Moreo Antonella, Ambrosio Giuseppe, De Chiara Benedetta, Pu Min, Tran Tam, Mauri Francesco, Raman Subha V
Ohio State University, Columbus, Ohio 43210, USA.
Circ Cardiovasc Imaging. 2009 Nov;2(6):437-43. doi: 10.1161/CIRCIMAGING.108.838367. Epub 2009 Sep 3.
Fibrosis is a common end point of many pathological processes affecting the myocardium and may alter myocardial relaxation properties. By measuring myocardial fibrosis with cardiac magnetic resonance and diastolic function with Doppler echocardiography, we sought to define the influence of fibrosis on left ventricular diastolic function.
Two hundred four eligible subjects from 252 consecutive subjects undergoing late postgadolinium myocardial enhancement (LGE) cardiac magnetic resonance and Doppler echocardiography were investigated. Subjects with normal diastolic function exhibited no or minimal fibrosis (median LGE score, 0; interquartile range, 0 to 0). In contrast, the majority of patients with cardiomyopathy (regardless of underlying cause) had abnormal diastolic function indices and substantial fibrosis (median LGE score, 3; interquartile range, 0 to 6.25). Prevalence of LGE positivity by diastolic filling pattern was 13% in normal, 48% in impaired relaxation, 78% in pseudonormal, and 87% in restrictive filling (P<0.0001). Similarly, LGE score was significantly higher in patients with deceleration time <150 ms (P<0.012), and it progressively increased with increasing left ventricular filling pressure estimated by tissue Doppler imaging-derived E/E' (P<0.0001). After multivariate analysis, LGE remained significantly correlated with degree of diastolic dysfunction (P=0.0001).
Severity of myocardial fibrosis by LGE significantly correlates with the degree of diastolic dysfunction in a broad range of cardiac conditions. Noninvasive assessment of myocardial fibrosis may provide valuable insights into the pathophysiology of left ventricular diastolic function and therapeutic response.
纤维化是影响心肌的许多病理过程的常见终点，可能会改变心肌舒张特性。通过心脏磁共振测量心肌纤维化，并通过多普勒超声心动图测量舒张功能，我们试图确定纤维化对左心室舒张功能的影响。
对252名连续接受钆增强晚期心肌强化（LGE）心脏磁共振和多普勒超声心动图检查的受试者中的204名符合条件的受试者进行了研究。舒张功能正常的受试者无纤维化或仅有轻微纤维化（LGE评分中位数为0；四分位间距为0至0）。相比之下，大多数心肌病患者（无论潜在病因如何）舒张功能指标异常且有大量纤维化（LGE评分中位数为3；四分位间距为0至6.25）。根据舒张期充盈模式，LGE阳性的患病率在正常组为13%，在舒张功能受损组为48%，在假性正常组为78%，在限制性充盈组为87%（P<0.0001）。同样，减速时间<150毫秒的患者LGE评分显著更高（P<0.012），并且随着组织多普勒成像衍生的E/E'估计的左心室充盈压升高而逐渐增加（P<0.0001）。多变量分析后，LGE仍与舒张功能障碍程度显著相关（P=0.0001）。
LGE评估的心肌纤维化严重程度与广泛心脏疾病中的舒张功能障碍程度显著相关。心肌纤维化的无创评估可能为左心室舒张功能的病理生理学和治疗反应提供有价值的见解。
