Non-invasive quantitation of myocardial fibrosis using combined tissue harmonic imaging and integrated backscatter analysis in dilated cardiomyopathy
Non-invasive quantitation of myocardial fibrosis using combined tissue harmonic imaging and integrated backscatter analysis in dilated cardiomyopathy
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DOI：
10.1159/000095595
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发表时间：
2007-01-01
期刊：
影响因子：
1.9
通讯作者：
Nakamura, Shinobu
中科院分区：
文献类型：
--
作者：
Mizuno, Reiko;Fujimoto, Shinichi;Nakamura, Shinobu
背景：超声心动图对心肌组织定征提出了挑战，但这种可靠性尚未达到临床应用。本研究探讨组织谐波成像(THI)和背向散射积分分析(IB)联合应用能否为特发性扩张型心肌病(DCM)心肌纤维化提供可靠的定量信息，并与心肌活检结果进行比较。方法：对56例扩张型心肌病患者进行研究。所有患者均行左室心内膜心肌活检和IB基础成像(FI)及THI检查。结果：在超声心动图图像质量良好的患者中，心肌纤维化面积百分比(%纤维化)与FI或THI测量的心动周期内背向散射积分(m-IB)之间具有良好的相关性，且与THI的相关性比FI更密切。而在图像质量较差的患者中，m-IB与%纤维化的相关性仅在FI上较弱，而在THI上相关性很好。由受试者工作特征曲线得到的m-IB和THI的4个临界值，对纤维化程度大于或小于25%、30%、35%和40%的患者具有较高的敏感性和特异性。多因素分析显示，m-IB和THI是判断心肌纤维化严重程度的独立预测因子。结论：IB和THI联合应用是一种临床适用的方法，可替代心肌活检定量评价DCM的心肌纤维化。版权所有(C)2007 S.Karger AG，巴塞尔。
Background: Echocardiographic modalities have challenged the myocardial tissue characterization, but this reliability has not reached to the clinical use. This study investigated whether combined tissue harmonic imaging (THI) and integrated backscatter analysis (IB) provide the reliable and quantitative information about myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM) in comparison with myocardial biopsy findings. Methods: We studied 56 patients with DCM. All patients underwent left ventricular endomyocardial biopsy and IB with fundamental imaging (FI) and THI. Results: In patients with good echocardiographic image quality, excellent correlations between the percentage of area occupied by myocardial fibrosis (% fibrosis) and the mean of integrated backscatter during a cardiac cycle (m-IB) measured with FI or THI were seen, and the correlation was closer with THI compared with FI. While in patients with poor image quality the correlation between m-IB and % fibrosis was only modest with FI, but the correlation was excellent with THI. Four cut-off values of m-IB with THI obtained from receiver operating characteristic curve discriminated between % fibrosis of more and less than 25, 30, 35, and 40% with high sensitivity and specificity. Multivariate analysis revealed that m-IB with THI was an independent predictor for discrimination of the severity of myocardial fibrosis. Conclusion: Combined IB and THI are a clinically applicable method and may be an alternative to myocardial biopsy in evaluating quantitatively myocardial fibrosis in DCM. Copyright (c) 2007 S. Karger AG, Basel.