title: Real-time assessment of myocardial viability in the catheterization laboratory using the intracoronary electrograms recorded by the PTCA guidewire in patients with left ventricular dysfunction: comparison with delayed-enhancement magnetic resonance imaging.
abstract: OBJECTIVE
  This study aimed to determine whether the intracoronary electrograms (IC-EGMs) recorded using a standard percutaneous coronary intervention guidewire could provide myocardial viability information.
  
  
  BACKGROUND
  The revascularization of dysfunctional but viable myocardium may confer prognostic benefits compared with medical therapy in patients with post-ischemic heart failure. However, knowledge of myocardial viability is often unavailable at the time of the procedure.
  
  
  METHODS
  The peak-to-peak voltage of 317 IC-EGMs recordings from 25 patients with a previous myocardial infarction and systolic dysfunction were matched with corresponding delayed-enhancement magnetic resonance imaging sites using a 17-segment model of the left ventricle.
  
  
  RESULTS
  Sixty-seven recordings were obtained from segments classified as complete scar on delayed-enhancement magnetic resonance imaging (group A), 162 from partially viable segments (group B), and 88 from fully viable segments (group C). Three high-pass (HP) filters (0.5, 30, and 100 Hz) were applied to the signals to modulate their spatial resolution. For all filters, the peak-to-peak voltage significantly decreased from group C to group B to group A (p < 0.001 for all comparisons). When receiver-operating characteristic analysis was used to compare nonviable (group A) with viable (group B + C) segments, the optimal discriminating voltages were 4.6, 2.2, and 0.78 mV for, respectively, HP-0.5, HP-30, and HP-100 filters, with a sensitivity of 92%, 94%, and 99% and a specificity of 70%, 79%, and 69%.
  
  
  CONCLUSIONS
  The amplitude of the IC-EGMs discriminates viable from nonviable left ventricular segments. Because this technique is simple and inexpensive and provides real-time results, it is potentially useful to aid decision making in the catheterization laboratory.
authors.affiliation: Cardiologia Interventistica, Ospedale di Busto Arsizio, Busto Arsizio, Italy. Electronic address: epetrucci@aobusto.it.
authors.forename: Ettore
authors.initials: E
authors.lastname: Petrucci
authors.affiliation: Cardiologia Interventistica, Ospedale di Busto Arsizio, Busto Arsizio, Italy.
authors.forename: Vruyr
authors.initials: V
authors.lastname: Balian
authors.affiliation: Ingegneria Clinica, Ospedale di Busto Arsizio, Busto Arsizio, Italy, and Dipartimento di Informatica e Sistemistica, Facoltà di Bioingegneria, Università di Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bocchieri
mesh_terms: D000200:Action Potentials; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D019540:Area Under Curve; D006328:Cardiac Catheterization / Q000295:instrumentation*; D062906:Cardiac Catheters; D016507:Cardiology Service, Hospital; D003287:Contrast Media; D017023:Coronary Angiography; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D013318:Stroke Volume; D014022:Tissue Survival; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media
keywords: angioplasty; electrocardiography; revascularization; viability