title: Three-dimensional contrast-enhanced multidetector CT for anatomic, dynamic, and perfusion characterization of abnormal myocardium to guide ventricular tachycardia ablations.
abstract: BACKGROUND
  Advances in contrast-enhanced multidetector CT enable detailed characterization of the left ventricular myocardium. Myocardial scar and border zone (BZ), as the target of ventricular tachycardia ablations, displays abnormal anatomic, dynamic, and perfusion characteristics during first-pass CT. This study assessed how contrast-enhanced CT can predict voltage-defined scar and BZ and integrate its scar reconstructions into clinical mapping systems to guide ventricular tachycardia ablations.
  
  
  RESULTS
  Eleven patients with ischemic cardiomyopathy underwent contrast-enhanced CT before ventricular tachycardia ablation. Segmental anatomic (end-systolic and end-diastolic wall thickness), dynamic (wall thickening, wall motion), and perfusion (hypoenhancement) characteristics were evaluated. Receiver operating characteristic curves assessed the ability of CT to determine voltage-defined scar and BZ segments. Three-dimensional epi- and endocardial surfaces and scar borders were reconstructed, coregistered, and compared to voltages using a 17-segment model. Abnormal anatomic, dynamic, and perfusion data correlated well with abnormal (<1.5 mV) endocardial voltages (r=0.77). Three-dimensional reconstruction integrated into the clinical mapping system (registration accuracy, 3.31±0.52 mm) allowed prediction of homogenous abnormal voltage (<1.5 mV) in 81.7% of analyzed segments and correctly displayed transmural extent and intramural scar location. CT hypoperfusion correlated best with scar and BZ areas and encompassed curative ablations in 82% cases.
  
  
  CONCLUSIONS
  Anatomic, dynamic, and perfusion imaging using contrast-enhanced CT allows characterization of left ventricular anatomy and 3D scar and BZ substrate. Integration of reconstructed 3D data sets into clinical mapping systems supplements information of voltage mapping and may enable new image approaches for substrate-guided ventricular tachycardia ablation.
authors.affiliation: University of Maryland School of Medicine, Baltimore, MD, USA. jtian@medicine.umaryland.edu
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.forename: Jean
authors.initials: J
authors.lastname: Jeudy
authors.forename: Mark F
authors.initials: MF
authors.lastname: Smith
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jimenez
authors.forename: Xianghua
authors.initials: X
authors.lastname: Yin
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Bruce
authors.forename: Peng
authors.initials: P
authors.lastname: Lei
authors.forename: Aharon
authors.initials: A
authors.lastname: Turgeman
authors.forename: Aharon
authors.initials: A
authors.lastname: Abbo
authors.forename: Raj
authors.initials: R
authors.lastname: Shekhar
authors.forename: Magdi
authors.initials: M
authors.lastname: Saba
authors.forename: Stephen
authors.initials: S
authors.lastname: Shorofsky
authors.forename: Timm
authors.initials: T
authors.lastname: Dickfeld
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media / Q000494:pharmacology*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055420:Perfusion Imaging / Q000379:methods*; D015203:Reproducibility of Results; D017180:Tachycardia, Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media