背景:肺静脉(PV)狭窄是房颤射频消融术后的一种罕见但严重的并发症,需要在相对狭窄的治疗干预窗口内进行全面的诊断,包括形态学狭窄分级以及对其功能后果的评估。本研究确定了联合用药的临床实用性,单节心血管磁共振(CMR)成像方案结合肺灌注和PV血管造影评估,用于术前计划和对接受介入性PV狭窄治疗的患者进行随访.
方法:CMR检查(电影成像,动态肺灌注,在对PV狭窄进行介入治疗之前以及随访1天和3个月时,对32例连续患者进行了三维PV血管造影)。在CMR血管造影上目视确定PV狭窄程度;对所有五个肺叶进行了肺灌注成像的视觉和定量分析。
结果:肺静脉狭窄的介入治疗取得了90%的急性手术成功率。视觉评估的肺灌注成像与是否存在≥70%肺静脉狭窄之间的一致性几乎是完美的(Cohen\skappa,0.96)。ROC分析显示定量肺灌注测量对≥70%肺静脉狭窄的检测具有很高的辨别能力(AUC为达到峰值的时间增强,0.96;洗入率,0.93;最大增强,0.90)。定量肺灌注分析证明了非常大的治疗效果,这归因于1天后成功的PV血运重建。
结论:将CMR肺灌注成像整合到肺静脉狭窄患者的临床检查中,可以进行有效的围手术期分层和血运重建成功的随访评估。
BACKGROUND: Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment.
METHODS: CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes.
RESULTS: Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen\'s kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day.
CONCLUSIONS: Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.