High sensitivity of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens in hypertrophic cardiomyopathy.
High sensitivity of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens in hypertrophic cardiomyopathy.
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DOI：
10.1371/journal.pone.0101465
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Yamagishi M
中科院分区：
文献类型：
--
作者：
Konno T;Hayashi K;Fujino N;Nagata Y;Hodatsu A;Masuta E;Sakata K;Nakamura H;Kawashiri MA;Yamagishi M
心肌瘢痕可以通过心脏磁共振成像和心肌内膜活检来评估。然而，在肥厚型心肌病中，晚期钆增强预测活检标本中显微镜下心肌瘢痕形成的准确性仍然未知。我们研究了在肥厚型心肌病的小活检标本中，整个心脏的晚期钆增强是否反映了显微镜下的心肌瘢痕。回顾性研究了21例连续的肥厚型心肌病患者，他们都接受了心脏磁共振成像和肌内膜活检。所有患者均以右室间隔为心肌内膜活检的靶点。在预测活检标本中显微镜下心肌瘢痕方面，室间隔的晚期钆增强具有极好的敏感性（100%）和较低的特异性（40%）。晚期钆增强在整个心脏的敏感性仍然是100%，特异性为27%，预测显微镜下心肌瘢痕活检标本。纤维化的定量评估显示，整个心脏中的晚期钆增强程度是与活检标本中显微镜下胶原蛋白分数相关的唯一自变量（β = 0.59，95%置信区间：0.15 - 1.0，p = 0.012）。 尽管特异性有所降低，但晚期钆增强对预测肥厚型心肌病显微镜下心肌瘢痕的敏感性极佳。此外，晚期钆增强的严重程度与肥大性心肌病活检标本中胶原蛋白的定量分数独立相关。这些结果表明，晚期钆增强可以反映肥厚型心肌病小活检标本中微观心肌瘢痕的存在和程度。
Myocardial scarring can be assessed by cardiac magnetic resonance imaging with late gadolinium enhancement and by endomyocardial biopsy. However, accuracy of late gadolinium enhancement for predicting microscopic myocardial scarring in biopsied specimens remains unknown in hypertrophic cardiomyopathy. We investigated whether late gadolinium enhancement in the whole heart reflects microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy. Twenty-one consecutive patients with hypertrophic cardiomyopathy who were examined both by cardiac magnetic resonance imaging and by endomyocardial biopsy were retrospectively studied. The right interventricular septum was the target site for endomyocardial biopsy in all patients. Late gadolinium enhancement in the ventricular septum had an excellent sensitivity (100%) with a low specificity (40%) for predicting microscopic myocardial scarring in biopsied specimens. The sensitivity of late gadolinium enhancement in the whole heart remained 100% with a specificity of 27% for predicting microscopic myocardial scarring in biopsied specimens. Quantitative assessments of fibrosis revealed that the extent of late gadolinium enhancement in the whole heart was the only independent variable related to the microscopic collagen fraction in biopsied specimens (β = 0.59, 95% confident interval: 0.15 – 1.0, p = 0.012). Although there was a compromise in the specificity, the sensitivity of late gadolinium enhancement was excellent for prediction of microscopic myocardial scarring in hypertrophic cardiomyopathy. Moreover, the severity of late gadolinium enhancement was independently associated with the quantitative collagen fraction in biopsied specimens in hypertrophic cardiomyopathy. These findings indicate that late gadolinium enhancement can reflect both the presence and the extent of microscopic myocardial scarring in the small biopsied specimens in hypertrophic cardiomyopathy.
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影响因子：
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作者：
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通讯作者：
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Mewton, Nathan;Liu, Chia Ying;Croisille, Pierre;Bluemke, David;Lima, Joao A. C.
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