Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance.
Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance.
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DOI：
10.1186/1532-429x-14-50
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发表时间：
2012-07-28
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影响因子：
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通讯作者：
Prasad SK
中科院分区：
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作者：
Dweck MR;Joshi S;Murigu T;Gulati A;Alpendurada F;Jabbour A;Maceira A;Roussin I;Northridge DB;Kilner PJ;Cook SA;Boon NA;Pepper J;Mohiaddin RH;Newby DE;Pennell DJ;Prasad SK
心血管磁共振(CMR)是确定左心室(LV)质量和容量的金标准无创性方法，但以前尚未被用来表征主动脉狭窄患者的LV重构反应。我们试图用CMR研究主动脉狭窄患者的肥厚程度和肥厚类型。对主动脉中重度狭窄、冠状动脉正常、无其他明显瓣膜病变或心肌病的患者行CMR扫描，用平面测量法和速度图评价瓣膜的严重程度。通过测量左心室质量指数、指数化左心室体积和左心室质量/体积比来研究肥厚的程度和类型。不对称形式的重构和肥厚是由局部室壁增厚≥13 mm和相对心肌节段厚度的1.5倍来定义的。入选主动脉瓣狭窄患者91例，年龄61±21岁，男57例，主动脉瓣面积0.93±0.32cm2。主动脉狭窄程度与肥厚程度(R2=0.012.43，P=0.43)和肥厚类型(P=0.2 2)无关。单因素分析显示，只有男性与LV质量指数相关(P=0.02)。观察到6种类型的左心室适应：正常左心室几何构型(n=11)、向心性重构(n=11)、非对称性重构(n=11)、向心性肥厚(n=34)、非对称性肥厚(n=14)和左心室失代偿(n=10)。不对称表现与肥厚型心肌病的表现有相当大的重叠(壁厚17±2 mm)。我们已经证明，在中度和重度主动脉狭窄患者中，左室适应模式和肥厚程度与瓣膜狭窄的严重程度并不密切相关，而不对称的管壁增厚模式是常见的。ClinicalTrials.gov参考编号：NCT00930735
Cardiovascular magnetic resonance (CMR) is the gold standard non-invasive method for determining left ventricular (LV) mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR. Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening ≥13 mm and >1.5-fold the thickness of the opposing myocardial segment. Ninety-one patients (61±21 years; 57 male) with aortic stenosis (aortic valve area 0.93±0.32cm2) were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43) and pattern (P=0.22) of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02). Six patterns of LV adaption were observed: normal ventricular geometry (n=11), concentric remodeling (n=11), asymmetric remodeling (n=11), concentric hypertrophy (n=34), asymmetric hypertrophy (n=14) and LV decompensation (n=10). Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17±2mm) with hypertrophic cardiomyopathy. We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common. ClinicalTrials.gov Reference Number: NCT00930735