我们感谢强生约翰诺森律师事务所的顾问闫俊明，他负责研究资助。这项工作由吉林省科学技术厅（20220402076GH）资助。

该研究程序严格遵守吉林大学中日协和医院人体研究伦理委员会的规定。在Carto系统（3D映射系统）上搜索接受心房颤动射频消融的患者。然后，使用PACS系统确定患者在手术前是否进行了左心房CT检查，以确定每个选定的患者是否进行了左心房CT图像进行比较。Soundstar 是本研究中使用的 ICE 导管，3D 映射系统中提供了 Cartosound 模块。每位患者在 ICE 3D 建模前都提供了书面知情同意书。
1. 扫描前的准备
<ol><li>检查患者信息，例如准确的心率、节律、血压和血氧饱和度。让患者仰卧，双臂在两侧，大腿略微外展。</li>
	<li>在整个手术过程中，为所有患者提供芬太尼 （200 μg/mL） 的深度清醒镇静。选择右侧股静脉作为穿刺点，用2%利多卡因消毒并铺路进行局部麻醉。</li>
	<li>设置 ICE 导管：将 ICE 导管尾线与 3D 映射系统和超声波机器连接。在 3D 映射系统中打开“研究”界面，然后在“连接的机器”中选择“P500”。</li>
	<li>将ICE导管（直径：10f;超声模式：B模式）置于股静脉内。在推压过程中，实时监测超声波，确保导管处于安全空间。</li>
	<li>将消融导管传递到右心房，以形成右心房和冠状窦模型。将冠状动脉窦电极与 ICE 引导相结合放置冠状窦电极。</li>
	<li>ICE导管进入右心房后，确保左心房和左心耳结构在3D映射系统显示屏上显示左心房和左心耳结构，同时排除左心房血栓。</li>
	<li>插入房间隔穿刺针后，在ICE引导下确定最佳穿刺部位。然后，进行经鼻中隔穿刺。<ol><li>使用 “主页 ”视图确认 ICE 已到达右心房。然后软件显示左侧 PV 部分。单击 右弯 以显示下腔静脉和房间隔。</li>
		<li>将穿刺针鞘移至指向四点钟方向。在监测 ICE 的同时将针鞘缩回椭圆形窝，可以看到“帐篷征”。</li>
		<li>调整 ICE 导管以显示左侧 PV 为“兔耳征”。在ICE引导下，将针鞘慢慢撤回到椭圆形窝的下缘。</li>
		<li>顺时针旋转穿刺针以突破椭圆形窝。然后，通过房间隔穿刺针注射肝素生理盐水。 注意：在 LA 中观察到盐水泡，表明房间隔成功穿刺。</li>
	</ol></li>
</ol>左心房和肺静脉的2. 3D建模
注：ICE在两个方向上构建左心房模型。
<ol><li>将ICE导管推入股静脉后，穿过下腔静脉和上腔静脉，进入右心房。</li>
	<li>将超声导管推到短轴右心房中间，顺时针旋转。现在，超声波风扇指向描绘右心房和右心室的一点钟方向（家庭视图）。</li>
	<li>拧紧张力 旋钮以实现锁定张力 调整。然后转到 “主页 ”视图并单击 前曲率 （A） 以完全显示三尖瓣环。附着在三尖瓣环上进行门控训练，并使用呼吸末期建模。</li>
	<li>从 主页 视图，顺时针转向左心房前壁，导致左心耳的出现。</li>
	<li>继续顺时针转动至左心房，导致左上肺静脉和下肺静脉的出现，显示为“兔耳征”。然后，顺时针和逆时针转动它，通过识别前金静脉和后金静脉边界来精确收集左肺静脉的图像。</li>
	<li>继续顺时针转动左心房，建立后壁，在此过程中，食管出现“双轨征”。</li>
	<li>顺时针方向转向左心房，观察右下肺静脉，显示为“3字征”。然后，顺时针和逆时针转动它，通过识别前后边界来精确捕获右肺静脉的图像。</li>
	<li>在长轴上，单击 Palintrope（P） 使导管的尖端与冠状窦口的高度相同。这是对左心房模型的补充。调整左弯/ 右弯 （L/R） 以观察左心房长轴的前壁。该图像捕获了左心房的前壁。</li>
	<li>相应地标记重要的解剖位置，包括肺静脉口、左心耳和其他重要部位（视频 1）。</li>
</ol>3.肺静脉区域的图像采集和测量
<ol><li>左心房CT<ol><li>双击图标打开 PACS 系统 。单击 “高级查询 ”以输入患者姓名和检查项目。单击 “确定 ”以查找图像。</li>
		<li>点击 Tune 将图片传输到 vue pacs 系统（图片存档和通信系统）。</li>
		<li>将 3D 体积重建图像传输到工作箱，然后单击导出图像以将左心房后前 （PA）、左后 （LL） 和右外侧 （RL） 位置 图像 保存在文件夹中。</li>
		<li>返回上一个程序后，将左心房动脉期增强序列转移到工作框中，然后单击显示为 3D 的图像。</li>
		<li>双击 3D 图像，然后单击工具栏中的 3D 。选择切除 工具切除 肋骨、脊柱、主动脉和其他结构，以暴露左心房和肺静脉系统。</li>
		<li>暴露肺静脉前庭。单击工具栏中的“ 图 ”，然后选择 “面积 ”以计算肺静脉前庭的横截面积。</li>
	</ol></li>
	<li>冰<ol><li>打开 3D 映射系统。然后，单击 “查看研究 ”并输入患者姓名。最后，使用 “搜索当前患者 ”来识别图像。</li>
		<li>单击 “确定 ”打开工作界面。</li>
		<li>单击 “研究”>“继续研究 ”，然后选择 “模型 ”和 “通道 ”序列。</li>
		<li>单击“ 捕获首选项”，然后选择“ 区域 ”并将图像调整为“后前”、“左外侧”、“右外侧”、“左前斜肌 （LAO）”和“右前斜肌 （RAO）”。</li>
		<li>单击“图片”，选择照片区域，然后单击“确定”以保存图片。</li>
		<li>单击 “ 地图”选项，然后选择 “保存地图”。然后，使用工具栏中的 橡皮擦 去除左右肺静脉。</li>
		<li>单击图像，选择面积测量并测量肺静脉前庭的 面积 。</li>
	</ol></li>
</ol>

基于 ICE 的左心房和肺静脉 3D 重塑

<ol>
	<li>Xu, Y., Sharma, D., Li, G., Liu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+remodeling:+new+pathophysiological+mechanism+of+atrial+fibrillation.">Atrial remodeling: new pathophysiological mechanism of atrial fibrillation.</a> Medical Hypotheses. 80 (1), 53-56 (2013).</li><li>George, J. C., Varghese, V., Mogtader, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography:+evolving+use+in+interventional+cardiology.">Intracardiac echocardiography: evolving use in interventional cardiology.</a> Journal of Ultrasound in Medicine. 33 (3), 387-395 (2014).</li><li>Jingquan, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography+Chinese+expert+consensus.">Intracardiac echocardiography Chinese expert consensus.</a> Frontiers in Cardiovascular Medicine. 9, 1012731 (2022).</li><li>Anter, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+intracardiac+echocardiography+and+transesophageal+echocardiography+for+imaging+of+the+right+and+left+atrial+appendages.">Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages.</a> Heart Rhythm. 11 (11), 1890-1897 (2014).</li><li>Rossillo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+ICE-guided+registration+strategy+for+integration+of+electroanatomical+mapping+with+three-dimensional+CT/MR+images+to+guide+catheter+ablation+of+atrial+fibrillation.">Novel ICE-guided registration strategy for integration of electroanatomical mapping with three-dimensional CT/MR images to guide catheter ablation of atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 20 (4), 374-378 (2009).</li><li>Okumura, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+ultrasound+for+image-guided+mapping+and+intervention:+methods,+quantitative+validation,+and+clinical+feasibility+of+a+novel+multimodality+image+mapping+system.">Three-dimensional ultrasound for image-guided mapping and intervention: methods, quantitative validation, and clinical feasibility of a novel multimodality image mapping system.</a> Circulation: Arrhythmia and Electrophysiology. 1 (2), 110-119 (2008).</li><li>Liu, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+evolving+utility+of+intracardiac+echocardiography+in+cardiac+procedures.">The evolving utility of intracardiac echocardiography in cardiac procedures.</a> Journal of Atrial Fibrillation. 6 (6), 1055 (2014).</li><li>Bartel, T., Edris, A., Velik-Salchner, C., M&#252;ller, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography+for+guidance+of+transcatheter+aortic+valve+implantation+under+monitored+sedation:+a+solution+to+a+dilemma.">Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma.</a> European Heart Journal. Cardiovascular Imaging. 17 (1), 1-8 (2016).</li><li>Haissaguerre, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spontaneous+initiation+of+atrial+fibrillation+by+ectopic+beats+originating+in+the+pulmonary+veins.">Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.</a> New England Journal of Medicine. 339 (10), 659-666 (1998).</li><li>Kaseno, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+the+CartoSound&#174;+image+directly+acquired+from+the+left+atrium+for+integration+in+atrial+fibrillation+ablation.">The impact of the CartoSound&#174; image directly acquired from the left atrium for integration in atrial fibrillation ablation.</a> Journal of Interventional Cardiac Electrophysiology. 53, 301-308 (2018).</li><li>Enriquez, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+intracardiac+echocardiography+in+interventional+cardiology:+working+with+the+anatomy+rather+than+fighting+it.">Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it.</a> Circulation. 137 (21), 2278-2294 (2018).</li></ol>

作者没有利益冲突需要声明。

心内超声心动图（ICE）是一种非接触式三维重建工具。它确定了合适的消融平面，并降低了肺静脉狭窄的发生率。此外，ICE 通过评估消融导管的远端位置及其与解剖结构的相对关联来提高导管消融的有效性。这些结构包括左心房和肺静脉以及肺静脉的直径和形态。
ICE引导的心房颤动导管消融术可以减少术中X线照射，减少房间隔穿刺时间，发现早期并发症，并提供及时治疗，...

心房颤动 （AF） 通常与心房重塑有关，包括机械重塑、电生理重塑和结构重塑1。结构重塑将极大地影响中庭的解剖结构。因此，评估 AF 患者的左心房解剖结构对于 AF 消融手术和任何针对左心房的手术都是必不可少的。对于FAM三维建模，通过不断置换心脏中的磁导管，根据其位置对应于固定磁场的空间位置变化，重建心脏的三维建模。相比之下，ICE 3D 建模通过将传感器定位在 ICE 相控阵导管的头端，将心腔中的二维图像与 3D 电解剖映射系统集成在一起。因此，超声扇区表示 3D 建模，以展示解剖关系和实时导管位置。
根据我们的临床经验，心内超声心动图（ICE）可以识别心房壁边界，并进一步建立3D重塑。然而，在 AF 消融或 3D 重塑期间，大多数 ICE 使用仅提供心房或肺静脉的简要轮廓。最初，ICE用于指导房间隔缺损和卵圆孔未闭2的介入闭合。ICE 可以明确房间隔的位置和形状，并已用于需要房间隔穿刺的各种介入手术3.这些包括心房颤动的射频导管消融术、二尖瓣介入治疗等。 ICE可以精确识别肺静脉边界和心房壁，以建立更详细的3D模型3。目前尚不清楚这种方法是否可以为操作者提供更精确的心房解剖学评估，特别是对于肺静脉、胃窦和经鼻中隔部位。在这项研究中，我们比较了使用传统方法和精确 ICE 程序建立的左心房 CT 图像和 3D 重塑，以确定更多信息。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>CARTO V6</td>
			<td>Johnson&#38;Johnson</td>
			<td>6.0.80.45</td>
			<td></td>
		</tr>
		<tr>
			<td>CARTO V7</td>
			<td>Johnson&#38;Johnson</td>
			<td>7.1.80.33</td>
			<td></td>
		</tr>
		<tr>
			<td>PACS system</td>
			<td>Philips(China) Investment Co.,Ltd</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Soundstar</td>
			<td>Johnson&#38;Johnson</td>
			<td>N/A</td>
			<td></td>
		</tr>
	</tbody>
</table>

three-dimensional modeling of the left atrium and pulmonary veins with a precise intracardiac echocardiography approach

心内超声心动图 （ICE） 是一种用于估计肺静脉隔离手术期间心脏解剖结构的新工具，尤其是左心房 （LA） 解剖结构和肺静脉结构。ICE广泛用于在消融过程中建立三维（3D）左心房结构模型。然而，目前尚不清楚在精确的 3D 建模方法中使用 ICE 是否可以提供更准确的左心房 3D 模型和经鼻中隔入路。本研究提出了一种使用 ICE 和快速解剖映射 （FAM） 导管重塑对左心房和肺静脉进行建模的方案。它通过观察者评分来评估使用这两种方法生成的模型的准确性。我们纳入了 50 名接受基于 ICE 的 3D 重塑的患者和 45 名接受基于肺静脉分离程序的 FAM 3D 重塑的患者。肺静脉窦重塑是通过比较重塑和左心房计算机断层扫描血管造影 （CTA） 获得的窦面积来估计的。ICE组和FAM组的观察者得分分别为3.40±0.81分和3.02分±0.72分（P<0.05）。使用基于 ICE 和 FAM 的方法获得的肺静脉窦面积与左心房 CT 获得的面积呈相关性。然而，使用 Bland-Altman 分析，ICE 获取模型的 95% 置信区间偏差比 FAM 获取模型（分别为 -238 cm 2 至 323 cm 2 和 -363 cm 2 至 386 cm 2）更窄。因此，精密ICE在估计左心房结构方面具有很高的准确率，成为未来心脏结构估计的一种有前途的方法。

Atrial fibrillation (AF) is commonly associated with atrial remodeling, including mechanical remodeling, electrophysiologic remodeling, and structural remodeling1. Structural remodeling will dramatically affect the anatomy of the atrium. Hence, assessing the left atrial anatomy in AF patients is essential for AF ablation procedures and any procedure targeting the left atrium. For the FAM 3D modeling, the 3D modeling of the heart is reconstructed based on the spatial position change of its position corresponding to the fixed magnetic field by continuously displacing the magnetic catheter in the heart. In contrast, ICE 3D modeling integrates the two-dimensional image in the cardiac cavity with the 3D electroanatomic mapping system by positioning the sensor at the head end of the ICE phase array catheter. Thus, the ultrasonic sector represents 3D modeling to demonstrate the anatomical relationship and real-time catheter position.
Based on our clinical experience, intracardiac echocardiography (ICE) can identify the atrial wall boundary and further establish the 3D remodel. However, most ICE usage during AF ablation or 3D remodeling just provides a brief profile of the atria or pulmonary veins. Originally, ICE was applied to guide the interventional closure of atrial septal defect and patent foramen ovale2. ICE can clarify the location and shape of the atrial septal and has been used for various interventional procedures requiring atrial septal puncture3. These include radiofrequency catheter ablation of atrial fibrillation, mitral valve interventional therapy, etc. ICE can precisely identify pulmonary vein boundaries and atrial walls to establish a more detailed 3D model3. It is unclear whether this method could provide operators with a more precise atrial anatomy assessment, especially for the pulmonary vein antrum and transseptal sites. In this study, we compared the left atrium CT image and 3D remodel established using traditional methods and precise ICE procedures to determine additional information.

作者聚焦：用于心房解剖评估的心内超声心动图的进展 

使用精确的心内超声心动图方法对左心房和肺静脉进行三维建模

Our research tries to evaluate whether intracardiac echocardiography-based 3D construction could enhance the accuracy of pulmonary atrium and assessments in arterial anatomy. Intracardiac echocardiography is capable of identifying the arterial wall boundary and creating a 3D model of pulmonary winds. Recently this has been increased, the focus on using S2 often detailed images for accurately determining arterial anatomy.One of the current experimental challenges is accurately imitating the left arterial structure. However, promising results have been obtained use as best arterial imaging and safety deconstruction, which has high accuracy and hold potential for future cardiac structure imaging.

2021年1月至2022年6月，我们选取了114例在我院接受心房颤动射频消融术的患者。根据以下标准排除患者：无左心房 CT 3D 体积重建图像 （n = 11）、无经隔穿刺 ICE 图像 （n = 4） 以及左心房和肺静脉图像重建不完全 （n = 4）。最后，纳入50例ICE 3D建模患者和45例FAM3D建模患者作为对照组。
两位专业的电生理学家分析了所有的3D建模图像。我们比较了Carto建模和左心房计算机断层扫描?...

Watch this Scientific Journal Video about Advancements in Intracardiac Echocardiography for Atrial Anatomy Assessment at JoVE.com

准确的心内超声心动图 （ICE） 在估计左心房结构方面显示出显着的准确性，这是一种有前途且有前途的心脏结构估计方法。在这里，我们提出了一种使用 ICE 和快速解剖映射 （FAM） 导管重塑对左心房和肺静脉进行三维建模的方案。

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left ...

我们的研究试图评估基于心内超声心动图的 3D 构建是否可以提高肺心房的准确性和动脉解剖学评估。心内超声心动图能够识别动脉壁边界并创建肺风的 3D 模型。最近，这已经增加，重点是使用S2经常详细的图像来准确确定动脉解剖结构。目前的实验挑战之一是准确模仿左动脉结构。然而，已经获得了有希望的结果，用作最佳的动脉成像和安全解构，具有很高的准确性，并具有未来心脏结构成像的潜力。

three-dimensional-modeling-left-atrium-pulmonary-veins-with-precise

Research

JoVE Journal

Medicine

Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach

583 次观看.  China-Japan Union Hospital of Jilin University. 我们的研究试图评估基于心内超声心动图的 3D 构建是否可以提高肺心房的准确性和动脉解剖学评估。心内超声心动图能够识别动脉壁边界并创建肺风的 3D 模型。最近，这已经增加，重点是使用S2经常详细的图像来准确确定动脉解剖结构。目前的实验挑战之一是准确模仿左动脉结构。然而，已经获得了有希望的结果，用作最佳的动脉成像和安全解构，具有很高的准确性，...

视频: 作者聚焦：用于心房解剖评估的心内超声心动图的进展 

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left atrium (LA) anatomy and pulmonary vein structures. ICE is widely used to establish a three-dimensional (3D) left atrial structural model during ablation procedures. However, it is unclear whether using ICE in a precise 3D modeling method can provide a more accurate left atrial 3D model and the transseptal approach. This study proposes a protocol to model the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling. It evaluates the accuracy of the models produced using the two methods through observer scoring. We included 50 patients who underwent ICE-based 3D remodeling and 45 who underwent FAM 3D remodeling based on pulmonary vein isolation procedures. The pulmonary vein antrum remodeling is estimated by comparing the antrum area acquired by remodeling and left atrial computed tomography angiography (CTA). The observer scores for the modeling in the ICE and FAM groups were 3.40 &#177; 0.81 and 3.02 &#177; 0.72 (P &#60; 0.05), respectively. The pulmonary vein antrum area obtained using the ICE- and FAM-based methods showed a correlation with the area acquired by left atrium CT. However, the 95% confidence interval bias was narrower in ICE-acquired models than in FAM-acquired models (-238 cm2 to 323 cm2 Vs. -363 cm2 to 386 cm2, respectively) using Bland-Altman analysis. Therefore, precise ICE possesses high accuracy in estimating the left atrial structure, becoming a promising approach for future cardiac structure estimation.

Accurate intracardiac echocardiography (ICE) shows significant accuracy in estimating the left atrial structure, a prospective and promising cardiac structure estimation method. Here we propose a protocol for three-dimensional modeling of the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling.

科研

医学

3D Modeling of the Left Atrium and Pulmonary Vein

Begin by inserting the intracardiac echocardiography catheter, or ICE catheter, into the femoral vein and guiding it through the inferior and superior vena cava into the right atrium. Position the ultrasound catheter in the middle of the right atrium on the short axis and rotate it clockwise, aiming the fan towards the one o'clock direction or home view to view the right atrium and right ventricle. Next, tighten the tension knob to achieve locking tension tuning.Then turn to the home view and click anti-curvature to fully display the tricuspid annulus. Attach to the tricuspid annulus for gating training and utilize the end-breath phase modeling. From the home view, rotate clockwise towards the left atrial anterior wall to reveal the left atrial appendage.Keep turning the catheter clockwise to the left atrium to view the left upper and lower pulmonary veins displayed as a rabbit-ear sign. Rotate to identify the anterior and posterior venous boundaries for left pulmonary vein imaging. Continue turning clockwise to the left atrium, establishing the posterior wall during which the esophagus appears as the double track sign.Keep rotating to observe the right lower pulmonary vein displayed as a three-word sign. Turn in either direction to precisely capture the right pulmonary veins by identifying the anterior and posterior boundaries. Click on palintrope along the long axis to align the catheter tip with the coronary sinus mouth, enhancing the left atrium model.Adjust left bend or right bend to visualize the anterior wall of the left atrium in the long-axis view. Identify and mark the critical anatomical landmarks such as pulmonary vein ostia, left atrial appendage, and other vital sites. The modeling observer scores were 3.40 plus or minus 0.81 in the ICE and 3.02 plus or minus 0.72 in the FAM groups.The observer scores for selecting transseptal puncture sites were 4.62 plus or minus 0.73 in the ICE and 4.29 plus or minus 0.97 in the FAM groups. The pulmonary vein antrum area acquired using the ICE and FAM-based methods correlates with the area acquired by left atrial CT.However, the 95%confidence interval bias obtained using Bland-Altman analysis was narrower in ICE-acquired models than in the FAM-acquired models.