基于心脏磁共振的室间隔瘢痕对左束支起搏导线植入的影响  

Effect of ventricular septal scar on left bundle branch pacing based on cardiac magnetic scan

作　　者：王垚 朱晓梅 钱智勇 高越 曾嘉欣 秦朝彤 薛思源 侯小锋 徐怡 邹建刚 Wang Yao;Zhu Xiaomei;Qian Zhiyong;Gao Yue;Zeng Jiaxin;Qin Chaotong;Xue Siyuan;Hou Xiaofeng;Xu Yi;Zou Jiangang(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China;Department of Radiology,The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital),Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)心血管内科,南京210029 [2]南京医科大学第一附属医院(江苏省人民医院)放射科,南京210029

出　　处：《中华心律失常学杂志》2023年第5期406-412,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(82070521);江苏省财政厅新技术专项(JX233C202103);江苏省人民医院临床能力提升工程项目(JSPH-MA-2020-3,JSPH-MA-2022-2,JSPH-MB-2022-11)。

摘　　要：目的通过分析心脏磁共振探讨室间隔瘢痕对左束支起搏(LBBP)植入的影响。方法本文为回顾性研究。选取2019年8月至2023年2月在南京医科大学第一附属医院心血管内科接受LBBP且术前完成心脏磁共振扫描患者。采用受试者工作特征曲线评估室间隔延迟钆增强(LGE)负荷及室间隔瘢痕得分(SSS)诊断LBBP成功的敏感度和特异度。以室间隔LGE负荷及SSS为自变量,LBBP成功为因变量,进行单因素二元Logistic回归分析。采用Spearman相关系数检验室间隔LGE负荷及SSS与LBBP各参数的相关性。结果纳入52例患者,其中女18例,年龄(63±13)岁;成功实现LBBP患者44例(84.6%,44/52),LBBP成功的患者室间隔LGE负荷[4.00(1.25,8.00)%对13.00(5.00,26.00)%,P=0.015]和SSS[(0.80±0.41)分对(1.13±0.24)分,P=0.034]更低。采用7.50%为室间隔LGE负荷的截断值,其诊断LBBP成功的敏感度为75.0%,特异度为72.7%,阳性预测值为94.1%。采用1.10为SSS的截断值,其诊断LBBP成功的敏感度为62.5%,特异度为88.6%,阳性预测值为92.9%。高室间隔LGE负荷与LBBP成功率降低相关(Wald=5.535,OR=0.125,P=0.019);高SSS与LBBP成功率降低相关(Wald=8.668,OR=0.077,P=0.003)。结论室间隔瘢痕能够有效地预测左束支导线的植入成功率,瘢痕负荷低的患者植入成功率更高。ObjectiveTo investigate the effect of ventricular septal scar on left bundle branch pacing(LBBP)implantation by analyzing the results of cardiac magnetic scan.MethodsPatients who intended to receive LBBP in the Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University from August 2019 to February 2023 were enrolled,and cardiac MRI scan was completed before surgery.Receiver operating characteristic curve(ROC)was used to evaluate the sensitivity and specificity of ventricular septal late-gadolinium-enhancement(LGE)and ventricular septal scar score(SSS)to diagnose the success of LBBP.With ventricular septal LGE load and SSS as independent variables and LBBP success as dependent variables,univariate binary Logistic regression analysis was performed.Spearman correlation coefficient was used to examine the correlation between ventricular septal LGE load,SSS and LBBP parameters.ResultsFifty-two patients were included in the study,including 18 females,aged(63±13)years.LBBP was successfully achieved in 44 patients(84.6%,44/52).The LGE load[4.00(1.25,8.00)%vs.13.00(5.00,26.00)%,P=0.015]and SSS[(0.80±0.41)scores vs.(1.13±0.24)scores,P=0.034]of interventricular septum were smaller in patients with LBBP.Using 7.50%as the cut-off value of LGE load in the interventricular septum,the sensitivity,specificity and positive predictive value of the successful of LBBP were 75.0%,72.7%and 94.1%,respectively.Using 1.10 as the cut-off value of SSS,the sensitivity,specificity and positive predictive value of successful of LBBP were 62.5%,88.6%and 92.9%,respectively.High ventricular septal LGE load was associated with lower LBBP success rate(Wald=5.535,OR=0.125,P=0.019).High SSS was associated with lower LBBP success rates(Wald=8.668,OR=0.077,P=0.003).ConclusionVentricular septal scar can effectively predict the success rate of LBBP,and the success rate of implantation is higher in patients with less scar load.

关 键 词：磁共振成像 左束支起搏 室间隔瘢痕得分 延迟钆增强 心脏磁共振 

分 类 号：R445.2[医药卫生—影像医学与核医学] R54[医药卫生—诊断学]