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Evaluation of global left ventricular function assessment of non-fluorescent electromechanical endocardial mapping compared with biplane left ventricular contrast angiography
Auteurs:
E-S Tan, P. A. Van der Vleuten, G. A. J. Jessurun, R. A. Tio, F. Zijlstra, I. C. Van Gelder
Prognosis after ST-elevation myocardial infarction (STEMI) is closely related to cardiac volumes, myocardial mass and global left ventricular (LV) function, expressed as left ventricular ejection fraction (LVEF).1 Accurate assessment of these parameters is required for the prediction of prognosis in individual patients as well as in entire cohorts.2-4 The introduction of primary percutaneous intervention (PCI) for STEMI has been proven to increase LV rest function in this patient category. However, some patients suffer from symptoms of heart failure as a result of post-infarct deterioration of left ventricular function. One strategy to improve left ventricular function after reperfusion therapy is bone marrow-derived progenitor cell infusion.5-7 The optimal route of delivery is still under debate.8,9 Commercially available non-fluoroscopic electromechanical endocardial mapping systems (EEM) that measure both wall motion and electrical activity can aid the interventional cardiologist by providing on-line anatomical and functional information without excessive radiation exposure. In addition, these systems can be fitted with dedicated (cell) injection catheters. This technique has proved to be safe and feasible both in the cell- and gene-delivery setting.5,10-12 It was hypothesised that besides facilitating cell delivery, the generated maps could provide global LV function assessment, which can be used to measure efficacy of the applied therapy. Since EEM is being used ever more frequently in clinical practice, it is increasingly relevant to assess its diagnostic accuracy for analysis of global LV function parameters. Although there have been many studies focusing on the differentiation between viable and non-viable myocardium, to date only a few studies focusing on the diagnostic accuracy of EEM for assessment of global LV function have been published.13,14 Therefore, we sought to investigate the diagnostic accuracy of EEM in a cohort of post-STEMI patients undergoing routine cardiac catheterisation.
Figure 1
Example of endocardial electromechanical map.
Figure 2
Example of a biplane left ventricular contrast angiogram with a 30° right anterior oblique (RAO) projection and a 60° left anterior oblique (LAO) projection.
Evaluation of global left ventricular function assessment of non-fluorescent electromechanical endocardial mapping compared with biplane left ventricular contrast angiography
Auteurs
E-S Tan P. A. Van der Vleuten G. A. J. Jessurun R. A. Tio F. Zijlstra I. C. Van Gelder
