Sinn Martin, Petersen Johannes, Lenz Alexander, von Stumm Maria, Sequeira Groß Tatiana Maria, Huber Lukas, Reichenspurner Hermann, Adam Gerhard, Lund Gunnar, Bannas Peter, Girdauskas Evaldas
Department of Diagnostic and Interventional Radiology, University Hospital Eppendorf, Hamburg, Germany.
Department of Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany.
Front Cardiovasc Med. 2023 Jun 23;10:1155787. doi: 10.3389/fcvm.2023.1155787. eCollection 2023.
To assess whether cardiac T1 mapping for detecting myocardial fibrosis enables preoperative identification of patients at risk for early left ventricular dysfunction after surgery of aortic regurgitation.
1.5 Tesla cardiac magnetic resonance imaging was performed in 40 consecutive aortic regurgitation patients before aortic valve surgery. Native and post-contrast T1 mapping was performed using a modified Look-Locker inversion-recovery sequence. Serial echocardiography was performed at baseline and 8 ± 5 days after aortic valve surgery to quantify LV dysfunction. Receiver operating characteristic analysis was performed to determine the diagnostic accuracy of native T1 mapping and extracellular volume for predicting postoperative LV ejection fraction decrease >-10% after aortic valve surgery.
Native T1 was significantly increased in patients with a postoperatively decreased LVEF ( = 15) vs. patients with a preserved postoperative LV ejection fraction ( = 25) (i.e., 1,071 ± 67 ms vs. 1,019 ± 33 ms, = .001). Extracellular volume was not significantly different between patients with preserved vs. decreased postoperative LV ejection fraction. With a cutoff-of value of 1,053 ms, native T1 yielded an area under the curve (AUC) of .820 (95% CI: .683-.958) for differentiating between patients with preserved vs. reduced LV ejection fraction with 70% sensitivity and 84% specificity.
Increased preoperative native T1 is associated with a significantly higher risk of systolic LV dysfunction early after aortic valve surgery in aortic regurgitation patients. Native T1 could be a promising tool to optimize the timing of aortic valve surgery in patients with aortic regurgitation to prevent early postoperative LV dysfunction.
评估用于检测心肌纤维化的心脏T1 mapping能否在主动脉瓣反流手术后术前识别有早期左心室功能障碍风险的患者。
对40例连续的主动脉瓣反流患者在主动脉瓣手术前进行1.5特斯拉心脏磁共振成像。使用改良的Look-Locker反转恢复序列进行心肌T1 mapping和对比剂增强后的T1 mapping。在基线和主动脉瓣手术后8±5天进行系列超声心动图检查以量化左心室功能障碍。进行受试者操作特征分析以确定心肌T1 mapping和细胞外容积预测主动脉瓣手术后左心室射血分数下降>-10%的诊断准确性。
术后左心室射血分数降低的患者（n = 15）与术后左心室射血分数保留的患者（n = 25）相比，心肌T1显著升高（即1,071±67毫秒对1,019±33毫秒，P = .001）。术后左心室射血分数保留与降低的患者之间细胞外容积无显著差异。以1,053毫秒为临界值，心肌T1区分左心室射血分数保留与降低患者的曲线下面积（AUC）为.820（95%CI：.683-.958），敏感性为70%，特异性为84%。
术前心肌T1升高与主动脉瓣反流患者主动脉瓣手术后早期收缩期左心室功能障碍风险显著升高相关。心肌T1可能是优化主动脉瓣反流患者主动脉瓣手术时机以预防术后早期左心室功能障碍的有前景的工具。
