弥漫性系统性硬化症中的假性梗死模式。心血管磁共振评估

Pseudo-infarction pattern in diffuse systemic sclerosis. Evaluation using cardiovascular magnetic resonance.

作者信息

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

机构信息

Onassis Cardiac Surgery Center, Athens, Greece.

Navy Hospital, Athens, Greece.

出版信息

Int J Cardiol. 2016 Jul 1;214:465-8. doi: 10.1016/j.ijcard.2016.03.235. Epub 2016 Apr 8.

DOI:10.1016/j.ijcard.2016.03.235

PMID:27096964

Abstract

BACKGROUND

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.

RESULTS

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.

CONCLUSION

CMR unveiled that the pattern of myocardial fibrosis in dSSc with Q waves is due to the systemic disease and not to CAD.

摘要

背景

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。

患者与方法

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。

结果

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%。