经典型低流量低梯度主动脉瓣狭窄的多模态成像方法和全身生物标志物：风险分层的关键发现
Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification.
作者信息
Lopes Maria Antonieta Albanez A de M, Campos Carlos M, Rosa Vitor Emer Egypto, Sampaio Roney O, Morais Thamara C, de Brito Júnior Fábio Sândoli, Vieira Marcelo L C, Mathias Wilson, Fernandes Joao Ricardo Cordeiro, de Santis Antonio, Santos Luciano de Moura, Rochitte Carlos E, Capodanno Davide, Tamburino Corrado, Abizaid Alexandre, Tarasoutchi Flavio
机构信息
Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
Real Hospital Português, Real Cardiologia, Recife, PE, Brazil.
出版信息
Front Cardiovasc Med. 2023 Apr 27;10:1149613. doi: 10.3389/fcvm.2023.1149613. eCollection 2023.
OBJECTIVES
The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS).
BACKGROUND
Elevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS.
METHODS
Prospective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 ( = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 ( = 14) when BNP or hsTnI were higher than median; and Group 3 ( = 18) when both hsTnI and BNP were higher than median.
RESULTS
49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance ( = 0.03) and lower left ventricular ejection fraction ( = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31-47] vs. 32 [29-41] vs. 26 [19-33]%; < 0.01) and right ventricular EF (62 [53-69] vs. 51 [35-63] vs. 30 [24-46]%; < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8-30.7] vs. 28.2 [26.9-34.5] vs. 31.8 [28.9-35.5]%; = 0.03) and indexed ECV (iECV) (28.7 [21.2-39.1] vs. 28.8 [25.4-39.9] vs. 44.2 [36.4-51.2] ml/m, respectively; < 0.01) from Group 1 to Group 3.
CONCLUSIONS
Higher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.
目的
本研究旨在根据全身生物标志物、高敏肌钙蛋白I（hsTnI）和B型利钠肽（BNP）水平，评估低流量、低梯度主动脉瓣狭窄（LFLG-AS）患者的多模态成像结果。
背景
BNP和hsTnI水平升高与LFLG-AS患者的不良预后相关。
方法
对LFLG-AS患者进行前瞻性研究，这些患者接受了hsTnI、BNP、冠状动脉造影、T1映射心脏磁共振（CMR）、超声心动图和多巴酚丁胺负荷超声心动图检查。根据BNP和hsTnI水平将患者分为3组：第1组（n = 17），BNP和hsTnI水平低于中位数[BNP < 1.98倍上限参考值（URL）且hsTnI < 1.8倍URL]；第2组（n = 14），BNP或hsTnI高于中位数；第3组（n = 18），hsTnI和BNP均高于中位数。
结果
3组共纳入49例患者。各组间临床特征（包括风险评分）相似。第3组患者经超声心动图检查的瓣膜动脉阻抗较低（P = 0.03），左心室射血分数较低（P = 0.02）。CMR显示，从第1组到第3组，右心室和左心室腔逐渐增大，左心室射血分数（EF）恶化（40 [31 - 47]% vs. 32 [29 - 41]% vs. 26 [19 - 33]%；P < 0.01），右心室EF也恶化（62 [53 - 69]% vs. 51 [35 - 63]% vs. 30 [24 - 46]%；P < 0.01）。此外，通过细胞外容积分数（ECV）评估的心肌纤维化显著增加（28.4 [24.8 - 30.7]% vs. 28.2 [26.9 - 34.5]% vs. 31.8 [28.9 - 35.5]%；P = 0.03），从第1组到第3组，指数化ECV（iECV）也显著增加（分别为28.7 [21.2 - 39.1] ml/m vs. 28.8 [25.4 - 39.9] ml/m vs. 44.2 [36.4 - 51.2] ml/m；P < 0.01）。
结论
LFLG-AS患者中较高水平的BNP和hsTnI与心脏重塑和纤维化的多模态证据较差相关。
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