Mavrogeni Sophie, Karabela Georgia, Koutsogeorgopoulou Loukia, Stavropoulos Efthymios, Katsifis Gikas, Plastiras Sotiris C, Kitas George D, Panopoulos Stylianos, Pentazos George, Tzatzaki Eleni, Markousis-Mavrogenis George, Kolovou Genovefa, Sfikakis Petros P
Onassis Cardiac Surgery Center, Athens, Greece.
Navy Hospital, Athens, Greece.
Int J Cardiol. 2016 Jul 1;214:465-8. doi: 10.1016/j.ijcard.2016.03.235. Epub 2016 Apr 8.
Diffuse systemic sclerosis (dSSc) is characterized by vascular lesions and fibrosis. Cardiac involvement, although silent, accounts for 36% of deaths. We hypothesized that cardiovascular magnetic resonance (CMR) can clarify the pathophysiology of Q waves in dSSc patients.
PATIENTS-METHODS: 105 dSSc, aged 48±2years, with atypical symptoms and normal routine assessment, were evaluated by ECG and CMR using a 1.5 T system. Biventricular function was assessed by steady-state free-precession sequence (SSFP). To identify fibrosis, late gadolinium enhanced areas (LGE) were evaluated 15min after injection of 0.2mmol/kg gadolinium-DTPA and expressed as % of LV mass.
Q waves in V1-V5 (Group A), II, III, AVF (Group B) and I, AVL, II, III, AVF, V1-V5 (Group C) were found in 25/105, 8/105 and 5/105 dSSc, respectively. In 25 dSSc with Q in V1-V6, patchy intramyocardial LGE was detected in 24/25 and involved 8±2% of LV mass. LGE involved the intraventricular septum (IVS) in 11/24 and the lateral wall (LAT) in 5/24 dSSc. Only in 1/25 dSSc, an anterior, transmural LGE, due to LAD occlusion, was identified. In 8 dSSc with Q in II, III, AVF, patchy intramyocardial LGE was detected in the inferior wall and involved 5±2% of LV mass. In 5 dSSc with Q in V1-V5, II, III, AVF, patchy intramyocardial LGE was detected in anterior and inferolateral wall and involved 9±2% of LV mass.
CMR unveiled that the pattern of myocardial fibrosis in dSSc with Q waves is due to the systemic disease and not to CAD.
弥漫性系统性硬化症（dSSc）的特征为血管病变和纤维化。心脏受累虽无明显症状，但却是36%的死亡原因。我们推测心血管磁共振成像（CMR）能够阐明dSSc患者Q波的病理生理学机制。
105例年龄为48±2岁、有非典型症状且常规评估正常的dSSc患者，采用1.5T系统进行心电图和CMR评估。通过稳态自由进动序列（SSFP）评估双心室功能。为识别纤维化，在注射0.2mmol/kg钆喷酸葡胺15分钟后评估延迟钆增强区域（LGE），并以左心室质量的百分比表示。
在105例dSSc患者中，分别有25例（V1-V5导联出现Q波，A组）、8例（II、III、AVF导联出现Q波，B组）和5例（I、AVL、II、III、AVF、V1-V5导联出现Q波，C组）出现Q波。在25例V1-V6导联出现Q波的dSSc患者中，24例（24/25）检测到心肌内散在LGE，累及左心室质量的8±2%。在24例患者中，11例（11/24）LGE累及室间隔（IVS），5例（5/24）累及侧壁（LAT）。仅1例（1/25）dSSc患者因左前降支闭塞出现前壁透壁性LGE。在8例II、III、AVF导联出现Q波的dSSc患者中，下壁检测到心肌内散在LGE，累及左心室质量的5±2%。在5例V1-V5、II、III、AVF导联出现Q波的dSSc患者中，前壁和下侧壁检测到心肌内散在LGE，累及左心室质量的9±2%。
CMR显示，dSSc患者出现Q波时的心肌纤维化模式是由系统性疾病引起，而非冠状动脉疾病所致。
