RESUMEN
BACKGROUND: Adapting the ablation index (AI) to the left atrial wall thickness (LAWT) derived from computed tomography angiography (CTA) allows for a personalized approach that showed to improve PVI safety and outcomes. METHODS: Three observers with different degrees of experience performed complete LAWT analysis of CTA for 30 patients and repeated the analysis for 10 of these patients. Intra- and inter-observer reproducibility of these segmentations was assessed. RESULTS: Geometric congruence of repeated reconstruction of LA endocardial surface showed that 99.4% of points in the 3D reconstructed mesh were within < 1 mm distance for the intra-observer variability and 95.1% for the inter-observer. For the LA epicardial surface, an 82.4% of points were within < 1 mm for intra-observer and a 77.7% for inter-observer. A 1.99% of points were further than 2 mm for the intra-observer and a 4.1% for the inter-observer. Colour agreement between LAWT maps showed that a 95.5% and a 92.9% intra- and inter-observer respectively presented the same colour or a change to the colour immediately above or below. The ablation index (AI), which was adapted to this LAWT colour maps to perform a personalized pulmonary vein isolation (PVI), showed an average difference in the derived AI lower than 25 units in all cases. For all analyses, the concordance increased with user-experience. CONCLUSION: Geometric congruence of LA shape was high, for both endocardial and epicardial segmentations. LAWT measurements were reproducible, increasing with user experience. This translated into a negligible impact in the target AI.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Humanos , Fibrilación Atrial/cirugía , Angiografía por Tomografía Computarizada , Reproducibilidad de los Resultados , Atrios Cardíacos/cirugía , Angiografía , Ablación por Catéter/métodos , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/cirugía , Resultado del TratamientoRESUMEN
Se realizó un resumen en el Departamento Provincial de Genética para analizar retrospectivamente los resultados de la aplicación del programa de alfa-fetoproteina en la provincia Holguín, desde septiembre de 1985 hasta diciembre de 1989, para lo cual se revisaron 5 190 protocolos clínicos de pacientes cuya primera alfa-fetoproteína en suero materno resultó alterada, del total de 69 692 estudiadas: se evidenció como causa fundamental de este resultado el error en la edad gestacional. Se pesquisó el 90 por ciento de defectos del tubo neural mediante alfa-fetoproteína elevada y el 54 por ciento del total de 22 malformaciones de otro tipo diagnosticadas por ultrasonido. El diagnóstico prenatal fue confirmado en todos los fetos obtenidos de embarazos interrumpidos a los cuales se les realizó estudios necrópsico