Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging
Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging
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DOI：
10.1038/sj.ki.5000249
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发表时间：
2006-05-01
影响因子：
19.6
通讯作者：
Jardine, A. G.
中科院分区：
文献类型：
--
作者：
Mark, P. B.;Johnston, N.;Jardine, A. G.
终末期肾衰竭（ESRF）患者早发心血管疾病的风险增加。左心室（LV）异常，所谓的“尿毒症心肌病”，与较差的结果。心脏磁共振成像（CMR）可准确定义LV尺寸并识别潜在的心肌病理。我们研究了伴有CMR的ESRF患者左室功能与心肌病理的关系。共有134例ESRF患者接受了CMR。使用钆-二乙撑三胺五乙酸（DTPA）后获得的进一步图像评估LV功能。心肌纤维化的存在是由晚期钆增强（LGE）。确定了两种主要的心肌病理。共有19名患者（14.2%）显示代表心肌梗死的“内膜下LGE”，这与传统的心血管危险因素相关，包括缺血性心脏病（IHD）（P < 0.001）、高胆固醇血症（P < 0.05）和糖尿病（P < 0.01）病史。与无LGE证据的患者相比，有内膜下LGE的患者具有更大的LV质量（P < 0.05）、LV扩张（P < 0.01）和LV收缩功能障碍（P < 0.001）。第二种模式，“弥漫性LGE”，在19例患者（14.2%）中观察到，似乎代表弥漫性心肌纤维化的局部区域。弥漫性LGE与无LGE患者的左室质量相关（P < 0.01），但与收缩功能不全无关。总的来说，28.4%的患者表现出心肌纤维化的证据，证明了LGE。与描述三种形式的尿毒症心肌病-左心室肥大（LVH）、扩张和收缩功能障碍的已发表文献相比，我们已经证明LVH是尿毒症特有的主要心肌病，而LV扩张和收缩功能障碍是由于潜在的（可能是无症状的）缺血性心脏病。
Patients with end stage renal failure (ESRF) have an increased risk of premature cardiovascular disease. Left ventricular ( LV) abnormalities, so called 'uremic cardiomyopathy', are associated with poorer outcome. Cardiac magnetic resonance imaging (CMR) accurately defines LV dimensions and identifies underlying myocardial pathology. We studied the relationship between LV function and myocardial pathology in ESRF patients with CMR. A total of 134 patients with ESRF underwent CMR. LV function was assessed with further images acquired after gadolinium-diethylentriaminepentaacetic acid ( DTPA). The presence of myocardial fibrosis was indicated by late gadolinium enhancement (LGE). Two main myocardial pathologies were identified. A total of 19 patients (14.2%) displayed 'subendocardial LGE' representing myocardial infarction, which was associated with conventional cardiovascular risk factors including a history of ischemic heart disease (IHD) (P < 0.001), hypercholesterolemia (P < 0.05), and diabetes (P < 0.01). Patients with subendocardial LGE had greater LV mass (P < 0.05), LV dilation ( P < 0.01), and LV systolic dysfunction (P < 0.001) compared to patients with no evidence of LGE. The second pattern, 'diffuse LGE', seen in 19 patients ( 14.2%) appeared to represent regional areas of diffuse myocardial fibrosis. Diffuse LGE was associated with greater LV mass compared to patients without LGE ( P < 0.01) but not systolic dysfunction. In total, 28.4% of all patients exhibited evidence of myocardial fibrosis demonstrated by LGE. In contrast to published literature describing three forms of uremic cardiomyopathy - left ventricular hypertrophy ( LVH), dilation, and systolic dysfunction, we have shown that LVH is the predominant cardiomyopathy specific to uremia, while LV dilation and systolic dysfunction are due to underlying ( possibly silent) ischemic heart disease.