Lin Lian-Yu, Wu Cho-Kai, Juang Jyh-Ming Jimmy, Wang Yi-Chih, Su Mao-Yuan Marine, Lai Ling-Ping, Hwang Juey-Jen, Chiang Fu-Tien, Tseng Wen-Yih Issac, Lin Jiunn-Lee
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
Sci Rep. 2016 Feb 5;6:20711. doi: 10.1038/srep20711.
Left ventricular (LV) dyssynchrony is associated with poor prognosis in patients with heart failure (HF). The mechanisms leading to LV dyssynchrony are not fully elucidated. This study evaluates whether myocardium regional variation in interstitial fibrosis is associated with LV dyssynchrony. Forty-two patients with systolic heart failure (SHF), 76 patients with heart failure with preserved ejection fraction (HFpEF) and 20 patients without HF received cardiovascular magnetic resonance imaging (MRI) study. LV was divided into 18 segments by short-axis view. In each segment, regional extracellular volume fraction (ECV) and the time taken to reach minimum regional volume (Tmv) were derived. Intra-LV dyssynchrony were represented by maximum difference (Dysyn_max) and standard deviation (Dysyn_sd) of all Tmv. The results showed that among the covariates, only age (1.87, 95% CI: 0.61-3.13, p = 0.004) and ECV (3.77, 95% CI: 2.72-4.81, p < 0.001) were positively associated with Tmv. The results remained robust in certain subgroups. In conclusion, we demonstrated that LV myocardium regional variation in interstitial fibrosis is closely related to LV intra-ventricular dyssynchrony irrespective of the LV global function. These data might help explain the pathophysiology of LV dyssynchrony and it's underlying mechanisms leading to poor prognosis.
左心室（LV）不同步与心力衰竭（HF）患者的不良预后相关。导致LV不同步的机制尚未完全阐明。本研究评估心肌间质纤维化的区域差异是否与LV不同步相关。42例收缩性心力衰竭（SHF）患者、76例射血分数保留的心力衰竭（HFpEF）患者和20例无HF患者接受了心血管磁共振成像（MRI）检查。通过短轴视图将LV分为18个节段。在每个节段中，得出区域细胞外容积分数（ECV）和达到最小区域容积所需的时间（Tmv）。LV内不同步由所有Tmv的最大差值（Dysyn_max）和标准差（Dysyn_sd）表示。结果显示，在协变量中，只有年龄（1.87，95%CI：0.61 - 3.13，p = 0.004）和ECV（3.77，95%CI：2.72 - 4.81，p < 0.001）与Tmv呈正相关。在某些亚组中结果仍然稳健。总之，我们证明LV心肌间质纤维化的区域差异与LV心室内不同步密切相关，而与LV整体功能无关。这些数据可能有助于解释LV不同步的病理生理学及其导致不良预后的潜在机制。
