Extracellular volume quantification in isolated hypertension - changes at the detectable limits?
Extracellular volume quantification in isolated hypertension - changes at the detectable limits?
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细胞外体积定量在孤立的高血压 - 可检测到的限制下变化？
DOI：
10.1186/s12968-015-0176-3
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发表时间：
2015-08-12
期刊：
影响因子：
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通讯作者：
Moon JC
中科院分区：
文献类型：
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作者：
Treibel TA;Zemrak F;Sado DM;Banypersad SM;White SK;Maestrini V;Barison A;Patel V;Herrey AS;Davies C;Caulfield MJ;Petersen SE;Moon JC
弥漫性心肌纤维化（DMF）在心血管疾病中很重要，但直到最近只能通过侵入性活检进行评估。我们假设通过 T1 图谱测量的 DMF 在单纯性全身性高血压中升高。在一项针对三级专科中心控制良好的高血压患者的研究中，46 名高血压患者（中位年龄 56 岁，范围 21 至 78 岁，52% 男性）和 50 名健康志愿者（中位年龄 45 岁，范围 28 至 69，52% 男性）使用细胞外容量 (ECV) 平衡对比技术在 1.5 T 下进行了 T1 映射 (ShMOLLI) 临床 CMR量化。患者接受 24 小时自动血压监测 (ABPM)、舒张功能超声心动图评估、主动脉僵硬度评估以及 NT-pro-BNP 和胶原生物标志物测量。晚期钆增强 (LGE) 在 46 名患者中的 6 名中揭示了显着的意想不到的潜在病理（13%；心肌梗塞 n = 3；肥厚性心肌病 (HCM) n = 3）；这些后来被排除在外。其余 40 名患者中，有 11 名 (28%) 观察到有限的非缺血性 LGE 模式。接受治疗的高血压患者（平均 2.2 名药物）的平均 ABPM 为 152/88 mmHg，但只有 35% (14/40) 患有左心室肥厚（LVH；左心室质量男性 > 90 g/m2；女性 > 78 g/m2）。高血压患者和对照组的天然心肌 T1 相似（955±±30 ms 与 965±±38 ms，p=±0.16）。 ECV 的差异未达到显着性（0.26±0.02 与 0.27±0.03，p=0.06）。在 LVH 亚组中，ECV 显着较高（0.28±0.03 对比 0.26±0.02，p<0.001）。在控制良好的高血压患者中，传统 CMR 发现了以前甚至在本研究期间超声心动图未检测到的重大潜在疾病（慢性梗塞，HCM）。 T1 映射显示弥漫性心肌纤维化增加，但增加幅度很小，并且仅发生在 LVH 中。
Diffuse myocardial fibrosis (DMF) is important in cardiovascular disease, however until recently could only be assessed by invasive biopsy. We hypothesised that DMF measured by T1 mapping is elevated in isolated systemic hypertension. In a study of well-controlled hypertensive patients from a specialist tertiary centre, 46 hypertensive patients (median age 56, range 21 to 78, 52 % male) and 50 healthy volunteers (median age 45, range 28 to 69, 52 % male) underwent clinical CMR at 1.5 T with T1 mapping (ShMOLLI) using the equilibrium contrast technique for extracellular volume (ECV) quantification. Patients underwent 24-hours Automated Blood Pressure Monitoring (ABPM), echocardiographic assessment of diastolic function, aortic stiffness assessment and measurement of NT-pro-BNP and collagen biomarkers. Late gadolinium enhancement (LGE) revealed significant unexpected underlying pathology in 6 out of 46 patients (13 %; myocardial infarction n = 3; hypertrophic cardiomyopathy (HCM) n = 3); these were subsequently excluded. Limited, non-ischaemic LGE patterns were seen in 11 out of the remaining 40 (28 %) patients. Hypertensives on therapy (mean 2.2 agents) had a mean ABPM of 152/88 mmHg, but only 35 % (14/40) had left ventricular hypertrophy (LVH; LV mass male > 90 g/m2; female > 78 g/m2). Native myocardial T1 was similar in hypertensives and controls (955 ± 30 ms versus 965 ± 38 ms, p = 0.16). The difference in ECV did not reach significance (0.26 ± 0.02 versus 0.27 ± 0.03, p = 0.06). In the subset with LVH, the ECV was significantly higher (0.28 ± 0.03 versus 0.26 ± 0.02, p < 0.001). In well-controlled hypertensive patients, conventional CMR discovered significant underlying diseases (chronic infarction, HCM) not detected by echocardiography previously or even during this study. T1 mapping revealed increased diffuse myocardial fibrosis, but the increases were small and only occurred with LVH.