切换至 "中华医学电子期刊资源库"

中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (01) : 2 -6. doi: 10.3877/cma.j.issn.2095-6568.2022.01.002

所属专题: 总编推荐

临床研究

高分辨弥散加权成像在心房颤动导管消融围术期无症状脑栓塞发生的评估价值
王学成1, 陈子俊1, 俞娅娅2, 范丰华1, 谢欣1, 吴奕章1, 程典1, 周建1, 余金波1, 李小荣1, 杨兵1,(), 陈明龙3   
  1. 1. 200085 上海,同济大学附属东方医院心内科
    2. 211100 南京,南京医科大学附属江宁医院心内科
    3. 210029 南京,南京医科大学第一附属医院(江苏省人民医院)心血管内科
  • 收稿日期:2022-02-10 出版日期:2022-03-25
  • 通信作者: 杨兵
  • 基金资助:
    上海市浦东新区卫生和健康委员会项目(PW2019D-1); 上海市浦东新区临床高峰学科项目(PWYgf2021-01)

The value of high-resolution diffusion-weighted MRI in the diagnosis of asymptomatic cerebral emboli after atrial fibrillation ablation

Xuecheng Wang1, Zijun Chen1, Yaya Yu2, Fenghua Fan1, Xin Xie1, Yizhang Wu1, Dian Cheng1, Jian Zhou1, Jinbo Yu1, Xiaorong Li1, Bing Yang1,(), Minglong Chen3   

  1. 1. Department of Cardiology, Shanghai East Hospital,Tongji University, Shanghai 200120, China
    2. Department of Cardiology, Nanjing Jiangning Hospital, The Affiliated Hospital of Nanjing Medical University, Nanjing 211100, China
    3. Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
  • Received:2022-02-10 Published:2022-03-25
  • Corresponding author: Bing Yang
引用本文:

王学成, 陈子俊, 俞娅娅, 范丰华, 谢欣, 吴奕章, 程典, 周建, 余金波, 李小荣, 杨兵, 陈明龙. 高分辨弥散加权成像在心房颤动导管消融围术期无症状脑栓塞发生的评估价值[J/OL]. 中华心脏与心律电子杂志, 2022, 10(01): 2-6.

Xuecheng Wang, Zijun Chen, Yaya Yu, Fenghua Fan, Xin Xie, Yizhang Wu, Dian Cheng, Jian Zhou, Jinbo Yu, Xiaorong Li, Bing Yang, Minglong Chen. The value of high-resolution diffusion-weighted MRI in the diagnosis of asymptomatic cerebral emboli after atrial fibrillation ablation[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(01): 2-6.

目的

比较高分辨弥散加权成像(hDWI)和常规DWI(cDWI)检测心房颤动(房颤)导管消融相关无症状性脑栓塞(ACE)的发生率及其特征。

方法

连续入组2018年11月至2018年12月南京医科大学第一附属医院的32例房颤消融患者,以及上海市东方医院2019年1月至2019年2月的18例房颤消融患者。消融前24 h进行头颅高分辨率DWI检查以除外近期脑栓塞事件,消融后48 h内重复hDWI和cDWI检查。比较同一患者消融术后hDWI与cDWI中ACE的发生率、数量、大小和位置。

结果

与cDWI相比,hDWI显示急性ACE的发生率更高(70%对42%,P<0.001),ACE病灶数量明显更多(102对42,P < 0.001),且hDWI测量的病灶尺寸较大(5.42 mm对4.21 mm,P < 0.001)。多因素回归分析显示,左心室射血分数受损(P=0.047)和术中激活凝血时间较低(P=0.003)与ACE发生相关。

结论

hDWI能够更好地显示房颤消融相关ACE的发病情况及病灶特点。在评估ACE的研究中应考虑磁共振设置。

Objective

To compare the incidence and characteristics of atrial fibrillation (AF) ablation-related asymptomatic cerebral emboli(ACE) between high-resolution diffusion-weighted imaging(hDWI) and conventional DWI(cDWI).

Methods

Thirty eight consecutive AF patients in Jiangsu Province Hospital from November 2018 to December 2018, and 18 consecutive AF patients in Shanghai East Hospital from January 2019 to February 2019 who underwent ablation were recruited. All the patients received hDWI, in order to exclude recent events of cerebral embolism. High-resolution DWI and conventional DWI were performed after ablation within 48 h, and the incidence, number, size, and location of ACE in the same patient were compared.

Results

High-resolution DWI showed a higher incidence of acute ACE (70% vs. 42%, P<0.001), a significantly higher number of ACE lesions (102 vs. 42, P<0.001), and a larger ACE size (5.42 mm vs. 4.21 mm, P<0.001) compared to cDWI. Multivariate regression analysis revealed that impaired left ventricular ejection fraction (P=0.012) and low intraoperative active clotting time (P=0.009) were associated with the incidence of ACE.

Conclusion

High-resolution DWI showed higher incidence and greater features of ACE after AF ablation, and MRI settings should be considered in studies evaluating ACE.

表1 心房颤动消融术后基于头颅hDWI的ACE与非ACE患者基线资料比较
表2 消融后头颅cDWI和hDWI的磁共振结果比较[例(%)]
表3 基于头颅hDWI的ACE单变量与多变量回归模型
图1 术中激活血时间预测无症状性栓塞发生的ROC曲线注:ROC为受试者工作特征曲线;AUC为曲线下面积
[1]
Herrera Siklódy C, Deneke T, Hocini M, et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation: comparison of different atrial fibrillation ablation technologies in a multicenter study[J]. J Am Coll Cardiol, 2011, 58(7):681-688.
[2]
Hassell ME, Nijveldt R, Roos YB, et al. Silent cerebral infarcts associated with cardiac disease and procedures[J]. Nat Rev Cardiol, 2013, 10(12):696-706.
[3]
Herm J, Fiebach JB, Koch L, et al. Neuropsychological effects of MRI-detected brain lesions after left atrial catheter ablation for atrial fibrillation: long-term results of the MACPAF study[J]. Circ Arrhythm Electrophysiol, 2013, 6(5):843-850.
[4]
Haeusler KG, Koch L, Herm J, et al. 3 Tesla MRI-detected brain lesions after pulmonary vein isolation for atrial fibrillation: results of the MACPAF study[J]. J Cardiovasc Electrophysiol, 2013, 24(1):14-21.
[5]
Yang B, Jiang C, Lin Y, et al. STABLE-SR (Electrophysiological Substrate Ablation in the Left Atrium During Sinus Rhythm) for the treatment of nonparoxysmal atrial fibrillation: a prospective, multicenter randomized clinical trial [J]. Circ Arrhythm Electrophysiol, 2017, 10(11): e005405.
[6]
Yamatogi S, Furukawa M, Iida E, et al. Evaluation of small ischemic lesions after carotid artery stenting: the usefulness of thin-slice diffusion-weighted MR imaging [J]. Neuroradiology, 2011, 53(4): 255-260.
[7]
Ichiki H, Oketani N, Ishida S, et al. The incidence of asymptomatic cerebral microthromboembolism after atrial fibrillation ablation: comparison of warfarin and dabigatran[J]. Pacing Clin Electrophysiol, 2013, 36(11):1328-1335.
[8]
Verma A, Debruyne P, Nardi S, et al. Evaluation and reduction of asymptomatic cerebral embolism in ablation of atrial fibrillation, but high prevalence of chronic silent infarction: results of the evaluation of reduction of asymptomatic cerebral embolism trial [J]. Circ Arrhythm Electrophysiol, 2013, 6(5): 835-842.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[2] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[3] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[4] 吴少敏, 张世豪, 刘炳光, 李婵, 尹嘉敏, 郑昌业, 黄素然. 胎儿巨大蛛网膜囊肿并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 390-397.
[5] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[6] 刘明辉, 葛方明. MRI 对腹股沟疝修补术后患者早期并发症的评估价值研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 579-583.
[7] 张瑜, 姜梦妮. 基于DWI信号值构建局部进展期胰腺癌放化疗生存获益预测模型[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 657-664.
[8] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[9] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
[10] 姜超, 夏旭东, 王功夏, 何向宇, 王海彬, 李媛. 磁共振DWI及其ADC对乳腺导管原位癌伴微浸润腋窝淋巴结转移的诊断价值[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 234-243.
[11] 黎东城, 陈涛, 李新春, 周嘉璇, 包盈莹, 俞家熙, 万齐. MR 弥散加权成像与HRCT 在肺部病变良恶性鉴别中的诊断效能对比[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 249-253.
[12] 文明, 张丽, 谢芳, 艾克拜尔·艾力, 克力木·阿不都热依木. 构建胃食管反流病患者发生心房颤动的临床预测模型[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(03): 130-136.
[13] 郑屹, 刘莹, 张煜坤, 李广平, 陈康寅, 刘彤. 既往及新发心房颤动对急性心肌梗死患者远期卒中风险的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 406-417.
[14] 金安松, 邹玉松, 刘玖涛, 薛凤麟, 庞爱兰. 孤立性颅内浆细胞瘤一例及相关文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 495-500.
[15] 李芳, 戴西望, 王凯, 郭廷昊, 涂江龙. 非瓣膜性心房颤动相关性卒中的治疗研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 393-397.
阅读次数
全文


摘要