Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Duesseldorf 40221, Germany.
Philips Healthcare, Röntgenstraße 24, Hamburg 22335, Germany.
Eur Heart J Cardiovasc Imaging. 2018 May 1;19(5):574-582. doi: 10.1093/ehjci/jex230.
The aim of this study was to determine the value of T2 mapping for the non-invasive assessment of myocardial inflammation in different stages of systolic left ventricular dysfunction in dilated cardiomyopathy (DCM) in comparison with endomyocardial biopsy (EMB).
A total of 132 subjects were enrolled between 2013 and 2016 (62 controls and 70 patients with DCM). All patients underwent CMR at 1.5 T and received coronary angiogram and EMB. CMR applied standard protocols including T2 mapping with Gradient And SpinEcho sequence (GRASE). Global T2 relaxation time was significantly increased in patients with DCM compared to the healthy controls (T2 time DCM vs. controls: 65.9 ± 6.2 vs. 60.0 ± 4.2 ms; P < 0.001). Of note, patients with the presence of inflammatory cells in EMB exhibited further elevation of T2 values (T2 time in patients with the presence of inflammatory cells vs. T2 time in patients without: 68.8 ± 5.8 vs. 64.7 ± 5.9 ms; P = 0.02). Receiver operating characteristic analysis of our data deciphered a global myocardial T2 time >65.3 ms as the best cut-off for distinction between the healthy controls and patients with myocardial inflammation [sensitivity 93%, specificity 90%, P < 0.01, area under the curve (AUC) 0.95]. In patients with DCM, this threshold identified patients with biopsy-proven inflammation with a sensitivity of 79% and specificity 58% (AUC 0.72).
In patients with DCM and presence of inflammatory cells in the myocardium, myocardial T2 relaxation times may help to non-invasively detect myocardial inflammation. Although there is an overlap of T2 values between patients and healthy controls, T2 mapping may facilitate the identification of patients who may benefit from EMB for therapeutic decision-making.
本研究旨在比较 T2 映射与心肌活检（EMB），以评估不同阶段扩张型心肌病（DCM）收缩性左心功能障碍患者心肌炎症的无创评估价值。
2013 年至 2016 年间共纳入 132 例患者（对照组 62 例，DCM 患者 70 例）。所有患者均在 1.5T 磁共振上进行 CMR，并接受冠状动脉造影和 EMB。CMR 应用标准方案，包括梯度和自旋回波序列（GRASE）的 T2 映射。与健康对照组相比，DCM 患者的整体 T2 弛豫时间明显增加（DCM 患者的 T2 时间与对照组相比：65.9±6.2 比 60.0±4.2 毫秒；P<0.001）。值得注意的是，EMB 中存在炎症细胞的患者 T2 值进一步升高（有炎症细胞患者的 T2 时间与无炎症细胞患者的 T2 时间相比：68.8±5.8 比 64.7±5.9 毫秒；P=0.02）。我们数据的受试者工作特征分析显示，全球心肌 T2 时间>65.3 毫秒可作为区分健康对照组和心肌炎症患者的最佳截止值[敏感性 93%，特异性 90%，P<0.01，曲线下面积（AUC）0.95]。在 DCM 患者中，该阈值可识别出活检证实有炎症的患者，其敏感性为 79%，特异性为 58%（AUC 为 0.72）。
在 DCM 患者和心肌中存在炎症细胞的情况下，心肌 T2 弛豫时间可能有助于无创检测心肌炎症。尽管患者和健康对照组之间 T2 值存在重叠，但 T2 映射可能有助于识别可能受益于 EMB 进行治疗决策的患者。
