Karwatowski S P, Chronos N A, Sinclaire H, Forbat S M, St John Sutton M G, Black C, Underwood S R, Pennell D J
Royal Brompton Hospital, London, United Kingdom.
J Cardiovasc Magn Reson. 2000;2(2):109-17. doi: 10.3109/10976640009148679.
The aim of this study was to assess the effect of scleroderma on left ventricular mass and subendocardial function using cardiovascular magnetic resonance (CMR) to determine parameters reflecting early dysfunction from fibrosis. Fifteen patients with a history of scleroderma had left ventricular mass measured with standard techniques and regional subendocardial contractile function assessed using myocardial velocity mapping in the basal short-axis plane with long-axis sensitized velocity mapping. Peak myocardial velocities in systole and diastole were measured to reflect systolic and diastolic function. The variance in the regional myocardial velocity, was determined as a parameter of function heterogeneity around the ventricle. The results were compared with 19 healthy volunteers without a history of cardiovascular disease. In 10 patients, pulmonary transfer factor was measured using a single-breath helium dilution technique. The duration of scleroderma correlated with left ventricular mass (r = 0.7, p < 0.05), the coefficient of variation of velocity (r = 0.63, p < 0.05), and inversely with the mean left ventricular diastolic long-axis velocity (r = -0.63, p < 0.05). There was also a correlation between left ventricular diastolic long-axis velocity and the pulmonary transfer factor (r = 0. 7, p < 0.05). Trends suggested differences between control subjects and scleroderma patients for mean systolic (64 vs. 49 mm/sec, p = 0.09) and diastolic (90 vs. 72 mm/sec, p = 0.07) velocities, as well as velocity variance (26 vs. 33, p = 0.09). In conclusion, there is a relationship between duration of scleroderma and both left ventricular mass and diastolic function, which may result from increased myocardial fibrosis. Trends suggest absolute differences in functional values with control subjects that reflect impaired diastolic and systolic function, with greater regional heterogeneity that is consistent with nonuniform collagen deposition, but a larger sample size is required to confirm this. CMR should be explored further as a technique for monitoring myocardial involvement in scleroderma noninvasively.
本研究的目的是利用心血管磁共振成像（CMR）评估硬皮病对左心室质量和心内膜下功能的影响，以确定反映纤维化早期功能障碍的参数。15例有硬皮病病史的患者采用标准技术测量左心室质量，并在基底部短轴平面使用心肌速度映射结合长轴敏感速度映射评估局部心内膜下收缩功能。测量收缩期和舒张期心肌峰值速度以反映收缩和舒张功能。将心室周围区域心肌速度的方差确定为功能异质性参数。结果与19名无心血管疾病病史的健康志愿者进行比较。在10例患者中，采用单次呼吸氦稀释技术测量肺转移因子。硬皮病病程与左心室质量（r = 0.7，p < 0.05）、速度变异系数（r = 0.63，p < 0.05）呈正相关，与左心室舒张期平均长轴速度呈负相关（r = -0.63，p < 0.05）。左心室舒张期长轴速度与肺转移因子之间也存在相关性（r = 0.7，p < 0.05）。趋势表明，对照组与硬皮病患者在平均收缩期速度（64 vs. 49 mm/秒，p = 0.09）、舒张期速度（90 vs. 72 mm/秒，p = 0.07）以及速度方差（26 vs. 33，p = 0.09）方面存在差异。总之，硬皮病病程与左心室质量和舒张功能之间存在关联，这可能是心肌纤维化增加所致。趋势表明，与对照组相比，功能值存在绝对差异，反映出舒张和收缩功能受损，区域异质性更大，这与胶原沉积不均匀一致，但需要更大样本量来证实这一点。CMR作为一种无创监测硬皮病心肌受累情况的技术，应进一步探索。
