Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis
Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis
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DOI：
10.1016/j.ijcard.2016.11.282
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发表时间：
2017-03-15
影响因子：
3.5
通讯作者：
Pedrotti, Patrizia
中科院分区：
文献类型：
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作者：
Ammirati, Enrico;Moroni, Francesco;Pedrotti, Patrizia
背景资料：心脏磁共振（CMR）晚期钆增强（LGE）的存在对急性心肌炎（AM）患者具有诊断和预后价值。本研究的目的是量化AM后早期LGE延伸（LGE%）的变化，并评估其与双心室功能和形态的关系。我们调查了76例连续的AM患者（胸痛/心力衰竭/无法由其他原因解释的室性心律失常急性发作，和肌钙蛋白升高），符合CMR标准，基于症状发作后中位时间6天T2加权图像上的心肌水肿和造影后图像上的LGE。我们量化了49名患者基线时和148天后的LGE%。结果：左心室（LV）射血分数（EF）中位数为64%（四分位距[Q1-Q3]：56-67%），LGE%为9.4%（Q1-Q3：7.5-13.2%）。LGE%与LV收缩末期容积指数（LV-ESVi; r = +0.34; p = 0.003）相关。LGE%与LV-EF（r = -0.31; p = 0.009）和CMR扫描时间（r = -0.25; p = 0.028）呈负相关。在49例进行第二次CMR扫描的患者中，尽管LV-EF无显著变化，但观察到LGE%显著降低（p < 0.0001），与基线相比相对降低42%。在随访时显示LV-ESVi增加的患者LGE%下降较低（p = 0.038）。结论：在AM急性期，LGE延长是一个动态过程，反映了LV功能受损，并具有时间依赖性。LGE%在AM后的前几个月内是CMR参数中相对变化最大的参数之一。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Background: The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology.Methods: We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6 days from onset of symptoms. We quantified LGE% at baseline and after 148 days in 49 patients.Results: Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r = +0.34; p = 0.003). LGE% was inversely correlated with LV-EF (r = -0.31; p = 0.009) and time to CMR scan (r = -0.25; p = 0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p < 0.0001) with a relative reduction of 42% compared with baseline. Patients showing increased LV-ESVi at follow up had a lower decrease of LGE% (p = 0.038).Conclusions: In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM. (C) 2016 Elsevier Ireland Ltd. All rights reserved.