点】：本研究通过比较心脏计算机断层扫描(CCT)与心脏磁共振(CMR)在缺血性和非缺血性患者中进行室性心动过速消融术前疤痕组织特征化的表现，发现两种成像方式均具有价值，且CCT的碘摄取与CMR的延迟钆增强具有较高一致性，有助于预测消融术后心律失常的复发。

【方法】：采用回顾性分析，对连续接受CCT和LGE-CMR检查的患者数据进行研究，使用专门软件(MUSIC和ADAS)评估每种成像方式下疤痕的存在和范围。

【实验】：共纳入36名患者，在VT消融术前接受CCT和LGE-CMR检查。通过比较两种成像方式在17个AHA节段的疤痕分布和一致性，计算每种成像方式下疤痕的得分差异。随访期间，记录VT复发情况，并通过ROC曲线分析比较不同成像方式对VT复发的预测价值。结果显示，LGE-CMR和CCT在疤痕特征化方面均有价值，碘摄取与延迟钆增强一致性高，且在预测VT复发方面各有优势。