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Association between left ventricular wall-thickness by CT and endocardial voltage potentials in patients with ischemic cardiomyopathy
Session:
Posters (Sessão 6 - Écran 8) - Tomografia Computorizada Cardíaca
Speaker:
Daniel A. Gomes
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Daniel A. Gomes; Gonçalo Cunha; Pedro Freitas; Sara Guerreiro; João Abecasis; Gustavo Rodrigues; Daniel Matos; João Carmo; Pedro Galvão Santos; Francisco Moscoso Costa; Pedro Carmo; Diogo Cavaco; Francisco Belo Morgado; António M. Ferreira; Pedro Adragão
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong>Background</strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Although cardiac magnetic resonance (CMR) is the gold standard for planning ventricular tachycardia (VT) ablation, its accuracy is hindered in patients with cardiac implantable electrical devices (CIEDs). Cardiac computed tomography (CT) has emerged as an alternative for procedure planning in these patients. This pilot study aimed to evaluate the relationship between wall thickness (WT) on CT and voltage of electrical potentials on endocardial electroanatomic mapping (EAM) in patients <span style="color:black">with ischemic cardiomyopathy.</span></span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Methods</span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:black">Single centre retrospective study of consecutive patients with ischemic cardiomyopathy referred for endocardial VT ablation that underwent cardiac CT for procedure planning since 2021. CT images were analysed using ADAS 3D® software, automatically segmenting the left ventricle (LV) into the 17 American Heart Association segments and calculating end-diastolic WT for each one. Standardized views of the segmented LV on ADAS 3D® were used to aid in manual segmentation of the EAM (CARTO3®). For each patient, EAM was interpreted to create 2 different <em>bulls’ eye</em>, according to the presence or absence of bipolar potentials < 0.5mV (dense scar) or < 1.5mV (low voltage). CT images were blindly assessed by an experienced electrophysiologist to identify possible conduction channels and then compared to activation and voltage maps.</span></span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Results</span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:black">Overall, 8 patients were included (aged 67±12 years, 88% male, median LV ejection fraction of 32% [IQR 25-49], and 7 [88%] with a CIED). A total of 136 segments were analysed, 8 of which did not have voltage information. Of the remaining 128, 51 (39.8%) had dense scar and 57 (41.9%) had low voltage. There was a good correlation between mean WT and the presence or absence of both dense scar (area under the curve [AUC] 0.80, p<0.001) and low voltage (AUC 0.84, p<0.001). Cardiac CT images analysis allowed a correct identification of 13 out of 22 conduction channels. In 2 other cases (9%), the location asserted by CT was not confirmed in activation and voltage maps, yielding a sensitivity of 59% (95% CI 36-79%) and positive predictive value of 87% (95% CI 82-90%).</span></span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong><span style="color:black">Conclusion</span></strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><span style="color:black">In patients with ischemic cardiomyopathy undergoing VT ablation, WT measured by CT has a strong correlation with dense scar and low voltage on EAM. Using this information to assert possible conduction channels seems to have suboptimal sensitivity but good positive predictive value. This technique may be useful to plan interventions in patients in whom CMR is not feasible.</span></span></span></p>
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