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左心室机械变形与非缺血性心肌病心肌纤维化的关系。

Association Between Left Ventricular Mechanical Deformation and Myocardial Fibrosis in Nonischemic Cardiomyopathy.

机构信息

Department of Medicine Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA.

出版信息

J Am Heart Assoc. 2020 Oct 20;9(19):e016797. doi: 10.1161/JAHA.120.016797. Epub 2020 Oct 2.

Abstract

Background In patients with nonischemic cardiomyopathy, nonischemic fibrosis detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is related to adverse cardiovascular outcomes. However, its relationship with left ventricular (LV) mechanical deformation parameters remains unclear. We sought to investigate the association between LV mechanics and the presence, location, and extent of fibrosis in patients with nonischemic cardiomyopathy. Methods and Results We retrospectively identified 239 patients with nonischemic cardiomyopathy (67% male; 55±14 years) referred for a clinical cardiovascular magnetic resonance. LGE was present in 109 patients (46%), most commonly (n=52; 22%) in the septum. LV deformation parameters did not differentiate between LGE-positive and LGE-negative groups. Global longitudinal, radial, and circumferential strains, twist and torsion showed no association with extent of fibrosis. Patients with septal fibrosis had a more depressed LV ejection fraction (30±12% versus 35±14%; =0.032) and more impaired global circumferential strain (-7.9±3.5% versus -9.7±4.4%; =0.045) and global radial strain (10.7±5.2% versus 13.3±7.7%; =0.023) than patients without septal LGE. Global longitudinal strain was similar in both groups. While patients with septal-only LGE (n=28) and free wall-only LGE (n=32) had similar fibrosis burden, the septal-only LGE group had more impaired LV ejection fraction and global circumferential, longitudinal, and radial strains (all <0.05). Conclusions There is no association between LV mechanical deformation parameters and presence or extent of fibrosis in patients with nonischemic cardiomyopathy. Septal LGE was associated with poor global LV function, more impaired global circumferential and radial strains, and more impaired global strain rates.

摘要

背景 在非缺血性心肌病患者中,通过晚期钆增强(LGE)心血管磁共振检测到的非缺血性纤维化与不良心血管结局相关。然而,其与左心室(LV)机械变形参数之间的关系尚不清楚。我们旨在研究非缺血性心肌病患者的 LV 力学与纤维化的存在、位置和程度之间的关系。

方法和结果 我们回顾性地确定了 239 名非缺血性心肌病患者(67%为男性;55±14 岁),这些患者因临床心血管磁共振而接受检查。109 名患者(46%)存在 LGE,最常见的部位是(n=52;22%)间隔。LGE 阳性和 LGE 阴性组之间的 LV 变形参数没有差异。整体纵向、径向和周向应变、扭转和扭转与纤维化程度均无相关性。间隔纤维化患者的 LV 射血分数更低(30±12%与 35±14%;=0.032),整体周向应变(-7.9±3.5%与-9.7±4.4%;=0.045)和整体径向应变(10.7±5.2%与 13.3±7.7%;=0.023)更差。两组之间的整体纵向应变相似。虽然间隔仅 LGE(n=28)和壁仅 LGE(n=32)患者的纤维化负担相似,但间隔仅 LGE 组的 LV 射血分数和整体周向、纵向和径向应变更差(均<0.05)。

结论 在非缺血性心肌病患者中,LV 机械变形参数与纤维化的存在或程度之间没有关联。间隔 LGE 与整体 LV 功能不良、整体周向和径向应变更差以及整体应变率更差有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/02a4/7792406/a7a5b6866106/JAH3-9-e016797-g001.jpg

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