Matthew Webber, George Joy, Jonathan Bennett, Fiona Chan, Debbie Falconer, Hunain Shiwani, Rhodri H Davies, Gunther Krausz, Slobodan Tanackovic, Christoph Guger, Pablo Gonzalez, Emma Martin, Andrew Wong, Alicja Rapala, Kenan Direk, Peter Kellman, Iain Pierce, Yoram Rudy, Ramya Vijayakumar, Nishi Chaturvedi, Alun D Hughes, James C Moon, Pier D Lambiase, Xuyuan Tao, Vladan Koncar, Michele Orini, Gabriella Captur
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引用次数: 0
Abstract
Background: Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo.
Methods: CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests.
Results: 77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively).
Conclusion: Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification.
Clinical trial registration: Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.
背景:心电图成像(ECGI)产生电生理(EP)生物标志物,而心血管磁共振(CMR)成像提供心肌结构、功能和组织基质的数据。将这些信息合并到一个检查中是可取的,但需要一个负担得起的、可重用的和高吞吐量的解决方案。因此,我们开发了CMR-ECGI背心,并进行了这项技术开发研究,以评估其在体内的可行性和可重复性。方法:使用本地设计和制造的256导联ECGI背心收集表面电位后,在3T时对参与者进行前瞻性CMR。重建心外膜图,生成局部EP参数,如激活时间(AT)、复极时间(RT)和激活恢复间隔(ARI)。20个观察者内部和观察者之间以及8个扫描-再扫描重复性测试。结果:共招募77名参与者:年轻健康志愿者27名(HV, 38.9±8.5岁,男性35%),老年人50名(77.0±0.1岁,男性52%)。所有参与者使用相同的可重复使用、可清洗的背心,无并发症地实现了CMR-ECGI。观察者内部和观察者之间的变异性较低(单极电图的相关系数[rs]分别为0.99和0.98),扫描再扫描重复性较高(rs在0.81和0.93之间)。与年轻HV相比,老年人的RT (296.8 vs 289.3 ms, p = 0.002)、ARI (249.8 vs 235.1 ms, p = 0.002)和AT、RT和ARI的局部梯度(0.40 vs 0.34 ms/mm, p = 0.01;0.92 vs 0.77 ms/mm, p = 0.03;1.12 vs 0.92 ms/mm, p = 0.01)。结论:我们的高通量CMR-ECGI解决方案是可行的,并且在年轻和老年参与者中具有良好的重现性。这项新技术现在可用于高通量研究,为心律失常的发生提供新的见解,并有可能为更个性化的风险分层铺平道路。临床试验注册:标题:心肌健康的多病生命过程方法——MRC全国健康与发展调查(NSHD) (MyoFit46)的心脏亚研究。国家临床试验(NCT)编号:NCT05455125。URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1。
期刊介绍:
Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to:
New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system.
New methods to enhance or accelerate image acquisition and data analysis.
Results of multicenter, or larger single-center studies that provide insight into the utility of CMR.
Basic biological perceptions derived by CMR methods.