肥厚性梗阻性心肌病患者行室间隔心肌切除术后左心室心肌重构
Left ventricle myocardial remodeling following septal myectomy in patients with hypertrophic obstructive cardiomyopathy.
作者信息
Lu Guanyu, Cao Liqi, Ou Jiehao, Luo Xinyi, Zhu Wei, Du Zhicheng, Liu Jian, Yang Yuelong, Zhang Xinyue, Wei Peijian, Wu Hongxiang, Guo Huiming, Liu Hui
机构信息
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Department of Interventional Diagnosis and Therapy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
出版信息
J Cardiovasc Magn Reson. 2025 Feb 17;27(1):101864. doi: 10.1016/j.jocmr.2025.101864.
BACKGROUND
Left ventricular (LV) reverse myocardial remodeling occurs following septal myectomy in hypertrophic obstructive cardiomyopathy (HOCM), but it remains unclear whether diffuse fibrosis is reversible during this period. Extracellular volume fraction (ECV) and indexed extracellular volume (iECV) are important surrogate markers of diffuse myocardial fibrosis. This study aimed to investigate whether diffuse myocardial fibrosis in HOCM can regress after myectomy.
METHODS
A prospective cohort study was conducted among patients with HOCM. All subjects underwent clinical assessment (clinical history, 6-min walk test, biochemical analysis), echocardiography, and cardiovascular magnetic resonance preoperatively and 6months after septal myectomy.
RESULTS
A total of 43 patients (52±14years, 23 female) were included in the analysis. At 6months post-myectomy, there were significant within-person decreases in LV mass index (101.0 [82.5-121.0] to 85.8 [66.7-100.0]g/m; p<0.001), indexed cell volume (68.6 [53.2-82.6]mL/m to 54.0 [4.6-62.0]mL/m; p<0.001) and iECV (26.5 [22.4-30.1]mL/m to 21.2 [18.7-26.4]mL/m; p<0.001). Conversely, ECV (28.2±3.3% to 30.2±2.8%; p<0.001) and late gadolinium enhancement mass (4.5 [0.2-8.2]g to 8.7 [2.1-12.8]g; p<0.001) increased. These changes were accompanied by improvement of New York Heart Association functional class, 6-min walk test results, N-terminal pro-B-type natriuretic peptide, and high-sensitivity cardiac troponin T.
CONCLUSION
Six months after septal myectomy, both cellular hypertrophy and diffuse fibrosis are reversible in HOCM, while focal fibrosis does not regress. These changes are accompanied by improvement of exercise parameters and laboratory biomarkers, revealing the plastic nature of diffuse fibrosis in HOCM and its potential as a therapeutic target.
背景
肥厚型梗阻性心肌病（HOCM）患者行室间隔心肌切除术后左心室（LV）发生逆向心肌重构，但在此期间弥漫性纤维化是否可逆尚不清楚。细胞外容积分数（ECV）和指数化细胞外容积（iECV）是弥漫性心肌纤维化的重要替代标志物。本研究旨在探讨HOCM患者行心肌切除术后弥漫性心肌纤维化是否会消退。
方法
对HOCM患者进行一项前瞻性队列研究。所有受试者在术前及室间隔心肌切除术后6个月均接受临床评估（临床病史、6分钟步行试验、生化分析）、超声心动图检查和心血管磁共振成像检查。
结果
共有43例患者（年龄52±14岁，女性23例）纳入分析。心肌切除术后6个月，患者的左心室质量指数显著下降（从101.0[82.5 - 121.0]g/m降至85.8[66.7 - 100.0]g/m；p<0.001），指数化细胞容积下降（从68.6[53.2 - 82.6]mL/m降至54.0[4.6 - 62.0]mL/m；p<0.001），iECV下降（从26.5[22.4 - 30.1]mL/m降至21.2[18.7 - 26.4]mL/m；p<0.001）。相反，ECV升高（从28.2±3.3%升至30.2±2.8%；p<0.001），钆延迟强化质量增加（从4.5[0.2 - 8.2]g增至8.7[2.1 - 12.8]g；p<0.001）。这些变化伴随着纽约心脏协会心功能分级、6分钟步行试验结果、N末端B型利钠肽原和高敏心肌肌钙蛋白T的改善。
结论
室间隔心肌切除术后6个月，HOCM患者的细胞肥大和弥漫性纤维化均可逆，而局灶性纤维化不会消退。这些变化伴随着运动参数和实验室生物标志物的改善，揭示了HOCM中弥漫性纤维化的可塑性及其作为治疗靶点的潜力。
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