Noninvasive assessment of myocardial fibrosis in patients with obstructive hypertrophic cardiomyopathy
Noninvasive assessment of myocardial fibrosis in patients with obstructive hypertrophic cardiomyopathy
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DOI：
10.1136/heartjnl-2013-304923
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发表时间：
2014-04-15
期刊：
影响因子：
5.7
通讯作者：
Edvardsen, Thor
中科院分区：
文献类型：
--
作者：
Almaas, Vibeke M.;Haugaa, Kristina H.;Edvardsen, Thor
目的晚期钆增强心脏磁共振成像（LGE-CMR）是无创性评估心肌纤维化的参考标准。在肥厚型心肌病（HCM）患者中，LGE的组织学底物仍然未知。本研究的目的是评估LGE和应变超声心动图检测梗阻性HCM患者接受隔myectomy.Methods的心肌纤维化的类型和程度的能力32 HCM患者（年龄60 - 10）被纳入本横断面研究，术前检查斑点追踪应变超声心动图和LGE-CMR（n=21）。组织学纤维化分为间质性纤维化、替代性纤维化和完全性纤维化。总纤维化、间质纤维化和替代纤维化的百分比分别为15（7，31）%、11（5，24）%和3（1，6）%。纵向间隔应变减少与总纤维化（r=0.50，p=0.01）和间质纤维化（r=0.40，p=0.03）相关，但与替代纤维化无关（r=0.28，p=0.14）。在13/21例（62%）中检测到间隔LGE，但LGE百分比与总纤维化无关（r=0.25，p=0.28）。有和无间隔LGE的患者之间纤维化程度无差异（20（9，58）% vs 14（5，19）% p=0.41）。室性心律失常患者（n=8）在心肌切除术标本中，室间隔纵向应变较低，总纤维化和间质纤维化程度增加，但LGE无差异。减少纵向间隔应变和增加的程度，间质纤维化预测室性心律失常独立的年龄和gender.Conclusions在myectomised HCM患者，减少纵向间隔应变相关性更好，与间质和总纤维化myectomy标本，是一个更强大的工具来预测心律失常比LGE。
Objective Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the reference standard for non-invasive assessment of fibrosis. In hypertrophic cardiomyopathy (HCM) patients the histological substrate for LGE is still unknown. The aim of this study was to assess the ability of LGE and strain echocardiography to detect type and extent of myocardial fibrosis in obstructive HCM patients undergoing septal myectomy.Methods Thirty-two HCM patients (age 6010) were included in this cross-sectional study and preoperatively examined by speckle-tracking strain echocardiography and LGE-CMR (n=21). Histological fibrosis was classified as interstitial, replacement and total.Results Histological fibrosis was present in 31 patients. The percentage of total, interstitial and replacement fibrosis was 15(7, 31)%, 11(5, 24)% and 3(1, 6)%, respectively. Reduced longitudinal septal strain correlated with total (r=0.50, p=0.01) and interstitial (r=0.40, p=0.03), but not with replacement fibrosis (r=0.28, p=0.14). Septal LGE was detected in 13/21 (62%), but percentage LGE did not correlate with total fibrosis (r=0.25, p=0.28). Extent of fibrosis did not differ between patients with and without septal LGE (20(9, 58)% versus 14(5, 19)% p=0.41). Patients with ventricular arrhythmias (n=8) had lower septal longitudinal strain and increased extent total and interstitial fibrosis in myectomy specimens, but no differences were demonstrated in LGE. Reduced longitudinal septal strain and increased extent of interstitial fibrosis predicted ventricular arrhythmias independently of age and gender.Conclusions In myectomised HCM patients, reduced longitudinal septal strain correlated better with interstitial and total fibrosis in myectomy specimens, and was a more powerful tool to predict arrhythmias than LGE.