4789Non-invasive imaging of myocardial disarray associates with ventricular arrhythmia in hypertrophic cardiomyopathy
4789Non-invasive imaging of myocardial disarray associates with ventricular arrhythmia in hypertrophic cardiomyopathy
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4789 心肌紊乱的无创成像与肥厚型心肌病的室性心律失常相关
DOI：
10.1093/eurheartj/ehx493.4789
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发表时间：
2017
影响因子：
39.3
通讯作者：
Ariga R
中科院分区：
文献类型：
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作者：
Ariga R
背景：预测肥厚型心肌病 (HCM) 中的心源性猝死 (SCD) 仍然是一个挑战，因为大多数患者症状轻微，预期寿命正常。死于 HCM 的患者的一个标志性尸检特征是片状心肌紊乱。紊乱是致命性心律失常的可能病灶。 目的：我们试图以非侵入方式评估活体 HCM 患者的心肌紊乱，并假设 24 小时动态心电图显示非持续性室性心动过速 (NSVT) 的 HCM 会出现更大的紊乱。 方法：66 名 HCM 患者（46±sd16 岁，69% 男性； 97% 无症状或轻度症状）和 32 名匹配对照者接受了基底、中部和心尖心室短轴切片的弥散张量 (DTI)、电影和晚期钆增强 (LGE) 磁共振成像。通过从扩散张量测量的分数各向异性 (FA) 来评估肌细胞排列（混乱）的变异性，并在每个切片的六个 AHA 片段中取平均值。分别在匹配的电影和 LGE 图像上评估每个节段是否存在肥大 (> 12mm) 和局灶性纤维化。拟合线性混合效应模型来解释重复节段测量的患者内部相关性以及切片节段位置对 FA 的影响。将肥大和 LGE 添加到模型中，以检查它们对 HCM 患者 FA 的影响。结果：与对照组相比，HCM 中 FA 减少（0.46 [95% CI 0.48 - 0.50] vs 0.49 [0.45 - 0.47]，p = 0.001）。在 HCM 中，LGE 是 FA 的显着预测因子（有或没有 LGE 的节段；0.44 [0.43 至 0.45] vs 0.47 [0.46 至 0.48]，p < 0.001），但肥大则不是（p = 0.06）。即使考虑到 LGE 的影响，患有 NSVT 的个体 (n= 12) 也具有较低的 FA，但仅限于特定节段（节段与 NSVT 的相互作用，p= 0.007）。成对比较表明，无论是否包含 LGE 作为协变量，NSVT 患者中前段的 FA 均局部减少（0.41 [0.35 至 0.46] vs 0.47 [0.44 至 0.50]，所有 p < 0.02 Bonferroni 校正 18 个节段比较）。该部分中的 FA 以最小的重叠区分 NSVT 患者和对照组。
Background: Predicting sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains a challenge as most patients are minimally symptomatic with a normal life expectancy. A hallmark post-mortem feature in patients dying of HCM is patchy myocardial disarray. Disarray is a likely nidus for fatal arrhythmia.Purpose: We sought to assess myocardial disarray non-invasively in living patients with HCM and hypothesised that HCM with non-sustained ventricular tachycardia (NSVT) on 24-hour Holter ECG will have greater disarray.Methods: 66 HCM patients (46±sd16 years, 69% male; 97% asymptomatic or mildly symptomatic) and 32 matched controls underwent diffusion tensor (DTI), cine and late gadolinium enhanced (LGE) magnetic resonance imaging of the basal, mid and apical ventricular short axis slices. Variability in myocyte alignment (disarray) was assessed by fractional anisotropy (FA) measured from the diffusion tensor and was averaged in six AHA segments per slice. The presence of hypertrophy (> 12mm) and focal fibrosis were assessed per segment on matched cine and LGE images respectively. A linear mixed-effects model was fitted to account for any within-patient correlations of repeated segmental measures and the effect of slice-segment position on FA. Hypertrophy and LGE were added to the model to examine their effects on FA in HCM patients.Results: FA was reduced in HCM compared to controls (0.46 [95% CI 0.48 to 0.50] vs 0.49 [0.45 to 0.47], p= 0.001). In HCM, LGE was a significant predictor of FA (segments with and without LGE; 0.44 [0.43 to 0.45] vs 0.47 [0.46 to 0.48], p< 0.001) but hypertrophy was not (p= 0.06). Even accounting for the effect of LGE, individuals with NSVT (n= 12) had lower FA, but only in specific segments (interaction of segment and NSVT, p= 0.007). Pairwise comparisons demonstrated that FA was focally reduced in the mid anterior segment of NSVT patients, both with and without LGE included as a covariate (0.41 [0.35 to 0.46] vs 0.47 [0.44 to 0.50], all p< 0.02 Bonferroni-corrected for 18 segmental comparisons). FA in this segment discriminated NSVT patients from controls with minimal overlap.