Endomyocardial Biopsy Characterization of Heart Failure With Preserved Ejection Fraction and Prevalence of Cardiac Amyloidosis.
Endomyocardial Biopsy Characterization of Heart Failure With Preserved Ejection Fraction and Prevalence of Cardiac Amyloidosis.
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DOI：
10.1016/j.jchf.2020.04.007
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Sharma K
中科院分区：
文献类型：
--
作者：
Hahn VS;Yanek LR;Vaishnav J;Ying W;Vaidya D;Lee YZJ;Riley SJ;Subramanya V;Brown EE;Hopkins CD;Ononogbu S;Perzel Mandell K;Halushka MK;Steenbergen C Jr;Rosenberg AZ;Tedford RJ;Judge DP;Shah SJ;Russell SD;Kass DA;Sharma K
我们前瞻性评估射血分数保留性心力衰竭（HFpEF）患者的肌内膜活检，以确定组织病理学表型及其与临床特征的相关性。缺乏反映当代合并症的前瞻性定义HFpEF队列的心肌组织分析。2014年8月至2018年9月期间转诊至约翰霍普金斯HFpEF诊所的HFpEF患者（EF ≥ 50%）入组接受右心导管插入术和肌内膜活检。确定临床特征、超声心动图、血流动力学和组织组织学，并与对照组（未使用的供体心脏）和EF降低的HF（HFrEF）进行比较。在入组的108例患者中，中位年龄为66（57-74）岁，61%为女性，57%为非洲裔美国人，62%有既往HF住院史，中位收缩压141 [125-162] mmHg，BMI 37 [32-45] kg/m2，97%接受袢利尿剂治疗。心肌纤维化和肥大经常出现（分别为93%和88%），但71%的纤维化和52%的肥大为轻度。HFpEF组的单核细胞浸润（CD 68+细胞/mm 2）高于对照组（60.4 [36.8-97.8] v. 32.1 [22.3-59.2]，p=0.02），且与年龄和肾脏疾病相关。15例（14%）患者被诊断为心脏淀粉样变性（CA）（HFpEF-CA：7例野生型甲状腺素运载蛋白[ATTR]，4例遗传性ATTR，3例AL和1例AA），其中7例未被怀疑。HFpEF-CA患者年龄较大，BMI较低，LV质量指数较高，NTproBNP和肌钙蛋白I较高。在HFpEF的大型前瞻性心肌组织分析中，心肌纤维化和肥大很常见，CD 68+炎症增加，CA患病率为14%。HFpEF中的组织分析可以通过识别相关心肌机制来提高精确治疗。
We prospectively evaluated endomyocardial biopsies in heart failure with preserved ejection fraction (HFpEF) patients to identify histopathological phenotypes and their association with clinical characteristics. Myocardial tissue analysis from a prospectively defined HFpEF cohort reflecting contemporary comorbidities is lacking. HFpEF patients (EF ≥ 50%) referred to the Johns Hopkins HFpEF Clinic between August 2014 - September 2018 were enrolled for right heart catheterization and endomyocardial biopsy. Clinical features, echocardiography, hemodynamics, and tissue histology were determined and compared to controls (unused donor hearts) and HF with reduced EF (HFrEF). Of 108 patients enrolled, median age was 66 (57–74) years, 61% were female, 57% African American, 62% with prior HF hospitalization, median systolic pressure 141 [125–162] mmHg, BMI 37 [32–45] kg/m2, and 97% were on a loop diuretic. Myocardial fibrosis and hypertrophy were often present (93% and 88%, respectively), however mild in 71% with fibrosis and in 52% with hypertrophy. Monocyte infiltration (CD68+ cells/mm2) was greater in HFpEF versus controls (60.4 [36.8–97.8] v. 32.1 [22.3–59.2], p=0.02), and correlated with age and renal disease. Cardiac amyloidosis (CA) was diagnosed in 15 (14%) patients (HFpEF-CA: 7 wild-type transthyretin [ATTR], 4 hereditary ATTR, 3 AL, and 1 AA), of which 7 cases were unsuspected. HFpEF-CA patients were older, with lower BMI, higher LV mass index, and higher NTproBNP and troponin I. In this large, prospective myocardial tissue analysis of HFpEF, myocardial fibrosis and hypertrophy were common, CD68+ inflammation was increased, and CA prevalence was 14%. Tissue analysis in HFpEF may improve precision therapies by identifying relevant myocardial mechanisms.
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影响因子：
37.8
作者：
Shah SJ;Kitzman DW;Borlaug BA;van Heerebeek L;Zile MR;Kass DA;Paulus WJ
通讯作者：
Paulus WJ
影响因子：
20.1
作者：
Sharma K;Kass DA
通讯作者：
Kass DA
影响因子：
39.3
作者：
Gonzalez-Lopez, Esther;Gallego-Delgado, Maria;Garcia-Pavia, Pablo
通讯作者：
Garcia-Pavia, Pablo
影响因子：
5.7
作者：
Phelan, Dermot;Collier, Patrick;Thomas, James D.
通讯作者：
Thomas, James D.
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe