Department of Physiology, University of Kentucky, Lexington, KY, USA.
Glaxo Smith Kline Research and Development, Philadelphia, PA, USA.
Sci Rep. 2018 Nov 19;8(1):16972. doi: 10.1038/s41598-018-35394-4.
Patients with end stage renal disease (ESRD) suffer high mortality from arrhythmias linked to fibrosis, but are contraindicated to late gadolinium enhancement magnetic resonance imaging (MRI). We present a quantitative method for gadolinium-free cardiac fibrosis imaging using magnetization transfer (MT) weighted MRI, and probe correlations with widely used surrogate markers including cardiac structure and contractile function in patients with ESRD. In a sub-group of patients who returned for follow-up imaging after one year, we examine the correlation between changes in fibrosis and ventricular structure/function. Quantification of changes in MT revealed significantly greater fibrotic burden in patients with ESRD compared to a healthy age matched control cohort. Ventricular mechanics, including circumferential strain and diastolic strain rate were unchanged in patients with ESRD. No correlation was observed between fibrotic burden and concomitant measures of either circumferential or longitudinal strains or strain rates. However, among patients who returned for follow up examination a strong correlation existed between initial fibrotic burden and subsequent loss of contractile function. Gadolinium-free myocardial fibrosis imaging in patients with ESRD revealed a complex and longitudinal, not contemporary, association between fibrosis and ventricular contractile function.
终末期肾病（ESRD）患者因与纤维化相关的心律失常而死亡率较高，但不能进行晚期钆增强磁共振成像（MRI）。我们提出了一种使用磁共振磁化转移（MT）加权成像进行无钆心脏纤维化成像的定量方法，并探讨了其与广泛使用的替代标志物（包括 ESRD 患者的心脏结构和收缩功能）之间的相关性。在一年后返回进行随访成像的患者亚组中，我们研究了纤维化变化与心室结构/功能之间的相关性。MT 定量显示，与健康年龄匹配的对照组相比，ESRD 患者的纤维化负担明显更大。ESRD 患者的心室力学，包括圆周应变和舒张应变率均无变化。纤维化负担与圆周或纵向应变或应变率的同时测量之间没有相关性。然而，在返回进行随访检查的患者中，纤维化负担与随后收缩功能丧失之间存在很强的相关性。在 ESRD 患者中进行无钆心肌纤维化成像揭示了纤维化与心室收缩功能之间存在复杂的、纵向的、而非当前的关联。
