John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom; Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, United Kingdom; National Centre for Sport and Exercise Medicine, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom.
John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom; Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, United Kingdom.
Kidney Int. 2016 Oct;90(4):835-44. doi: 10.1016/j.kint.2016.07.014.
Left ventricular hypertrophy and myocardial fibrosis frequently occur in patients with end-stage renal disease receiving hemodialysis therapy and are associated with poor prognosis. Native T1 mapping is a novel cardiac magnetic resonance imaging technique that measures native myocardial T1 relaxation, a surrogate of myocardial fibrosis. Here we compared global and segmental native myocardial T1 time and global longitudinal, circumferential and segmental strain, and cardiac function of 35 hemodialysis patients and 22 control individuals. The median native global T1 time was significantly higher in the hemodialysis than the control group (1270 vs. 1085 ms), with the septal regions of hemodialysis patients having significantly higher median T1 times than nonseptal regions (1293 vs. 1252 ms). The mean peak global circumferential strain and global longitudinal strain were both significantly reduced in hemodialysis patients compared with controls (-18.3 vs. -21.7 and -16.1 vs. -20.4, respectively). Systolic strain was also significantly reduced in the septum compared with the nonseptal myocardium in hemodialysis patients (-16.2 vs. -21.9) but not in control subjects. Global circumferential strain and longitudinal strain significantly correlated with global native T1 values (r = 0.41 and 0.55, respectively), and the septal native T1 significantly correlated with the septal systolic strain (r = 0.46). Thus, myocardial fibrosis may be assessed noninvasively with native T1 mapping; the interventricular septum appears to be particularly prone to the development of fibrosis in hemodialysis patients.
左心室肥厚和心肌纤维化在接受血液透析治疗的终末期肾病患者中很常见，与预后不良有关。本地产 T1 映射是一种新的心脏磁共振成像技术，可测量本地产心肌 T1 弛豫，这是心肌纤维化的替代指标。在这里，我们比较了 35 名血液透析患者和 22 名对照组个体的整体和节段性本地产心肌 T1 时间以及整体纵向、周向和节段应变和心功能。血液透析组的中位数本地产整体 T1 时间明显高于对照组（1270 与 1085 毫秒），血液透析患者的室间隔区域的 T1 时间中位数明显高于非室间隔区域（1293 与 1252 毫秒）。与对照组相比，血液透析患者的平均峰值整体周向应变和整体纵向应变均显著降低（分别为-18.3 与-21.7 和-16.1 与-20.4）。与对照组相比，血液透析患者的室间隔收缩应变也明显降低（-16.2 与-21.9），但非室间隔心肌没有降低。整体周向应变和纵向应变与整体本地产 T1 值显著相关（分别为 r=0.41 和 0.55），室间隔本地产 T1 与室间隔收缩应变显著相关（r=0.46）。因此，心肌纤维化可以通过本地产 T1 映射进行无创评估；室间隔似乎特别容易在血液透析患者中发生纤维化。
