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间质纤维化在高血压与肥厚型心肌病左心室功能中的意义。

The Significance of Interstitial Fibrosis on Left Ventricular Function in Hypertensive versus Hypertrophic Cardiomyopathy.

机构信息

Department of Cardiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, 200127, China.

Department of Radiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, 200127, China.

出版信息

Sci Rep. 2018 Jul 3;8(1):9995. doi: 10.1038/s41598-018-27049-1.

Abstract

Extracellular volume (ECV) has been validated as a surrogate measure of interstitial fibrosis, that is increased in both hypertension-induced left ventricular hypertrophy (H-LVH) and hypertrophic cardiomyopathy (HCM). We aimed to explore the correlation between ECV and left ventricular cardiac function. Eighty-one patients with HCM, 44 with H-LVH and 35 controls were prospectively enrolled. Even among patients with normal diastolic function, patients in HCM group had increased- ECV. In terms of diastolic dysfunction (DD), a similar increase in ECV was associated with a larger percentage of patients with severe or moderate-to-severe DD in HCM group. In addition, there was a compensatory increase in the left ventricular ejection fraction (LVEF) in HCM, but no hyperdynamic LVEF was observed in H-LVH. ECV was negatively correlated with LVEF in the late gadolinium enhancement (+) (LGE+) subgroups in the H-LVH group, while no significant linear correlation was observed in HCM group. The increased ECV in HCM patients with normal diastolic function warrants further exploration of the prognostic value of ECV assessments in the early stages of HCM. The associations between ECV and left ventricular functional parameters differed and taking both LGE and ECV into account might be reasonable way to differentiate between the two disorders.

摘要

细胞外容积 (ECV) 已被验证为间质纤维化的替代指标,在高血压性左心室肥厚 (H-LVH) 和肥厚型心肌病 (HCM) 中均增加。我们旨在探讨 ECV 与左心室心功能之间的相关性。前瞻性纳入 81 例 HCM 患者、44 例 H-LVH 患者和 35 名对照者。即使在舒张功能正常的患者中,HCM 组的 ECV 也增加。在舒张功能障碍 (DD) 方面,在 HCM 组中,与严重或中度重度 DD 患者比例增加相关的 ECV 增加相似。此外,HCM 中左心室射血分数 (LVEF) 代偿性增加,但在 H-LVH 中未观察到高动力性 LVEF。在 H-LVH 组的晚期钆增强 (+) (LGE+) 亚组中,ECV 与 LVEF 呈负相关,而在 HCM 组中未观察到显著的线性相关性。在舒张功能正常的 HCM 患者中,ECV 的增加需要进一步探讨 ECV 评估在 HCM 早期阶段的预后价值。ECV 与左心室功能参数之间的相关性不同,同时考虑 LGE 和 ECV 可能是区分这两种疾病的合理方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16b4/6030120/d76ab3eb253d/41598_2018_27049_Fig1_HTML.jpg

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