经导管主动脉瓣置换术后的功能性和结构性逆向心肌重构：一项前瞻性心血管磁共振研究。
Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study.
机构信息
Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
出版信息
J Cardiovasc Magn Reson. 2022 Jul 28;24(1):45. doi: 10.1186/s12968-022-00874-0.
BACKGROUND
Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
METHODS
CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented.
RESULTS
Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (- 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (- 36.9 ± 14.3% to - 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m to 73.5 ± 17.0 ml/m, p < 0.001) including cellular (55.2 ± 13.2 ml/m to 45.3 ± 11.1 ml/m, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m to 18.8 ± 5.3 ml/m, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001).
CONCLUSION
CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479.
背景
由于心血管磁共振（CMR）成像允许对心肌功能和结构进行全面定量，我们旨在评估接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄（AS）患者的心肌重构过程。
方法
在 TAVR 前和 1 年后对 40 例严重 AS 患者进行 CMR 成像。图像分析包括评估心肌容积、CMR 特征追踪的心房和心室应变、心肌 T1 映射、基于细胞外容积分数的左心室（LV）细胞和基质容积计算、以及缺血和非缺血性晚期钆增强分析。此外，还记录了生物标志物，包括 NT-proBNP 以及功能和临床状况。
结果
TAVR 后 1 年心肌功能改善：LV 射血分数（57.9±16.9%至 65.4±14.5%，p=0.002）；LV 整体纵向应变（-21.4±8.0%至-25.0±6.4%，p<0.001）和环向应变（-36.9±14.3%至-42.6±11.8%，p=0.001）；左心房储备（13.3±6.3%至 17.8±6.7%，p=0.001）、传导（5.5±3.2%至 8.4±4.6%，p=0.001）和增强泵应变（8.2±4.6%至 9.9±4.2%，p=0.027）。这与总心肌容积的回归（90.3±21.0 ml/m 至 73.5±17.0 ml/m，p<0.001）相一致，包括细胞（55.2±13.2 ml/m 至 45.3±11.1 ml/m，p<0.001）和基质容积（20.7±6.1 ml/m 至 18.8±5.3 ml/m，p=0.036）。这些变化与心力衰竭的恢复相平行（NYHA 分级下降：p<0.001；NT-proBNP 水平下降：2456±3002 ng/L 至 988±1222 ng/L，p=0.001）。
结论
CMR 成像能够全面检测 TAVR 患者的心肌重构。LV 基质容积的回归作为可逆转弥漫性心肌纤维化的替代指标，伴随着心肌功能的增加和心力衰竭的恢复。需要进一步的数据来确定这些参数作为治疗靶点的价值，以优化 TAVR 患者的管理。
试验注册
DRKS，DRKS00024479。2021 年 12 月 10 日注册-回顾性注册，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479。
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