Kim Eun Kyoung, Lee Sang-Chol, Chang Sung-A, Jang Shin-Yi, Kim Sung Mok, Park Sung-Ji, Choi Jin-Oh, Park Seung Woo, Jeon Eun-Seok, Choe Yeon Hyeon
Division of Cardiology, Department of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Department of Radiology and Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
J Cardiovasc Magn Reson. 2020 May 4;22(1):30. doi: 10.1186/s12968-020-00623-1.
Hypertrophic cardiomyopathy (HCM) is thought to be associated with microvascular dysfunction. Adenosine stress-perfusion cardiovascular magnetic resonance imaging (CMR) is a sensitive method for assessing microvascular perfusion abnormalities. We evaluated the prevalence and clinical characteristics of HCM patients with adenosine-induced perfusion defects on CMR.
Among 189 consecutive patients with HCM who underwent adenosine-stress perfusion CMR, 115 patients who had clinical, echocardiography, 24-h Holter monitoring and treadmill exercise test data were analyzed. We calculated myocardial perfusion ratio index from the intensity-over-time curve to quantify perfusion defects. The presence and extent of the stress-induced perfusion defect were compared with clinical characteristics, presence and extent of late gadolinium enhancement (LGE), left ventricular (LV) mass index and volume, presence of non-sustained ventricular tachycardia (NSVT) and results of treadmill exercise test.
The mean age of enrolled patients was 51.8 ± 11.3 years. Most patients were asymptomatic except 25 subjects presented with New York Heart Association Class II dyspnea and 16 patients with atypical non-exertional chest discomfort. LGE was present in 103 (89.6%) subjects. Adenosine stress-induced perfusion defects were present in 48 (42%) subjects. None of the perfusion defects corresponded with a single or multiple coronary artery territories, showing a multiple patchy pattern in 24 (50.0%), a concentric subendocardial pattern in 20 subjects (41.7%), and as a single blot-like defect in the remaining 4 (8.3%). A perfusion defect was associated with NSVT, LV apical aneurysm, higher LV mass index, and higher LGE volume on univariate analysis. Multivariate analysis revealed female gender (P = 0.008), presence of apical aneurysm and NSVT (P = 0.036 and 0.047, respectively), and LV mass index (P = 0.022) to be independently associated with adenosine stress-induced perfusion defects.
In patients with HCM, adenosine-stress perfusion defects on CMR are present in more than 40% of subjects. This perfusion defect is associated with NSVT, higher LV mass index, and apical aneurysms. The prognostic value of this finding needs further elucidation.
肥厚型心肌病（HCM）被认为与微血管功能障碍有关。腺苷负荷灌注心血管磁共振成像（CMR）是评估微血管灌注异常的一种敏感方法。我们评估了CMR上出现腺苷诱导灌注缺损的HCM患者的患病率及临床特征。
在189例连续接受腺苷负荷灌注CMR的HCM患者中，分析了115例有临床、超声心动图、24小时动态心电图监测及平板运动试验数据的患者。我们从强度-时间曲线计算心肌灌注比指数以量化灌注缺损。将负荷诱导的灌注缺损的存在情况及范围与临床特征、延迟钆增强（LGE）的存在情况及范围、左心室（LV）质量指数和容积、非持续性室性心动过速（NSVT）的存在情况以及平板运动试验结果进行比较。
入选患者的平均年龄为51.8±11.3岁。除25例出现纽约心脏协会II级呼吸困难和16例出现非劳力性非典型胸痛的患者外，大多数患者无症状。103例（89.6%）患者存在LGE。48例（42%）患者存在腺苷负荷诱导的灌注缺损。没有一个灌注缺损与单一或多个冠状动脉区域相对应，24例（50.0%）表现为多发斑片状，20例（41.7%）表现为同心内膜下型，其余4例（8.3%）表现为单个斑点状缺损。单因素分析显示灌注缺损与NSVT、左心室心尖部动脉瘤、较高的左心室质量指数及较高的LGE容积相关。多因素分析显示女性（P = 0.008）、心尖部动脉瘤和NSVT的存在（分别为P = 0.036和0.047）以及左心室质量指数（P = 0.022）与腺苷负荷诱导的灌注缺损独立相关。
在HCM患者中，超过40%的患者CMR上存在腺苷负荷灌注缺损。这种灌注缺损与NSVT、较高的左心室质量指数及心尖部动脉瘤相关。这一发现的预后价值需要进一步阐明。
