心脏 CT 量化主动脉瓣狭窄患者细胞外容积的区域性分布：对疾病机制的深入了解及其对预后的影响。

Regional Distribution of Extracellular Volume Quantified by Cardiac CT in Aortic Stenosis: Insights Into Disease Mechanisms and Impact on Outcomes.

机构信息

Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (K.P.P., P.R.S., B.S., A.S., J.J.L.Y.-S., E.C., M.M., L.J.M., J.C.M., F.P., T.A.T.).

Institute of Cardiovascular Sciences, University College London, United Kingdom (K.P.P., P.R.S., J.C.M., T.A.T.).

出版信息

Circ Cardiovasc Imaging. 2024 May;17(5):e015996. doi: 10.1161/CIRCIMAGING.123.015996. Epub 2024 May 21.

DOI:10.1161/CIRCIMAGING.123.015996

PMID:38771906

Abstract

BACKGROUND

Extracellular volume fraction (ECV) is a marker for myocardial fibrosis and infiltration, can be quantified using cardiac computed tomography (ECV), and has prognostic utility in several diseases. This study aims to map out regional differences in ECV to obtain greater insights into the pathophysiological mechanisms of ECV expansion and its clinical implications.

METHODS

Three prospective cohorts were included: patients with aortic stenosis (AS) and coexisting AS and transthyretin cardiac amyloidosis were referred for a transcatheter aortic valve replacement and had ECG-gated CT angiography and Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy to differentiate between the 2 cohorts. Controls had CT angiography and cardiac magnetic resonance demonstrating no significant coronary artery disease or infarction. Global and regional ECV was analyzed, and its association with mortality was assessed for patients with AS.

RESULTS

In 199 patients, controls (n=65; 66% male), AS (n=115), and coexisting AS and transthyretin cardiac amyloidosis (n=19) had a global ECV of 26.1 (25.0-27.8%) versus 29.1 (27.5-31.1%) versus 37.4 (32.5-46.6%), respectively; <0.001. Across cohorts, ECV was higher at the base (versus apex), the inferoseptum (versus anterolateral wall), and the subendocardium (versus subepicardium); <0.05 for all. Among patients with AS, epicardial ECV, rather than any other regional value or global ECV, was the strongest predictor of mortality at a median of 3.9 (max 6.3) years (adjusted hazard ratio, 1.21 [95% CI, 1.08-1.36]; =0.002).

CONCLUSIONS

Regional differences in ECV suggest a predilection for fibrosis and amyloid infiltration at the base, subendocardium, inferior wall, and septum more than the anterior and lateral myocardium. ECV can predict long-term mortality with the subepicardium demonstrating the strongest discriminatory power.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03029026 and NCT03094143.

摘要

背景

细胞外容积分数（ECV）是心肌纤维化和浸润的标志物，可通过心脏计算机断层扫描（ECV）进行定量，并在多种疾病中具有预后价值。本研究旨在绘制 ECV 的区域差异图，以更深入地了解 ECV 扩张的病理生理机制及其临床意义。

方法

纳入了三个前瞻性队列：患有主动脉瓣狭窄（AS）并同时患有转甲状腺素蛋白心脏淀粉样变性的患者被转介进行经导管主动脉瓣置换术，并进行心电图门控 CT 血管造影和锝-99m 标记的 3,3-二膦酸-1,2-丙二醇闪烁显像以区分这两个队列。对照组进行 CT 血管造影和心脏磁共振检查，未发现明显的冠状动脉疾病或梗死。分析了整体和局部 ECV，并评估了其与 AS 患者死亡率的相关性。

结果

在 199 名患者中，对照组（n=65；66%为男性）、AS 组（n=115）和同时患有 AS 和转甲状腺素蛋白心脏淀粉样变性的患者（n=19）的整体 ECV 分别为 26.1（25.0-27.8%）、29.1（27.5-31.1%）和 37.4（32.5-46.6%）；<0.001。在所有队列中，ECV 在基底（与心尖相比）、下间隔（与前外侧壁相比）和心内膜下（与心外膜下相比）更高；<0.05。在 AS 患者中，心外膜 ECV 而不是任何其他局部值或整体 ECV 是中位随访 3.9（最大 6.3）年后死亡率的最强预测因子（调整后的危险比，1.21 [95%CI，1.08-1.36]；=0.002）。