Department of Medical Biophysics, Western University.
Lilibeth Caberto Kidney Clinic Research Unit, London Health Sciences Centre, London, Ontario, Canada.
Curr Opin Nephrol Hypertens. 2020 Nov;29(6):555-563. doi: 10.1097/MNH.0000000000000645.
Patients on hemodialysis have significantly higher rates of cardiovascular mortality resulting from a multitude of myocardial dysfunctions. Current imaging modalities allow independent assessment of cardiac morphology, contractile function, coronary arteries and cardiac perfusion. Techniques such as cardiac computed tomography (CT) imaging have been available for some time, but have not yet had widespread adoption because of technical limitations related to cardiac motion, radiation exposure and safety of contrast agents in kidney disease.
Novel dynamic contrast-enhanced (DCE) CT imaging can be used to acquire high-resolution cardiac images, which simultaneously allow the assessment of coronary arteries and the quantitative measurement of myocardial perfusion. The advancement of recent CT scanners and cardiac protocols have allowed noninvasive imaging of the whole heart in a single imaging session with minimal cardiac motion artefact and exposure to radiation.
DCE-CT imaging in clinical practice would allow comprehensive evaluation of the structure, function, and hemodynamics of the heart in a short, well tolerated scanning session. It is an imaging tool enabling the study of myocardial dysfunction in dialysis patients, who have greater cardiovascular risk than nonrenal cardiovascular disease populations, both at rest and under cardiac stress associated with hemodialysis itself.
血液透析患者的心血管死亡率显著更高，这是多种心肌功能障碍导致的结果。目前的成像方式可独立评估心脏形态、收缩功能、冠状动脉和心脏灌注。心脏计算机断层扫描（CT）等技术已经存在一段时间，但由于与心脏运动、辐射暴露以及肾病对比剂安全性相关的技术限制，尚未得到广泛应用。
新型动态对比增强（DCE）CT 成像可用于获取高分辨率的心脏图像，同时可评估冠状动脉并定量测量心肌灌注。最近 CT 扫描仪和心脏方案的进步使得可以在单次成像过程中对整个心脏进行非侵入性成像，同时最小化心脏运动伪影和辐射暴露。
DCE-CT 成像在临床实践中的应用将允许在短时间内耐受良好的扫描过程中全面评估心脏的结构、功能和血液动力学。它是一种成像工具，能够研究透析患者的心肌功能障碍，这些患者的心血管风险高于非肾脏心血管疾病人群，无论是在休息时还是在与血液透析本身相关的心脏应激下。
