Electromechanical mapping of the left ventricle for stem cell injection in a patient with permanent atrial fibrillation
Notice bibliographique
Résumé
Stem cell therapies for improvement of the ischaemic myocardium are an emerging and promising therapeutic option. Three-dimensional NOGA mapping allows simultaneous registration of left ventricle (LV) mechanical and electrical activity, enabling assessment of myocardial viability and targeted cell delivery. However, LV mapping in patients during atrial fibrillation (AF) is considered time consuming and difficult. A 77-year-old man was admitted to our centre presenting with refractory angina. His risk factors included hypertension, hyperlipidaemia, and advanced chronic renal failure, he also had a history of permanent AF. In the past he had undergone coronary artery bypass grafting twice: in 1985 and 2002, he had also suffered from a non-ST-elevation myocardial infarction treated with percutaneous coronary intervention with a drug eluting stent implantation in 2010. At the moment of admission, he was in CCS class III despite optimal medical treatment. The patient had previously been disqualified from any further revascularisation by the Heart Team. Echocardiography revealed a mild impairment of the LV ejection fraction (LVEF 45%), with hypokinesia of the intraventricular septum and inferior wall. Single-photon emission computed tomography (SPECT) showed reversible perfusion defects in the anterolateral region. AF with short QRS duration (80 ms) and relatively good rate control (80 bpm) was observed in an electrocardiogram. The patient was enrolled to the REGENT (autologous CD133+ cells vs. placebo, double-blind, placebo-controlled RCT) trial to undergo targeted transendocardial treatment. We used a NOGA-XP System to perform electromechanical mapping and direct transendocardial cell injection. A diagnostic NOGA STAR catheter was placed in the LV under fluoroscopic guidance, and LV electromechanical mapping was performed. Completing the data necessary to build the map and localise the target area took about 60 min. The regions of hibernating myocardium defined by preserved electrical and decreased mechanical activity correlated with reversible perfusion defects detected by SPECT. Time volume graphs showed evident dyssynchrony of the hibernating areas (Fig. 1). Following the standardised NOGA injection criteria, twelve 0.2 mL injections of autologous CD133+ bone marrow stem cells or placebo (procedure double-blinded) were placed into the anterolateral viable area (> 5 mV unipolar) with low wall movement (< 6% LLS) (Fig. 2). Only limited premature ventricular contractions were detectable at injections, which can probably be explained by a reduced time window for excitation after the electrical refractory period. Total injection time was 20 min. Mapping and injection were completed within 80 min despite permanent AF. No raise in creatinine levels, pericardial effusion, and no local complications were observed in the days following the procedure. To conclude, despite technical difficulties due to irregular rhythm, electromechanical mapping on AF is feasible. Completing the procedure in patients with AF and good heart rate control does not have to be more time consuming than in patients on sinus rhythm. Additionally, time volume graphs display differences in wall movement of hibernating and normal tissue even during AF, providing us with additional information on segmental ventricular contraction synchrony.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».