Detection of Left Ventricular Regional Dysfunction and Myocardial Abnormalities Using Complementary Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis without Cardiac Symptoms: A Pilot Study
Detection of Left Ventricular Regional Dysfunction and Myocardial Abnormalities Using Complementary Cardiac Magnetic Resonance Imaging in Patients with Systemic Sclerosis without Cardiac Symptoms: A Pilot Study
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DOI：
10.2169/internalmedicine.55.4441
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发表时间：
2016-01-01
影响因子：
1.2
通讯作者：
Takei, Masami
中科院分区：
文献类型：
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作者：
Kobayashi, Yasuyuki;Kobayashi, Hitomi;Takei, Masami
目的应用互补心脏磁共振(CMR)成像方法检测无心脏症状的系统性硬化症(SSC)患者是否存在左室局部功能障碍和心肌异常。通过对电影MRI获得的左心室中部切片进行特征跟踪分析，计算周向应变和径向应变的峰值收缩区域功能(ECC，%和ERR，%)。此外，我们还通过对比MRI观察了心肌的形态特征。药物应激和静息灌注扫描用于评估微血管或大血管损伤引起的灌注缺陷(PD)，晚期Gd增强(LGE)图像用于评估心肌炎和/或纤维化。结果15例SSC患者和10例健康对照组进行了比较。患者和健康对照组之间的基线特征没有统计学意义上的差异。各节段的平均峰值误差和平均ECC均显著低于对照组(p=0.011和p=0.003)。LGE患者4例(28.6%)，PD患者7例(50.0%)。PD与指端溃疡显著相关(p=0.005)。利用线性回归模型，心肌LGE的存在与ECC峰值显著相关(p=0.024)。调整年龄后，心肌LGE与ECC峰值的关联性增强。结论CMR检测到无心脏症状的SSc患者存在亚临床心肌损害。在无心脏症状的SSc患者中，局部功能障碍可能预示心肌异常。
Objective We sought to detect the presence of left ventricular regional dysfunction and myocardial abnormalities in systemic sclerosis (SSc) patients without cardiac symptoms using a complementary cardiac magnetic resonance (CMR) imaging approach.Methods Consecutive patients with SSc without cardiac symptoms and healthy controls underwent CMR on a 1.5 T scanner. The peak systolic regional function in the circumferential and radial strain (Ecc, % and Err, %) were calculated using a feature tracking analysis on the mid-left ventricular slices obtained with cine MRI. In addition, we investigated the myocardial characteristics by contrast MRI. Pharmacological stress and rest perfusion scans were performed to assess perfusion defect (PD) due to micro-or macrovascular impairment, and late gadolinium enhancement (LGE) images were obtained for the assessment of myocarditis and/or fibrosis.Results We compared 15 SSc patients with 10 healthy controls. No statistically significant differences were observed in the baseline characteristics between the patients and healthy controls. The mean peak Err and Ecc of all segments was significantly lower in the patients than the controls (p=0.011 and p=0.003, respectively). Four patients with LGE (28.6%) and seven patients with PD (50.0%) were observed. PD was significantly associated with digital ulcers (p=0.005). Utilizing a linear regression model, the presence of myocardial LGE was significantly associated with the peak Ecc (p=0.024). After adjusting for age, the association between myocardial LGE and the peak Ecc was strengthened.Conclusion A subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Regional dysfunction might predict the myocardial abnormalities observed in SSc patients without cardiac symptoms.