Examining the impact of inducible ischemia on myocardial fibrosis and exercise capacity in hypertrophic cardiomyopathy.
Examining the impact of inducible ischemia on myocardial fibrosis and exercise capacity in hypertrophic cardiomyopathy.
复制标题
DOI：
10.1038/s41598-020-71394-z
复制
发表时间：
2020-09-29
影响因子：
4.6
通讯作者：
Shah DJ
中科院分区：
文献类型：
--
作者：
Malahfji M;Senapati A;Debs D;Angulo C;Zhan Y;Nagueh SF;Shah DJ
肥厚型心肌病（HCM）的心肌缺血与不良结局相关。血管舒张负荷心脏磁共振（CMR）可以检测和定量HCM患者的诱导性缺血。我们假设CMR评估的心肌缺血与HCM患者的心肌纤维化和运动能力降低有关。在105例连续HCM患者中，我们对左心室体积和质量、室壁厚度、节段性室壁增厚百分比、节段性晚期钆增强（LGE）和细胞外容积分数（ECV）进行了定量评估。在压力和休息时，为每个节段生成首过灌注序列的时间-信号强度曲线。计算心肌灌注储备指数（MPRI）（应力/静息斜率）。纳入了在30天内接受超声心动图（n = 73）和心肺运动试验（n = 37）的患者。平均年龄为53.2 ± 15.4岁; 60%为男性，82例患者患有不对称肥大。舒张末期厚度≥ 1.2 cm的节段具有较高的LGE负荷（每个节段4.1% vs 0.5%）、降低的MPRI（2.6 ± 1.5 vs 3.1 ± 1.8）和降低的增厚百分比（48.9 ± 41.7% vs 105.3 ± 59.5%）（所有比较均P < 0.0001）。心肌缺血患者（MPRI < 2的任何节段）更可能有动态性左室流出道（LVOT）梗阻（63.3% vs 36.7%，P = 0.01），吸烟者（17% vs 6.9%，P = 0.04），ECV更高（30% vs 28%，P = 0.04）。两组的总LGE负荷相似（P = 0.47）。缺血负荷增加（MPRI < 2的节段数）与通气效率（VE/VCO 2）降低相关（P < 0.001），但与峰值耗氧量和无氧阈值无关（P > 0.2）。在患者水平的多变量logistic回归模型中，只有LVOT阻塞仍然是缺血负荷的重要预测因素（P = 0.03）。在HCM患者中，即使在无LGE的节段中，CMR引起的心肌缺血与心肌节段性功能障碍和间质纤维化相关，如ECV所评估的。相反，通过总LGE负荷评估，定量缺血负荷与替代性纤维化无关。缺血患者动态LVOT梗阻的发生率更高;在一部分心肺运动试验患者中，缺血负荷与透析效率恶化相关。
Myocardial ischemia in hypertrophic cardiomyopathy (HCM) is associated with poor outcomes. Vasodilator stress cardiac magnetic resonance (CMR) can detect and quantitate inducible ischemia in HCM patients. We hypothesized that myocardial ischemia assessed by CMR is associated with myocardial fibrosis and reduced exercise capacity in HCM. In 105 consecutive HCM patients, we performed quantitative assessment of left ventricular volume and mass, wall thickness, segmental wall thickening percent, segmental late Gadolinium enhancement (LGE), and extracellular volume fraction (ECV). Time-signal intensity curves of first pass perfusion sequences were generated for each segment at stress and rest. A myocardial perfusion reserve index (MPRI) (stress/rest slope) was calculated. Patients who underwent an echocardiographic (n = 73) and cardiopulmonary exercise test (n = 37) within 30 days were included. The mean age was 53.2 ± 15.4 years; 60% were male, and 82 patients had asymmetric hypertrophy. Segments with end diastolic thickness ≥ 1.2 cm had a higher burden of LGE (4.1% vs 0.5% per segment), reduced MPRI (2.6 ± 1.5 vs 3.1 ± 1.8) and reduced thickening percent (48.9 ± 41.7% vs. 105.3 ± 59.5%), (P < 0.0001 for all comparisons). Patients with ischemia (any segment with MPRI < 2) were more likely to have dynamic left ventricular outflow tract (LVOT) obstruction (63.3% vs 36.7%, P = 0.01), to be smokers (17% vs 6.9%, P = 0.04), and had a higher ECV (30% vs 28%, P = 0.04). The total LGE burden was similar between the two groups (P = 0.47). Increasing ischemia burden (number of segments with MPRI < 2) was associated with worsened ventilatory efficiency (VE/VCO2) (P < 0.001) but not peak oxygen consumption or anerobic threshold (P > 0.2). In a patient-level multivariable logistic regression model, only LVOT obstruction remained a significant predictor of ischemia burden (P = 0.03). Myocardial ischemia by CMR is associated with myocardial segmental dysfunction and interstitial fibrosis, as assessed by ECV, in HCM patients, even in segments free of LGE. Conversely, quantitative ischemia burden was not associated with replacement fibrosis as assessed by total LGE burden. Patients with ischemia had greater prevalence of dynamic LVOT obstruction; and in a subset of patients with cardiopulmonary exercise testing, ischemia burden was associated with worsened ventilatory efficiency.
登录
查看更多内容
CMR通过自动像素定量的心肌灌注映射，以检测阻塞性冠状动脉疾病和冠状动脉微血管功能障碍：针对侵入性冠状动脉生理学的验证。
DOI：
10.1016/j.jcmg.2018.12.022
发表时间：
2019-10
期刊：
JACC. Cardiovascular imaging
影响因子：
--
作者：
Kotecha T;Martinez-Naharro A;Boldrini M;Knight D;Hawkins P;Kalra S;Patel D;Coghlan G;Moon J;Plein S;Lockie T;Rakhit R;Patel N;Xue H;Kellman P;Fontana M
通讯作者：
Fontana M
DOI：
10.1186/s12968-016-0223-8
发表时间：
2016-01-14
期刊：
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
影响因子：
--
作者：
Villa AD;Sammut E;Zarinabad N;Carr-White G;Lee J;Bettencourt N;Razavi R;Nagel E;Chiribiri A
通讯作者：
Chiribiri A
影响因子：
158.5
作者：
Maron, MS;Olivotto, I;Maron, BJ
通讯作者：
Maron, BJ
影响因子：
24
作者：
Olivotto, I;Cecchi, F;Camici, PG
通讯作者：
Camici, PG
影响因子：
7.5
作者：
Dass, Sairia;Suttie, Joseph J.;Neubauer, Stefan
通讯作者：
Neubauer, Stefan