Feasibility study of cardiac magnetic resonance elastography in cardiac amyloidosis.
Feasibility study of cardiac magnetic resonance elastography in cardiac amyloidosis.
复制标题
心脏磁共振弹性成像治疗心脏淀粉样变性的可行性研究。
DOI：
10.1080/13506129.2017.1278689
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Araoz,PhilipA
中科院分区：
文献类型：
--
作者：
Chang,IanCY;Arani,Arvin;PoigaiArunachalam,Shivaram;Grogan,Martha;Dispenzieri,Angela;Araoz,PhilipA
磁共振弹性成像（MRE）已在临床上用于评估肝硬化等疾病的组织刚度[文献1]。然而，MRE对心肌僵硬是否可行尚不清楚。心脏淀粉样变使心脏“变硬”并导致收缩和舒张功能障碍[文献2，文献3]。MRI延迟增强有助于诊断，但常因并发肾功能不全而被排除。MRE是无对比的，可能是诊断和治疗监测的有用工具。这项可行性初步研究的目的是确定MRE是否可以区分心脏淀粉样变性患者和健康对照者的心肌僵硬度。材料和方法：我们从梅奥诊所的淀粉样蛋白门诊鉴别出经心肌内膜活检证实的心脏淀粉样变性患者。年龄和性别匹配的控制组从校园招聘中招募。从图表回顾中获得基线临床信息。受试者在胸前使用振动驱动器进行了一次性磁共振成像。图像是用1.5 T MRI扫描仪（Optima 450W, GE Medical Systems, Milwaukee， WI）在R波后的最小允许延迟下获得的，使用心脏门控MRE自旋回波回波平面成像脉冲序列，振动频率为140 Hz。采用局部频率估计反演算法生成刚度图。结果本研究纳入1例患者（58岁，男性）和1例对照组（57岁，男性）。诊断为遗传性心脏转甲状腺蛋白淀粉样变性伴缬氨酸122异亮氨酸突变。他有NYHA功能II级症状。超声心动图显示3级舒张功能障碍，射血分数（EF）降低46%。对照组舒张、收缩功能正常。MREs的短轴心肌刚度图如图1所示。患者和对照组的平均刚度值有显著差异：分别为15.7 kPa和7.2 kPa。
BackgroundMagnetic resonance elastography (MRE) has been used clinically to assess tissue stiffness in diseases such as liver cirrhosis [Citation 1]. However, whether MRE is feasible for myocardial stiffness is unclear. Cardiac amyloidosis “stiffens” the heart and leads to systolic and diastolic dysfunction [Citation 2, Citation 3]. MRI with delayed enhancement is helpful in the diagnosis, but is often precluded due to frequently co-existing renal dysfunction. MRE is contrast-free and could potentially be a useful tool for diagnosis and treatment monitoring. The aim of this feasibility pilot study was to determine if MRE could differentiate the myocardial stiffness between a cardiac amyloidosis patient and healthy control.Materials and methodsWe identified endomyocardial-biopsy proven cardiac amyloidosis patients from the amyloid clinic at the Mayo Clinic. Age-and gender-matched controls were recruited from campus postings. Baseline clinical information was acquired from chart review. Subjects underwent a one-time MRE using a vibrating driver on the chest. Images were acquired with a 1.5 T MRI scanner (Optima 450W, GE Medical Systems, Milwaukee, WI) at the minimum allowed delay after the R wave using a cardiac-gated MRE spin echo echo planar imaging pulse sequence, at a vibration frequency of 140 Hz. Stiffness maps were generated using local frequency estimation inversion algorithm.ResultsOne patient (58 years, male) and one control (57 years, male) were included in this pilot study. The patient was diagnosed with hereditary cardiac transthyretin amyloidosis with valine 122 isoleucine mutation. He had NYHA functional class II symptoms. Echocardiogram showed grade 3 diastolic dysfunction and reduced ejection fraction (EF) of 46%. The control had normal diastolic and systolic function. Short axis myocardial stiffness maps from the MREs are shown in Figure 1. The mean stiffness values were significantly different: 15.7 kPa and 7.2 kPa for the patient and control, respectively.