主动脉瓣狭窄中的左心室肥厚：主动脉瓣置换术后2个月细胞和基质的早期消退
Left Ventricular Hypertrophy in Aortic Stenosis: Early Cell and Matrix Regression 2 Months Post-Aortic Valve Replacement.
作者信息
Bennett Jonathan, Thornton George D, Nitsche Christian, Gama Francisco F, Aziminia Nikoo, Gul Uzma, Shetye Abhishek, Kellman Peter, Davies Rhodri H, Moon James C, Treibel Thomas A
机构信息
Institute of Cardiovascular Science, University College London, United Kingdom (J.B., G.D.T., C.N., N.A., R.H.D., J.C.M., T.A.T.).
Cardiovascular Imaging Department, Barts Heart Centre, London, United Kingdom (J.B., G.D.T., C.N., F.F.G., N.A., U.G., A.S., R.H.D., J.C.M., T.A.T.).
出版信息
Circ Cardiovasc Imaging. 2024 Dec;17(12):e017425. doi: 10.1161/CIRCIMAGING.124.017425. Epub 2024 Dec 4.
BACKGROUND
In aortic stenosis, the myocardium responds with left ventricular hypertrophy, which is characterized by increased left ventricular mass due to cellular hypertrophy and extracellular matrix expansion. Following aortic valve replacement (AVR), left ventricular hypertrophy regression occurs, but early cellular and extracellular dynamics are unknown.
METHODS
Patients with severe symptomatic aortic stenosis undergoing surgical or transcatheter AVR were prospectively recruited. Pre- and early post-AVR cardiac magnetic resonance imaging assessed left ventricular remodeling, global longitudinal strain, and T1 mapping to determine extracellular volume fraction and volume of cellular and extracellular compartments.
RESULTS
In all, 39 patients (aged 71.4±9.8 years, male 79%, aortic valve peak velocity 4.4±0.5 m/s) underwent cardiac magnetic resonance before and at median 7.7 weeks post-AVR. Left ventricular mass index reduced significantly by 15.4% (<0.001*), primarily driven by cellular compartment regression (18.7%, <0.001*), with a smaller reduction in the extracellular compartment (7.2%, <0.001*). This unbalanced regression led to an apparent increase in extracellular volume fraction (27.4±3.1% to 30.2±2.8%; <0.001*). Although there was no significant change in global longitudinal strain post-AVR, an increase in extracellular volume fraction was associated with worsening of global longitudinal strain (Pearson r=0.41, =0.01). Mode of intervention (transcatheter versus surgical) did not influence the above myocardial parameters post-AVR (all >0.05). The asterisk in values indicates a statistical significance of <0.05.
CONCLUSIONS
Within 8 weeks of AVR for aortic stenosis, substantial left ventricular hypertrophy regression occurs involving both cellular and extracellular compartments, demonstrating the early myocardial adaptability to afterload relief. Cellular compartment regression is greater than extracellular regression, leading to an apparent increase in extracellular volume fraction. Mode of intervention did not affect degree of reverse remodeling, indicating that both are effective at resulting beneficial changes post-AVR.
REGISTRATION
URL: https://www.isrctn.com; Unique identifier: NCT04627987.
背景
在主动脉瓣狭窄中，心肌会出现左心室肥厚，其特征是由于细胞肥大和细胞外基质扩张导致左心室质量增加。在主动脉瓣置换术（AVR）后，左心室肥厚会发生消退，但早期细胞和细胞外的动态变化尚不清楚。
方法
前瞻性招募患有严重症状性主动脉瓣狭窄并接受外科或经导管AVR的患者。在AVR术前和术后早期进行心脏磁共振成像，评估左心室重塑、整体纵向应变和T1映射，以确定细胞外体积分数以及细胞和细胞外成分的体积。
结果
共有39例患者（年龄71.4±9.8岁，男性占79%，主动脉瓣峰值速度4.4±0.5米/秒）在AVR术前和术后中位数7.7周时接受了心脏磁共振检查。左心室质量指数显著降低了15.4%（<0.001*），主要是由细胞成分消退所致（18.7%，<0.001*），细胞外成分的减少幅度较小（7.2%，<0.001*）。这种不平衡的消退导致细胞外体积分数明显增加（从27.4±3.1%增至30.2±2.8%；<0.001*）。尽管AVR术后整体纵向应变没有显著变化，但细胞外体积分数的增加与整体纵向应变的恶化相关（Pearson相关系数r = 0.41，P = 0.01）。干预方式（经导管与外科手术）对AVR术后上述心肌参数没有影响（均>0.05）。P值中的星号表示统计学显著性<0.05。
结论
在主动脉瓣狭窄的AVR术后8周内，左心室肥厚显著消退，涉及细胞和细胞外成分，表明心肌对后负荷减轻具有早期适应性。细胞成分的消退大于细胞外成分的消退，导致细胞外体积分数明显增加。干预方式不影响逆向重塑的程度，表明两者在AVR术后均能有效带来有益变化。
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