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Wilczek J, Jadczyk T, Wojakowski W, Gołba KS. Left ventricular electrical potential measured by the NOGA XP electromechanical mapping method as a predictor of response to cardiac resynchronization therapy. Front Cardiovasc Med 2023; 10:1107415. [PMID: 37215549 PMCID: PMC10193837 DOI: 10.3389/fcvm.2023.1107415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives The aim of the study was to determine whether left ventricular electrical potential measured by electromechanical mapping with the NOGA XP system has predictive value for response to CRT. Background Approximately 30% of patients who undergo cardiac resynchronization therapy do not see the expected effects. Methods The group of 38 patients qualified for CRT implantation were included in the study, of which 33 patients were analyzed. A 15% reduction in ESV after 6 months of pacing was used as a criterion for a positive response to CRT. The mean value and sum of unipolar and bipolar potentials obtained by mapping with the NOGA XP system and their predictive value in relation to the effect of CRT were analyzed using a bulls-eye projection at three levels: 1) the global value of the left ventricular (LV) potentials, 2) the potentials of the individual LV walls and 3) the mean value of the potentials of the individual segments (basal and middle) of the individual LV walls. Results 24 patients met the criterion of a positive response to CRT vs. 9 non-responders. At the global analysis stage, the independent predictors of favorable response to CRT were the sum of the unipolar potential and bipolar mean potential. In the analysis of individual left ventricular walls, the mean bipolar potential of the anterior and posterior wall and in the unipolar system, mean septal potential was found to be an independent predictor of favorable response to CRT. In the detailed segmental analysis, the independent predictors were the bipolar potential of the mid-posterior wall segment and the basal anterior wall segment. Conclusions Measurement of bipolar and unipolar electrical potentials with the NOGA XP system is a valuable method for predicting a favorable response to CRT.
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Affiliation(s)
- Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
- Electrocardiology Department, Upper Silesian Medical Center, Katowice, Poland
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Third Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland
| | - Krzysztof S. Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
- Electrocardiology Department, Upper Silesian Medical Center, Katowice, Poland
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Lukács E, Magyari B, Tóth L, Petneházy Ö, Petrási Z, Simor T, Gyöngyösi M, Repa I, Koller Á, Rőth E, Horváth IG. Evaluation of experimental myocardial infarction models via electromechanical mapping and magnetic resonance imaging. Can J Physiol Pharmacol 2013; 91:617-24. [DOI: 10.1139/cjpp-2012-0410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The diagnostic characteristics of electromechanical mapping (EMM) were evaluated in porcine myocardial infarction (MI) models with the parallel application of cardiac magnetic resonance imaging (cMRI) from the aspect of different pathophysiology and localization. Balloon occlusion in the left anterior descending coronary artery (LAD balloon group) or coil deployment in the LAD (LAD coil group) or circumflex artery (Cx coil group) was applied percutaneously in 16 domestic pigs. Regional left ventricular viability data were captured via cMRI and EMM. The unipolar voltage (UV) value was significantly decreased in segments containing transmural and subendocardial late enhancement compared with viable segments in the LAD balloon, LAD coil, and Cx coil groups. Receiver operating characteristic analysis revealed area under the curve values of 0.809 and 0.691 in the LAD infarct territory, and 0.864 and 0.855 in the Cx infarct territory for the UV compared with cMRI viability results as transmural late enhancement or viable tissue and subendocardial late enhancement or viable tissue, respectively. In conclusion, the UV value detected the presence of scar tissue with differential transmural extent and which represented proper diagnostic features both in the reperfused and nonreperfused models. This data could provide additional benefit in the clinical use of EMM for diagnostic purposes.
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Affiliation(s)
- Edit Lukács
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Balázs Magyari
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Levente Tóth
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Örs Petneházy
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Zsolt Petrási
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Tamás Simor
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Imre Repa
- Institute of Diagnostic Imaging and Radiation Oncology, University of Kaposvár, Guba Sándor u. 40, Kaposvár, Hungary
| | - Ákos Koller
- Institute of Pathophysiology and Gerontology, Medical School, University of Pécs, Szigeti u. 12, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Ifjúság u. 10, Pécs, Hungary
| | - Erzsébet Rőth
- Department of Surgical Research and Techniques, Medical School, University of Pécs, Kodály Zoltán utca 20, Pécs, Hungary
| | - Iván G. Horváth
- Heart Institute, Medical School, University of Pécs, Ifjúság u. 13, Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, Ifjúság u. 10, Pécs, Hungary
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Hatt CR, Jain AK, Parthasarathy V, Lang A, Raval AN. MRI-3D ultrasound-X-ray image fusion with electromagnetic tracking for transendocardial therapeutic injections: in-vitro validation and in-vivo feasibility. Comput Med Imaging Graph 2013; 37:162-73. [PMID: 23561056 DOI: 10.1016/j.compmedimag.2013.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 11/17/2022]
Abstract
Myocardial infarction (MI) is one of the leading causes of death in the world. Small animal studies have shown that stem-cell therapy offers dramatic functional improvement post-MI. An endomyocardial catheter injection approach to therapeutic agent delivery has been proposed to improve efficacy through increased cell retention. Accurate targeting is critical for reaching areas of greatest therapeutic potential while avoiding a life-threatening myocardial perforation. Multimodal image fusion has been proposed as a way to improve these procedures by augmenting traditional intra-operative imaging modalities with high resolution pre-procedural images. Previous approaches have suffered from a lack of real-time tissue imaging and dependence on X-ray imaging to track devices, leading to increased ionizing radiation dose. In this paper, we present a new image fusion system for catheter-based targeted delivery of therapeutic agents. The system registers real-time 3D echocardiography, magnetic resonance, X-ray, and electromagnetic sensor tracking within a single flexible framework. All system calibrations and registrations were validated and found to have target registration errors less than 5 mm in the worst case. Injection accuracy was validated in a motion enabled cardiac injection phantom, where targeting accuracy ranged from 0.57 to 3.81 mm. Clinical feasibility was demonstrated with in-vivo swine experiments, where injections were successfully made into targeted regions of the heart.
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Affiliation(s)
- Charles R Hatt
- University of Wisconsin - Madison, College of Engineering, Department of Biomedical Engineering, 1415 Engineering Drive, Madison, WI 53706, USA.
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de la Fuente L, Stertzer S, Argentieri J, Peñaloza E, Koziner B, Rouy D, Altman P. Transendocardial autologous bone marrow in myocardial infarction induced heart failure, two-year follow-up in an open-label phase I safety study (the TABMMI study). EUROINTERVENTION 2011; 7:805-12. [DOI: 10.4244/eijv7i7a127] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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