Metabolic Dysfunction in Aortic Stenosis: A Key Piece of the Pathophysiological Puzzle.
Metabolic Dysfunction in Aortic Stenosis: A Key Piece of the Pathophysiological Puzzle.
复制标题
主动脉瓣狭窄的代谢功能障碍：病理生理学难题的关键部分。
DOI：
10.1161/circimaging.123.015977
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Elmariah,Sammy
中科院分区：
文献类型：
--
作者：
Sosnovik,DavidE;Elmariah,Sammy
主动脉瓣狭窄（AS）对心肌施加增加的负荷，根据拉普拉斯定律，心肌必须增加其厚度以维持正常的壁张力。事实上，左心室（LV）壁厚度增加被认为是代偿良好的AS的标志之一。然而，心肌肥厚的严重AS患者的心肌功能是不正常的。多年来，人们已经知道这些患者的左心室（LV）应变降低，即使LV射血分数完全正常。1严重AS患者的心肌也显示出代谢功能障碍、2脂质积聚和纤维化的证据。3这一点已通过磁共振（MR）成像和光谱学直接证明，2并通过血清代谢谱间接证明。[4]然而，这些变化何时开始发展，它们是否在AS病程的早期就被发现，以及它们是否完全可逆，目前尚不清楚。基于经导管的技术能够置换主动脉瓣，且发病率和死亡率较低，5这使得回答这些问题的需求非常迫切。因此，Monga及其同事在本期杂志上的研究是一项非常重要和受欢迎的研究。6
Aortic stenosis (AS) places an increased load on the myocardium, which according to Laplace’s law, must increase its thickness to maintain normal wall tension. Indeed, an increase in left ventricular (LV) wall thickness has been regarded as one of the hallmarks of well-compensated AS. However, myocardial function is not normal in the hypertrophied myocardium of patients with severe AS. It has been known for many years that left ventricular (LV) strain is reduced in these patients, even when LV ejection fraction is completely normal. 1 The myocardium in patients with severe AS also shows evidence of metabolic dysfunction, 2 lipid accumulation, and fibrosis. 3 This has been demonstrated directly using magnetic resonance (MR) imaging and spectroscopy, 2 and indirectly through metabolic profiling of the serum. 4 It has not been clear, however, when these changes begin to develop, whether they are seen early in the course of AS, and whether they are fully reversible. The ability of transcatheter-based techniques to replace the aortic valve with low morbidity and mortality, 5 makes the need to answer these questions highly compelling. The study by Monga and colleagues in this issue of the journal is, therefore, an extremely important and welcomed study. 6
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