Integrated backscatter as a fibrosis marker in the metabolic syndrome: association with biochemical evidence of fibrosis and left ventricular dysfunction
Integrated backscatter as a fibrosis marker in the metabolic syndrome: association with biochemical evidence of fibrosis and left ventricular dysfunction
复制标题
DOI：
10.1093/ejechocard/jer291
复制
发表时间：
2012-06-01
影响因子：
6.2
通讯作者：
Marwick, Thomas H.
中科院分区：
文献类型：
--
作者：
Kosmala, Wojciech;Przewlocka-Kosmala, Monika;Marwick, Thomas H.
目的心肌纤维化是代谢综合征（MS）患者左室功能障碍异质性的重要因素。将菌株与校准后向散射（cIB）和血清学纤维化标志物进行比较，可以为了解心功能与纤维化标志物的关系提供一种手段。方法和结果在一项前瞻性横断面研究中，我们研究了172例MS患者（50 +/- 13岁）和61名健康对照。超声心动图评价包括心肌速度和变形，校正cIB，测定血清前胶原III型氨基末端前肽（PIIINP）和前胶原I型羧基末端前肽（PICP）。MS患者表现为左室收缩和舒张功能，心肌回声密度紊乱，血清PIIINP和PICP水平升高。对于大多数功能变量，基底隔校准cIB是左室功能受损的最强决定因素，独立于较高的前胶原水平、左室质量指数、年龄、体重指数、肌酐水平和c反应蛋白。腹部脂肪沉积增加的患者（通过腰臀比评估）表现出更高水平的前胶原肽和间隔校准cIB，并且具有更严重的左室功能障碍，这表明心肌变形和早期舒张速度较低，E/ E′较高。结论心肌回声密度与MS左室收缩和舒张功能障碍的相关性强于循环前胶原肽。腰臀比越高，纤维化和左室功能异常都会增加，这可能为在这类患者中实施强化治疗提供了理论依据。
Aims Myocardial fibrosis is an important contributor to heterogeneity of left ventricular (LV) dysfunction in the metabolic syndrome (MS). Comparison of strain with calibrated integrated backscatter (cIB) and serological fibrosis markers could provide a means to understand the association of cardiac function with markers of fibrosis.Methods and results We studied 172 patients with MS (age 50 +/- 13years) and 61 healthy controls in a prospective, cross-sectional study. Echocardiographic evaluation included myocardial velocities and deformation, and calibrated cIB. Procollagen type III amino-terminal propeptide (PIIINP) and procollagen type I carboxy-terminal propeptide (PICP) were measured from serum. MS patients demonstrated LV systolic and diastolic function, and myocardial echodensity disturbances, as well as elevated serum PIIINP and PICP levels. For most functional variables, calibrated cIB in the basal septum was the strongest determinant of impaired LV performance, independent of higher procollagen levels, LV mass index, age, body mass index, creatinine level, and C-reactive protein. Patients with increased abdominal fat deposit (assessed by the waist-to-hip ratio) presented higher levels of procollagen peptides and septal calibrated cIB, and with more profound LV dysfunction as indicated by lower myocardial deformation and early diastolic velocity, and higher E/e'.Conclusion Myocardial echodensity is a stronger correlate of LV systolic and diastolic dysfunction in MS, than circulating procollagen peptides. Both fibrosis and LV function abnormalities are increased at a higher waist-to-hip ratio, which might provide a rationale for the implementation of intensified therapy in this subset of patients.