系统性硬化症患者室性心律失常、传导障碍与心肌纤维化的关系。

Relationship Between Ventricular Arrhythmias, Conduction Disorders, and Myocardial Fibrosis in Patients With Systemic Sclerosis.

出版信息

J Clin Rheumatol. 2018 Jan;24(1):25-33. doi: 10.1097/RHU.0000000000000623.

PMID:29200022

Abstract

BACKGROUND

Delayed-enhancement magnetic resonance imaging (DE-MRI) is a noninvasive diagnostic tool able to identify myocardial fibrosis. In patients with scleroderma, its relationship with arrhythmias and conduction disorders has not been fully explored.

OBJECTIVES

The aim of this study was to evaluate the possible correlations between ventricular arrhythmias, conduction disorders, and myocardial fibrosis in patients with systemic sclerosis.

METHODS

Thirty-six patients with diffuse or limited cutaneous scleroderma underwent 12-lead electrocardiogram (ECG), 24-hour Holter ECG monitoring, transthoracic echocardiography, and cardiac DE-MRI, with gadolinium administration in 33 patients.

RESULTS

High-quality DE-MRI scans were obtained in 30 patients. Myocardial fibrosis was detected in 25 patients (83.3%). Eighteen patients (60%) had ventricular arrhythmias or conduction disorders. There was no significant difference in ventricular arrhythmia burden (the total number of premature ventricular contractions [PVCs]/24 hours) (48 ± 304 vs. 69 ± 236, P = 0.97), ventricular arrhythmia severity (couplets, triplets, runs) on Holter ECG, or in the presence of conduction disorders (36% vs. 40%, P = 0.86) between patients with and without myocardial fibrosis. In univariate analysis, diffuse fibrosis was weakly associated with the number of PVCs/24 hours (R = 0.157, P = 0.03). A number of at least 597 PVCs/24 hours had a sensitivity of 60% and a specificity of 92% in predicting the presence of diffuse fibrosis on DE-MRI (area under the curve = 0.640).

CONCLUSIONS

Delayed-enhancement magnetic resonance imaging can identify myocardial fibrosis in a high percentage of scleroderma patients. Its presence does not seem to influence the ventricular arrhythmia burden and severity or the presence of conduction disorders, with the exception of diffuse myocardial fibrosis, which modestly influences the total number of PVCs/24 hours.

摘要

背景

延迟增强磁共振成像（DE-MRI）是一种能够识别心肌纤维化的非侵入性诊断工具。在硬皮病患者中，其与心律失常和传导障碍的关系尚未得到充分探讨。

目的

本研究旨在评估系统性硬皮病患者的室性心律失常、传导障碍与心肌纤维化之间的可能相关性。

方法

36 例弥漫性或局限性皮肤硬皮病患者接受了 12 导联心电图（ECG）、24 小时动态心电图监测、经胸超声心动图和心脏 DE-MRI 检查，其中 33 例患者给予钆剂注射。

结果

30 例患者获得了高质量的 DE-MRI 扫描。25 例（83.3%）患者检测到心肌纤维化。18 例（60%）患者存在室性心律失常或传导障碍。室性心律失常负荷（24 小时内室性期前收缩总数）（48 ± 304 与 69 ± 236，P = 0.97）、Holter ECG 上室性心律失常严重程度（成对、三联律、连发）或传导障碍（36%与 40%，P = 0.86）在有或无心肌纤维化的患者之间无显著差异。在单因素分析中，弥漫性纤维化与室性期前收缩总数呈弱相关（R = 0.157，P = 0.03）。至少 597 个室性期前收缩/24 小时的数量预测 DE-MRI 上弥漫性纤维化的存在具有 60%的敏感性和 92%的特异性（曲线下面积=0.640）。