与心血管磁共振成像显示的大量心肌和瓣膜纤维化相关的晚期慢性风湿性心脏病
Advanced Chronic Rheumatic Heart Disease Associated With Substantial Myocardial and Valvular Fibrosis on Cardiovascular Magnetic Resonance.
作者信息
Aremu Olukayode O, Samuels Petronella, Jermy Stephen, Lumngwena Evelyn N, Mutithu Daniel W, Familusi Mary, Herbert Estelle, Speelman Aladdin, Skatulla Sebastian, Ntusi Ntobeko A
机构信息
Department of Medicine, University of Cape Town, Cape Town, ZAF.
Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, ZAF.
出版信息
Cureus. 2025 Aug 13;17(8):e89991. doi: 10.7759/cureus.89991. eCollection 2025 Aug.
INTRODUCTION
Rheumatic heart disease (RHD) is a major public health concern, particularly in low- and middle-income countries. Cardiovascular magnetic resonance (CMR) is a reliable noninvasive technique that detects fibrosis and inflammation in cardiovascular diseases. The study aimed to investigate the association of advanced chronic RHD with myocardial and valvular fibrosis using multiparametric CMR.
METHODS
We assessed myocardial tissue characteristics in chronic RHD using multiparametric CMR. Forty-seven patients with severe, advanced RHD booked for valve replacement surgery, diagnosed on echocardiography, and matched with 30 healthy controls were scanned using a 3T MRI Siemens Magnetom Skyra scanner (Siemens, Erlangen, Germany). Baseline demographic and clinical characteristics, CMR findings including late gadolinium enhancement (LGE), T1 mapping, and extracellular volume (ECV) measurements were reported.
RESULTS
The mean age of patients was 42 ± 12.8 years; 29 (62%) were women (39 ± 12.1 years). LGE CMR detected focal myocardial fibrosis in 47 (100%) of RHD patients vs. 2 (7%) of controls (p < 0.001). In all RHD patients, LGE involving all segments was observed. Patterns of LGE were linear 12 (26%), patchy 17 (36%), and diffuse 18 (38%). The total mass of myocardial enhancement with LGE imaging was significantly different from control (26 ± 10.1 vs. 17 ± 9 g, p = 0.002), resulting in a total percentage of (26% ± 6% vs. 21% ± 6%, p = 0.01). We also report elevated mean native T1 (p < 0.001) and ECV (p < 0.001) in all RHD patients compared to controls, respectively. Myocardial fibrosis is abundant in patients with severe, chronic RHD.
CONCLUSION
We report a high fibrotic burden in patients with advanced chronic RHD. Our observations may provide an explanation for increased heart failure and mortality in RHD, as excess myocardial fibrosis has been strongly linked with mortality in other disease contexts.
引言
风湿性心脏病（RHD）是一个重大的公共卫生问题，在低收入和中等收入国家尤为如此。心血管磁共振成像（CMR）是一种可靠的非侵入性技术，可检测心血管疾病中的纤维化和炎症。本研究旨在使用多参数CMR研究晚期慢性RHD与心肌和瓣膜纤维化的关联。
方法
我们使用多参数CMR评估慢性RHD患者的心肌组织特征。47例预定进行瓣膜置换手术、经超声心动图诊断为重度晚期RHD的患者，并与30名健康对照者一起使用3T西门子Magnetom Skyra磁共振成像扫描仪（西门子，德国埃尔朗根）进行扫描。报告了基线人口统计学和临床特征、CMR结果，包括延迟钆增强（LGE）、T1映射和细胞外容积（ECV）测量。
结果
患者的平均年龄为42±12.8岁；29例（62%）为女性（39±12.1岁）。LGE CMR在47例（100%）RHD患者中检测到局灶性心肌纤维化，而在对照组中为2例（7%）（p<0.001）。在所有RHD患者中，均观察到累及所有节段的LGE。LGE的模式为线性12例（26%）、斑片状17例（36%）和弥漫性18例（38%）。LGE成像的心肌强化总量与对照组有显著差异（26±10.1 vs. 17±9 g，p=0.002），导致总百分比分别为（26%±6% vs. 21%±6%，p=0.01）。我们还报告，与对照组相比，所有RHD患者的平均固有T1（p<0.001）和ECV（p<0.001）均升高。重度慢性RHD患者心肌纤维化严重。
结论
我们报告晚期慢性RHD患者的纤维化负担较高。我们的观察结果可能为RHD患者心力衰竭和死亡率增加提供一种解释，因为在其他疾病背景下，过量的心肌纤维化与死亡率密切相关。
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