法洛四联症修复术后成人患者中心肌纤维化、应变成像与胶原蛋白生物标志物之间的相互作用
The Interplay between Myocardial Fibrosis, Strain Imaging and Collagen Biomarkers in Adults with Repaired Tetralogy of Fallot.
作者信息
Karali Konstantina, Makedou Kali, Kallifatidis Alexandros, Didagelos Matthaios, Giannakoulas George, Davos Constantinos H, Karamitsos Theodoros D, Ziakas Antonios, Karvounis Haralambos, Hadjimiltiades Stavros
机构信息
First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece.
Laboratory of Biochemistry, AHEPA General Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece.
出版信息
Diagnostics (Basel). 2021 Nov 13;11(11):2101. doi: 10.3390/diagnostics11112101.
BACKGROUND
We sought to assess the interplay between right ventricle (RV) fibrosis, biventricular dysfunction based on global longitudinal strain (GLS) analysis, and biomarkers such as Galectin-3 (Gal-3), procollagen type III (PCIII), and NTproBNP.
METHODS
We studied 35 adult patients with rToF. All patients underwent a cardiac magnetic resonance (CMR) scan including feature tracking for deformation imaging. Blood biomarkers were measured.
RESULTS
LGE RV was detected in all patients, mainly at surgical sites. Patients with the highest RV LGE scoring had greater RV dilatation and dysfunction whereas left ventricular (LV) function was preserved. LV GLS correlated with RV total fibrosis score ( = 0.007). A LV GLS value of -15.9% predicted LGE RV score > 8 (AUC 0.754 ( = 0.02)). Neither RV GLS nor biomarker levels were correlated with the extent of RV fibrosis. A cut-off value for NTproBNP of 145.25 pg/mL predicted LGE RV score > 8 points (AUC 0.729, ( = 0.03)). A cut-off value for Gal-3 of 7.42 ng/mL predicted PR Fraction > 20% [AUC 0.704, ( = 0.05)].
CONCLUSIONS
A significant extent of RV fibrosis was mainly detected at surgical sites of RV, affecting RV performance. CMR-FT reveals subtle LV dysfunction in rToF patients, due to decreased performance of the fibrotic RV. Impaired LV function and elevated NTproBNP in rToF reflect a dysfunctional fibrotic RV.
背景
我们试图评估右心室（RV）纤维化、基于整体纵向应变（GLS）分析的双心室功能障碍以及诸如半乳糖凝集素-3（Gal-3）、III型前胶原（PCIII）和N末端脑钠肽原（NTproBNP）等生物标志物之间的相互作用。
方法
我们研究了35例成年法洛四联症（rToF）患者。所有患者均接受了心脏磁共振（CMR）扫描，包括用于变形成像的特征跟踪。测量了血液生物标志物。
结果
所有患者均检测到右心室心肌晚期钆增强（LGE RV），主要位于手术部位。右心室LGE评分最高的患者右心室扩张和功能障碍更严重，而左心室（LV）功能保持正常。左心室GLS与右心室总纤维化评分相关（r = 0.007）。左心室GLS值为-15.9%预测LGE RV评分>8分（曲线下面积0.754，P = 0.02）。右心室GLS和生物标志物水平均与右心室纤维化程度无关。NTproBNP的截断值为145.25 pg/mL时预测LGE RV评分>8分（曲线下面积0.729，P = 0.03）。Gal-3的截断值为7.42 ng/mL时预测PR分数>20%[曲线下面积0.704，P = 0.05]。
结论
右心室纤维化的显著程度主要在右心室手术部位检测到，影响右心室功能。CMR特征跟踪（CMR-FT）显示rToF患者存在细微的左心室功能障碍，这是由于纤维化右心室功能下降所致。rToF患者左心室功能受损和NTproBNP升高反映了纤维化右心室功能失调。
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