Bello David, Shah Dipan J, Farah George M, Di Luzio Silvia, Parker Michele, Johnson Maryl R, Cotts William G, Klocke Francis J, Bonow Robert O, Judd Robert M, Gheorghiade Mihai, Kim Raymond J
Feinberg Cardiovascular Research Institute, Division of Cardiology, Northwestern University, Chicago, Ill, USA.
Circulation. 2003 Oct 21;108(16):1945-53. doi: 10.1161/01.CIR.0000095029.57483.60. Epub 2003 Oct 13.
In some patients with heart failure, beta-blockers can improve left ventricular (LV) function and reduce morbidity and mortality. We hypothesized that gadolinium-enhanced cardiovascular magnetic resonance imaging (CMR) can predict reversible myocardial dysfunction and remodeling in heart failure patients treated with beta-blockers.
Forty-five patients with chronic heart failure underwent CMR. Contrast imaging using gadolinium was performed to obtain high-resolution spatial maps of myocardial scarring and viability. Cine imaging was performed to assess LV function and morphology and was repeated in 35 patients after 6 months of beta-blockade. Gadolinium CMR demonstrated scarring in 30 of 45 patients (67%). Scarring was found in 100% of patients with ischemic cardiomyopathy (28 of 28) but in only 12% with nonischemic cardiomyopathy (2 of 17). In the 35 patients who were maintained on beta-blockers and had a second study, there was an inverse relation between the extent of scarring at baseline and the likelihood of contractile improvement 6 months later (P<0.001). For instance, contractility improved in 56% (674 of 1207) of regions with no scarring but in only 3% with >75% scarring (8 of 232). Multivariate analysis showed that the amount of dysfunctional but viable myocardium by CMR was an independent predictor of the change in ejection fraction (P=0.01), mean wall motion score (P=0.0007), LV end-diastolic volume index (P=0.007), and LV end-systolic volume index (P< or =0.0001).
For heart failure patients treated with beta-blockers, gadolinium-enhanced CMR predicts the response in LV function and remodeling.
在一些心力衰竭患者中，β受体阻滞剂可改善左心室（LV）功能并降低发病率和死亡率。我们推测钆增强心血管磁共振成像（CMR）可预测接受β受体阻滞剂治疗的心力衰竭患者可逆性心肌功能障碍和重塑情况。
45例慢性心力衰竭患者接受了CMR检查。使用钆进行对比成像以获取心肌瘢痕形成和存活情况的高分辨率空间图。进行电影成像以评估左心室功能和形态，并在35例患者接受β受体阻滞剂治疗6个月后重复进行。钆增强CMR显示45例患者中有30例（67%）存在瘢痕形成。在100%的缺血性心肌病患者（28例中的28例）中发现瘢痕形成，但在非缺血性心肌病患者中仅为12%（17例中的2例）。在35例持续使用β受体阻滞剂并进行第二次检查的患者中，基线时瘢痕形成的程度与6个月后收缩功能改善的可能性呈负相关（P<0.001）。例如，无瘢痕形成区域的56%（1207个区域中的674个）收缩功能得到改善，但瘢痕形成>75%的区域中只有3%（232个区域中的8个）收缩功能得到改善。多因素分析显示，CMR检测到的功能失调但存活的心肌量是射血分数变化（P=0.01）、平均壁运动评分（P=0.0007）、左心室舒张末期容积指数（P=0.007）和左心室收缩末期容积指数（P≤0.0001）变化的独立预测因素。
对于接受β受体阻滞剂治疗的心力衰竭患者，钆增强CMR可预测左心室功能和重塑的反应。
