Cardiovascular magnetic resonance for amyloidosis
Cardiovascular magnetic resonance for amyloidosis
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DOI：
10.1007/s10741-014-9470-7
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发表时间：
2015-03-01
影响因子：
4.6
通讯作者：
Moon, James C.
中科院分区：
文献类型：
--
作者：
Fontana, Marianna;Chung, Robin;Moon, James C.
心脏受累影响全身性淀粉样蛋白的预后和治疗。超声心动图是目前心脏成像的主流，它定义了心脏的结构和功能。超声心动图，结合临床表型，心电图和生物标志物（脑利钠肽和肌钙蛋白），提供了心脏受累的可能性和程度的评估。骨示踪扫描和心血管磁共振（CMR）两项检测正在改变我们对心脏淀粉样变性的认识。CMR为心脏结构和收缩功能提供了“第二意见”，比超声心动图更准确、更精确，但不能评估舒张功能，应用范围不广。CMR的独特优势在于评估心肌组织特征。随着造影剂的使用，最新类型的晚期钆增强成像（相敏反转恢复序列）具有高度的敏感性和特异性，图像几乎是淀粉样变性的典型特征。CMR还表明，心脏淀粉样蛋白结构和功能变化的范围比传统认为的要广泛。CMR与T1映射是一种相对较新的CMR技术，可以测量淀粉样蛋白负荷和肌细胞对浸润（肥大/细胞损失）的反应，具有跟踪随时间或治疗期间变化的优势（例如，壁厚可以保持不变，但成分可以改变）。这些技术对推进这一领域的药物开发和提供新的预后见解具有很大的希望。具有组织特征的CMR正在改写我们对心脏淀粉样变性的理解，并可能导致新的分类、治疗和预后系统的发展。
Cardiac involvement drives the prognosis and treatment in systemic amyloid. Echocardiography, the mainstay of current cardiac imaging, defines cardiac structure and function. Echocardiography, in conjunction with clinical phenotype, electrocardiogram and biomarkers (brain natriuretic peptide and troponin), provides an assessment of the likelihood and extent of cardiac involvement. Two tests are transforming our understanding of cardiac amyloidosis, bone tracer scanning and cardiovascular magnetic resonance (CMR). CMR provides a "second opinion" on the heart's structure and systolic function with better accuracy and more precision than echocardiography but is unable to assess diastolic function and is not as widely available. Where CMR adds unique advantages is in evaluating myocardial tissue characterisation. With administration of contrast, the latest type of late gadolinium enhancement imaging (phase-sensitive inversion recovery sequence) is highly sensitive and specific with images virtually pathognomonic for amyloidosis. CMR is also demonstrating that the range of structural and functional changes in cardiac amyloid is broader than traditionally thought. CMR with T1 mapping, a relatively new CMR technique, can measure the amyloid burden and the myocyte response to infiltration (hypertrophy/cell loss) with advantages for tracking change (e.g. the wall thickness can stay the same but the composition can change) over time or during therapy. Such techniques hold great promise for advancing drug development in this arena and providing new prognostic insights. CMR with tissue characterisation is rewriting our understanding of cardiac amyloidosis and may lead to the development of new classification, therapies and prognostic systems.