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Catheter‐based electromechanical mapping to assess regional myocardial function: A comparative analysis with transthoracic echocardiography
Author(s) -
Kornowski Ran,
Fuchs Shmuel,
Shiran Avinoam,
Summers Natama,
Pietrusewicz Matthew,
Ellahham Samer,
Goldstein Steven A.,
Leon Martin B.
Publication year - 2001
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.1078
Subject(s) - medicine , cardiology , contractility , coronary artery disease , area under the curve , receiver operating characteristic , basal (medicine) , insulin
Recent studies using a nonfluoroscopic three‐dimensional left ventricular mapping system showed considerable changes in voltage potentials and mechanical activity detected in ischemic and infracted myocardial regions with mechanical dysfunction. This study examined the electromechanical characteristics in relation to regional wall motion assessed by echocardiography in patients with coronary artery disease. A 12‐segment model of mapping (apical, mid, basal of septal, anterior, lateral, and inferior/posterior segments) was compared to echo wall motion score in 74 patients (836 segments). Unipolar voltage and local endocardial shortening signals were distinguished according to graded echo segmental rest scores (0 = normal, 1 = mild hypokinesis, 2 = moderate hypokinesis, 3 = severe hypokinesis, 4 = akinesis). Results show a significant difference in voltage potentials and shortening values in groups distinguished according to echocardiography motion score. The average voltage potentials and shortening values were highest in myocardial segments with normal or slightly reduced contractility and lowest in myocardial segments with moderate to severely impaired contractility scores (voltage: 12.3 ± 5.0, 12.1 ± 5.3, 10.7 ± 5.4, 8.7 ± 3.9, 7.1 ± 3.0 mV, P = 0.0001; local shortening: 9.7 ± 6.5, 8.4 ± 5.9, 8.0 ± 5.4, 5.6 ± 6.3, 5.1 ± 4.6%, P = 0.0001 in regions with segmental scores of 0, 1, 2, 3, 4 by echo, respectively). Using receiver‐operating curve calculations, the area under the curve was 0.72 ± 0.06 (voltage) and 0.67 ± 0.05 (local shortening) without a significant difference between the two curves. The 90% thresholds for defining preserved vs. impaired contractility were 12.8 and 5.6 mV for voltage and 12.6% and 1.6% for local shortening. We conclude that electromechanical mapping correlates with regional changes in wall motion scores assessed by echo, showing a gradual proportional decrease in measured voltage and shortening signals in segments with impaired function. Cathet Cardiovasc Intervent 2001;52:342–347. © 2001 Wiley‐Liss, Inc.