延迟增强磁共振成像和三维电解剖标测系统对房颤患者射频消融术前心肌纤维化评估的应用比较

Comparison of the application of LGE-MRI and CARTO in the evaluation of myocardial fibrosis before radiofrequency ablation for patients with atrial fibrillation

目的:探讨延迟增强-磁共振成像(LGE-MRI)和三维电解剖标测(CARTO)系统检查在房颤患者射频消融术前心肌纤维化分级评估中的价值。方法:选取医院收治并接受射频消融术的80例房颤患者,所有患者均行LGE-MRI和CARTO检查,采用Kappa检验比较二者在评价心肌纤维化分级中的一致性;房颤患者接受射频消融术后随访观察1年,观察分析患者复发情况。结果:房颤患者经LGE-MRI图像心肌纤维化分级显示0级26例,I级17例,Ⅱ级18例,Ⅲ级19例;CARTO图像显示0级26例、I级15例、Ⅱ级19例、Ⅲ级20例,LGE-MRI图像与CARTO图像心肌纤维化分级间一致性较高(Kappa=0.781,P<0.05)。心肌纤维化分级时LGE-MRI与CARTO一致分级67例,一致率为83.75%。LGE-MRI分级及CARTO分级中,左心房心肌纤维化分级高的房颤患者射频消融术后1年复发率均高于左心房心肌纤维化分级低的患者,差异有统计学意义(x^(2)=12.638,x^(2)=19.909;P<0.05)。结论:LGE-MRI与CARTO检查在评估左心房心肌纤维化分级时一致性较高,且心肌纤维化分级高的患者射频消融术后1年复发率高于心肌纤维化分级低的患者,LGE-MRI与CARTO检查对手术治疗及术后护理有重要的指导意义。

Objective:To explore the value of late gadolinium enhancement-magnetic resonance imaging(LGE-MRI)and three-dimensional electroanatomical mapping under CARTO system(CARTO) in the evaluation of myocardial fibrosis grade before radiofrequency ablation in patients with atrial fibrillation.Methods:From March 2017 to April2020,80 patients with atrial fibrillation who were admitted to our hospital and received radiofrequency ablation were selected as research objects For all patients underwent LGE-MRI and CARTO examinations,Kappa test was used to compare the consistency of evaluating myocardial fibrosis grading;patients with atrial fibrillation were followed up for 1 year after radiofrequency ablation,and the recurrence of the patients was recorded.Results:LGE-MRI images showed the grades of myocardial fibrosis in patients with atrial fibrillation,which were 26 cases of grade 0,17 cases of grade Ⅰ,18 cases of grade Ⅱ,and 19 cases of grade Ⅲ;CARTO images showed that there were 26 cases of grade0,15 cases of grade I,19 cases of grade Ⅱ,and 20 cases of grade Ⅲ,the LGE-MRI image and CARTO image had a higher consistency in the myocardial fibrosis grading(Kappa value=0.781,P<0.05).In myocardial fibrosis grading,67 cases were graded consistently between LGE-MRI and CARTO,and 13 cases were graded inconsistently,which the consistency rate was 83.75%.In LGE-MRI grading and CARTO grading,the recurrence rate of AF patients with high left atrial myocardial fibrosis grade was higher than that of patients with low left atrial myocardial fibrosis grade at 1 year after radiofrequency ablation.The differences were statistically significant(χ^(2)=12.63,χ^(2)=19.909,P<0.05).Conclusion:LGE-MRI and CARTO have a higher consistency in evaluating left atrial myocardial fibrosis grading,and patients with high myocardial fibrosis grade have a higher recurrence rate than patients with low myocardial fibrosis grade at 1 year after radiofrequency ablation.Both of LGE-MRI and CARTO examination have important guiding significance for surgical treatment and postoperative care.