Department of Cardiology, National Heart Centre Singapore (N.R.I., T.-T.L., M.S.L.K., H.-C.T., C.-T.C., J.A.B., S.A.C., C.W.L.C.).
National Heart Research Institute Singapore (T.-T.L., J.A.B., C.-J.P., B.A., D.-F.T., S.A.C., C.W.L.C.).
Hypertension. 2022 Aug;79(8):1804-1813. doi: 10.1161/HYPERTENSIONAHA.122.19225. Epub 2022 May 23.
The prognostic significance of focal and diffuse myocardial fibrosis in patients with cardiovascular risk factors is unclear.
REMODEL (Response of the Myocardium to Hypertrophic Conditions in the Adult Population) is an observational cohort of asymptomatic patients with essential hypertension. All participants underwent cardiovascular magnetic resonance to assess for myocardial fibrosis: nonischemic late gadolinium enhancement (LGE), native myocardial T1, postcontrast myocardial T1, extracellular volume fraction including/excluding LGE regions, interstitial volume (extracellular volume×myocardial volume), and interstitial/myocyte ratio. Primary outcome was a composite of first occurrence acute coronary syndrome, heart failure hospitalization, strokes, and cardiovascular mortality. Patients were recruited from February 2016 and followed until June 2021.
Of the 786 patients with hypertension (58±11 years; 39% women; systolic blood pressure, 130±14 mm Hg), 145 (18%) had nonischemic LGE. Patients with nonischemic LGE were more likely to be men, have diabetes, be current smokers, and have higher blood pressure (<0.05 for all). Compared with those without LGE, patients with nonischemic LGE had greater left ventricular mass (66±22 versus 49±9 g/m; <0.001), worse multidirectional strain (<0.001 for all measures), and elevated circulating markers of myocardial wall stress and myocardial injury, adjusted for potential confounders. Twenty-four patients had primary outcome over 39 (30-50) months of follow-up. Of all the cardiovascular magnetic resonance markers of myocardial fibrosis assessed, only nonischemic LGE (hazard ratio, 6.69 [95% CI, 2.54-17.60]; <0.001) and indexed interstitial volume (hazard ratio, 1.11 [95% CI, 1.04-1.19]; =0.002) demonstrated independent association with primary outcome.
In patients with hypertension, myocardial fibrosis on cardiovascular magnetic resonance is associated with adverse cardiac remodeling and outcomes.
心血管危险因素患者局灶性和弥漫性心肌纤维化的预后意义尚不清楚。
REMODEL（成人人群中肥厚条件下心肌反应）是一项无症状高血压患者的观察性队列研究。所有参与者均接受心血管磁共振检查以评估心肌纤维化：非缺血性晚期钆增强（LGE）、心肌固有 T1、对比后心肌 T1、包括/不包括 LGE 区域的细胞外容积分数、间质容积（细胞外容积×心肌容积）和间质/心肌比。主要结局是首次发生急性冠状动脉综合征、心力衰竭住院、卒中和心血管死亡率的复合事件。患者于 2016 年 2 月招募，随访至 2021 年 6 月。
在 786 名高血压患者（58±11 岁；39%为女性；收缩压 130±14mmHg）中，有 145 名（18%）患有非缺血性 LGE。患有非缺血性 LGE 的患者更可能为男性、患有糖尿病、目前吸烟且血压更高（所有差异均<0.05）。与无 LGE 相比，非缺血性 LGE 患者的左心室质量更大（66±22 与 49±9g/m；<0.001），多方向应变更差（所有指标均<0.001），且循环心肌壁应力和心肌损伤标志物水平升高，在调整潜在混杂因素后亦然。在 39（30-50）个月的随访中，有 24 名患者出现主要结局。在评估的所有心肌纤维化心血管磁共振标志物中，只有非缺血性 LGE（风险比 6.69[95%CI，2.54-17.60]；<0.001）和指数化间质容积（风险比 1.11[95%CI，1.04-1.19]；=0.002）与主要结局具有独立相关性。
在高血压患者中，心血管磁共振上的心肌纤维化与不良心脏重构和结局相关。
