小儿心脏移植受者中心肌纤维化的心血管磁共振T1 mapping标志物的组织学验证
Histological validation of cardiovascular magnetic resonance T1 mapping markers of myocardial fibrosis in paediatric heart transplant recipients.
作者信息
Ide Seiko, Riesenkampff Eugenie, Chiasson David A, Dipchand Anne I, Kantor Paul F, Chaturvedi Rajiv R, Yoo Shi-Joon, Grosse-Wortmann Lars
机构信息
Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
出版信息
J Cardiovasc Magn Reson. 2017 Feb 1;19(1):10. doi: 10.1186/s12968-017-0326-x.
BACKGROUND
Adverse fibrotic remodeling is detrimental to myocardial health and a reliable method for monitoring the development of fibrotic remodeling may be desirable during the follow-up of patients after heart transplantation (HTx). Quantification of diffuse myocardial fibrosis with cardiovascular magnetic resonance (CMR) has been increasingly applied and validated histologically in adult patients with heart disease. However, comparisons of CMR findings with histological fibrosis burden in children are lacking. This study aimed to compare native T1 times and extracellular volume fraction (ECV) derived from CMR with the degree of collagen on endomyocardial biopsy (EmBx), and to investigate the association between myocardial fibrosis and clinical as well as functional markers in children after HTx.
METHODS
EmBx and CMR were performed on the same day. All specimens were stained with picrosirius red. The collagen volume fraction (CVF) was calculated as ratio of stained collagen area to total myocardial area on EmBx. Native T1 values and ECV were measured by CMR on a mid-ventricular short axis slice, using a modified look-locker inversion recovery approach.
RESULTS
Twenty patients (9.9 ± 6.2 years of age; 9 girls) after HTx were prospectively enrolled, at a median of 1.3 years (0.02-12.6 years) post HTx, and compared to 24 controls (13.9 ± 2.6 years of age; 12 girls). The mean histological CVF was 10.0 ± 3.4%. Septal native T1 times and ECV were higher in HTx patients compared to controls (1008 ± 32 ms vs 979 ± 24 ms, p < 0.005 and 0.30 ± 0.03 vs 0.22 ± 0.03, p < 0.0001, respectively). CVF showed a moderate correlation with native T1 (r = 0.53, p < 0.05) as well as ECV (r = 0.46, p < 0.05). Native T1 time, but not ECV and CVF, correlated with ischemia time (r = 0.46, p < 0.05).
CONCLUSIONS
CMR-derived fibrosis markers correlate with histological degree of fibrosis on EmBx in children after HTx. Further, native T1 times are associated with longer ischemia times.
背景
不良纤维化重塑对心肌健康有害，在心脏移植（HTx）患者的随访期间，可能需要一种可靠的方法来监测纤维化重塑的发展。心血管磁共振（CMR）对弥漫性心肌纤维化的定量分析已越来越多地应用于成年心脏病患者，并已得到组织学验证。然而，儿童CMR检查结果与组织学纤维化负担的比较尚缺乏。本研究旨在比较CMR得出的固有T1时间和细胞外容积分数（ECV）与心内膜心肌活检（EmBx）的胶原程度，并研究HTx术后儿童心肌纤维化与临床及功能指标之间的关联。
方法
EmBx和CMR在同一天进行。所有标本均用天狼星红染色。计算EmBx上胶原容积分数（CVF），即染色胶原面积与全心肌面积之比。采用改良的Look-Locker反转恢复法，在心室短轴切片上用CMR测量固有T1值和ECV。
结果
前瞻性纳入20例HTx术后患者（年龄9.9±6.2岁；9例女孩），HTx术后中位时间为1.3年（0.02 - 12.6年），并与对照组24例（年龄13.9±2.6岁；12例女孩）进行比较。组织学平均CVF为10.0±3.4%。与对照组相比，HTx患者的室间隔固有T1时间和ECV更高（分别为1008±32毫秒对979±24毫秒，p<0.005；0.30±0.03对0.22±0.03，p<0.0001）。CVF与固有T1（r = 0.53，p<0.05）以及ECV（r = 0.46，p<0.05）呈中度相关。固有T1时间与缺血时间相关（r = 0.46，p<0.05），而ECV和CVF与缺血时间无关。
结论
CMR得出的纤维化标志物与HTx术后儿童EmBx的组织学纤维化程度相关。此外，固有T1时间与更长的缺血时间有关。
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