心血管磁共振成像显示炎症性肠病活动期患者存在心肌受累情况。
Cardiovascular magnetic resonance reveals myocardial involvement in patients with active stage of inflammatory bowel disease.
作者信息
Fenski Maximilian, Abazi Endri, Gröschel Jan, Hadler Thomas, Kappelmayer Diane, Kolligs Frank, Prieto Claudia, Botnar Rene, Kunze Karl-Philipp, Schulz-Menger Jeanette
机构信息
Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany.
Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin Buch, Berlin, Germany.
出版信息
Clin Res Cardiol. 2024 Aug 5. doi: 10.1007/s00392-024-02503-5.
BACKGROUND
Active inflammatory bowel disease (A-IBD) but not remission (R-IBD) has been associated with an increased risk of cardiovascular death and hospitalization for heart failure.
OBJECTIVES
Using cardiovascular magnetic resonance (CMR), this study aims to assess adverse myocardial remodeling in patients with IBD in correlation with disease activity.
METHODS
Forty-four IBD patients without cardiovascular disease (24 female, median-age: 39.5 years, 26 A-IBD, 18 R-IBD) and 44 matched healthy volunteers (HV) were prospectively enrolled. The disease stage was determined by endoscopic and patient-reported criteria. Participants underwent CMR for cardiac phenotyping: cine imaging and strain analysis were performed to assess ventricular function. T1 mapping, extracellular volume and late-gadolinium enhanced images were obtained to assess focal and diffuse myocardial fibrosis. Simultaneous T1 and T2 elevation (T1 > 1049.3 ms, T2 > 54 ms) was considered to indicate a myocardial segment was inflamed.
RESULTS
16/44 (16.4%) IBD patients described dyspnea on exertion and 10/44 (22.7%) reported chest pain. A-IBD patients showed impaired ventricular function, indicated by reduced global circumferential and radial strain despite preserved left-ventricular ejection fraction. 16% of all IBD patients had focal fibrosis in a non-ischemic pattern. A-IDB patients had increased markers of diffuse left ventricular fibrosis (T1-values: A-IBD: 1022.0 ± 34.83 ms, R-IBD: 1010.10 ± 32.88 ms, HV: 990.61 ± 29.35 ms, p < .01). Significantly more participants with A-IDB (8/26, 30.8%) had at least one inflamed myocardial segment than patients in remission (0/18) and HV (1/44, 2.3%, p < .01). Markers of diffuse fibrosis correlated with disease activity.
CONCLUSION
This study, using CMR, provides evidence of myocardial involvement and patterns of adverse left ventricular remodeling in patients with IBD.
CLINICAL TRIAL REGISTRATION
ISRCTN30941346.
背景
活动性炎症性肠病（A-IBD）而非缓解期炎症性肠病（R-IBD）与心血管死亡及因心力衰竭住院风险增加相关。
目的
本研究旨在使用心血管磁共振成像（CMR）评估炎症性肠病患者的不良心肌重塑及其与疾病活动度的相关性。
方法
前瞻性纳入44例无心血管疾病的炎症性肠病患者（24例女性，中位年龄：39.5岁，26例A-IBD，18例R-IBD）和44例匹配的健康志愿者（HV）。通过内镜检查和患者报告的标准确定疾病阶段。参与者接受CMR心脏表型分析：进行电影成像和应变分析以评估心室功能。获取T1映射、细胞外容积和延迟钆增强图像以评估局灶性和弥漫性心肌纤维化。同时T1和T2升高（T1＞1049.3毫秒，T2＞54毫秒）被认为表明心肌节段有炎症。
结果
16/44（16.4%）的炎症性肠病患者描述有劳力性呼吸困难，10/44（22.7%）报告有胸痛。A-IBD患者显示心室功能受损，尽管左心室射血分数保留，但整体圆周应变和径向应变降低表明了这一点。所有炎症性肠病患者中有16%有非缺血性模式的局灶性纤维化。A-IDB患者弥漫性左心室纤维化标志物增加（T1值：A-IBD：1022.0±34.83毫秒，R-IBD：1010.10±32.88毫秒，HV：990.61±29.35毫秒，p＜0.01）。与缓解期患者（0/18）和HV（1/44，2.3%）相比，A-IDB患者中有更多参与者（8/26，30.8%）至少有一个心肌节段有炎症（p＜0.01）。弥漫性纤维化标志物与疾病活动度相关。
结论
本研究使用CMR提供了炎症性肠病患者心肌受累及左心室不良重塑模式的证据。
临床试验注册
ISRCTN30941346。
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