Tektonidou Maria G, Sfikakis Petros P, Kolovou Genovefa, Mavrogeni Sophie
First Department of Propaedeutic and Internal Medicine, Joint Rheumatology Program, Laikon Hospital, University of Athens Medical School, Athens, Greece.
Onassis Cardiac Surgery Center, Athens, Greece.
Mediterr J Rheumatol. 2018 Jun 29;29(2):99-102. doi: 10.31138/mjr.29.2.99. eCollection 2018 Jun.
Antiphospholipid syndrome (APS) is characterized by the combination of recurrent arterial and venous thrombotic events and detection of persistently elevated antiphospholipid antibody titers in the serum or plasma. APS clinical manifestations also include non-thrombotic complications from various organ systems, mainly the CNS, kidneys, and heart. Cardiac manifestations of APS include valvulopathy, myocardial infarction and angina (stable, unstable, and Pritzmental angina). A previously published case series of cardiac magnetic resonance (CMR) in patients with APS has revealed a high rate of asymptomatic myocardial necrosis and scarring, but the prevalence of myocardial ischemia identified as CMR perfusion defects prior to development of necrosis is unknown.
To detect CMR imaging markers of myocardial ischemia in APS patients without symptoms of cardiovascular disease (CVD).
We will scan fifty APS patients without symptoms of CVD stress-perfusion CMR in a 1.5 Tesla tomographer, after intravenous infusion of adenosine and gadolinium. In addition to markers of cardiac anatomy and function, we will record imaging markers of ischemia and scarring, namely perfusion defects (PDs), and late gadolinium enhancement (LGE). We will perform parametrics using dedicated software in order to derive each patient's myocardial perfusion reserve index (MPRI). Scans will be reviewed independently by two experienced reviewers, with evaluation of inter- and intra-observer reliability. Statistical hypotheses will be examined using Student's test and Pearson's correlation coefficient, or non-parametric equivalents (Kruskall-Wallis and Spearman) for continuous variables, and Fisher's exact test for binary variables. Linear or logistic regression analyses will be used to investigate APS-related determinants of subclinical myocardial ischemia.
We expect to identify CMR imaging patterns characteristic of APS, which will allow proactive therapeutic interventions for primary prevention of CVD and guide further research into the pathogenesis of APS cardiac manifestations.
抗磷脂综合征（APS）的特征是反复出现动脉和静脉血栓形成事件，以及血清或血浆中抗磷脂抗体滴度持续升高。APS的临床表现还包括来自各个器官系统的非血栓性并发症，主要是中枢神经系统、肾脏和心脏。APS的心脏表现包括瓣膜病、心肌梗死和心绞痛（稳定型、不稳定型和变异型心绞痛）。先前发表的一组关于APS患者心脏磁共振成像（CMR）的病例系列研究显示，无症状心肌坏死和瘢痕形成的发生率很高，但在坏死发生之前被确定为CMR灌注缺损的心肌缺血患病率尚不清楚。
检测无心血管疾病（CVD）症状的APS患者心肌缺血的CMR成像标志物。
我们将在1.5特斯拉断层扫描仪中对50例无CVD症状的APS患者进行静脉注射腺苷和钆后进行应力灌注CMR扫描。除了心脏解剖结构和功能的标志物外，我们还将记录缺血和瘢痕形成的成像标志物，即灌注缺损（PDs）和钆延迟增强（LGE）。我们将使用专用软件进行参数分析，以得出每位患者的心肌灌注储备指数（MPRI）。扫描将由两位经验丰富的审阅者独立审查，评估观察者间和观察者内的可靠性。对于连续变量，将使用学生检验和皮尔逊相关系数或非参数等效方法（Kruskal-Wallis和Spearman）检验统计假设，对于二元变量，将使用Fisher精确检验。将使用线性或逻辑回归分析来研究亚临床心肌缺血的APS相关决定因素。
我们期望识别出APS特有的CMR成像模式，这将有助于对CVD进行一级预防的积极治疗干预，并指导对APS心脏表现发病机制的进一步研究。
