Echocardiographic Characterization of Myocardial Stiffness in Healthy Volunteers, Cardiac Amyloidosis, and Hypertrophic Cardiomyopathy: A Case-Control Study Using Multimodality Imaging.

IF 6.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Circulation: Cardiovascular Imaging Pub Date : 2025-03-01 Epub Date: 2025-03-03 DOI:10.1161/CIRCIMAGING.124.017475
Dominik C Benz, Ali Sadeghi, Pat G Rafter, Olivier F Clerc, Jocelyn Canseco Neri, Alexandra Taylor, Shilpa Vijayakumar, Carolyn Y Ho, Sarah A M Cuddy, Rodney H Falk, Sharmila Dorbala
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引用次数: 0

Abstract

Background: Noninvasive tools to measure myocardial stiffness are limited. Intrinsic cardiac elastography in echocardiography relates to myocardial stiffness by measuring the propagation of the myocardial stretch generated by atrial contraction. The aims of the present study were (1) to evaluate myocardial stiffness using intrinsic cardiac elastography in healthy volunteers versus those with myocardial diseases (ie, cardiac amyloidosis [CA] and hypertrophic cardiomyopathy) and (2) to identify key factors that affect myocardial stiffness.

Methods: In this prospective study, myocardial stiffness was estimated in 54 participants, including 10 hypertrophic cardiomyopathy, 28 CA, and 16 healthy volunteers. Myocardial stiffness was assessed as intrinsic velocity propagation of myocardial stretch (iVP, m/s) measured by high frame rate echocardiography (ie, above 250 frames per second). Extracellular volume was quantified by cardiac magnetic resonance in 22 participants. Amyloid burden was quantified by cardiac amyloid activity in 99mTc-labeled pyrophosphate single-photon emission computed tomography in 10 participants.

Results: Myocardial stiffness was significantly higher in the CA cohort (median iVP, 2.6 m/s; interquartile range, 1.7-3.9 m/s) than in the hypertrophic cardiomyopathy cohort (median iVP, 1.4 m/s; interquartile range, 1.0-1.8 m/s; P=0.011). In patients with CA or hypertrophic cardiomyopathy, iVP was correlated with NT-proBNP (N-terminal pro-B-type natriuretic peptide) (ρ=0.498, P=0.003), extracellular volume (ρ=0.646, P=0.004), and cardiac amyloid activity (ρ=0.891, P<0.001). In multivariate linear regression analysis, extracellular volume was independently associated with myocardial stiffness even after accounting for indexed left ventricular mass, global longitudinal strain, and E/e'. In healthy volunteers, normal myocardial stiffness was defined by the upper limit of normal of iVP at 1.7 m/s. Patients with CA and normal myocardial stiffness (iVP <1.7 m/s) were characterized by a low risk profile including lower NT-proBNP (P=0.034), lower troponin T (P=0.041), lower National Amyloidosis Center stage (P=0.031), smaller interstitial expansion (P=0.014), and smaller amyloid burden (P=0.056).

Conclusions: Intrinsic cardiac elastography is a reliable noninvasive tool to measure myocardial stiffness. In this pilot study, it is related to imaging markers of interstitial expansion and amyloid burden.

健康志愿者、心肌淀粉样变性和肥厚性心肌病的超声心动图特征:一项使用多模态成像的病例对照研究。
背景:测量心肌硬度的无创工具是有限的。超声心动图中的内在心脏弹性图通过测量心房收缩引起的心肌拉伸的传播,与心肌刚度有关。本研究的目的是:(1)使用心脏固有弹性成像来评估健康志愿者与患有心肌疾病(即心脏淀粉样变性[CA]和肥厚性心肌病)的志愿者的心肌僵硬度;(2)确定影响心肌僵硬度的关键因素。方法:在这项前瞻性研究中,对54名参与者的心肌硬度进行了估计,其中包括10名肥厚性心肌病患者,28名CA和16名健康志愿者。通过高帧率超声心动图(即每秒250帧以上)测量心肌拉伸的固有速度传播(iVP, m/s)来评估心肌刚度。通过心脏磁共振对22名参与者的细胞外体积进行量化。在99mtc标记焦磷酸盐单光子发射计算机断层扫描中,通过心脏淀粉样蛋白活性量化10名参与者的淀粉样蛋白负荷。结果:心肌僵硬度在CA队列中显著升高(iVP中位数为2.6 m/s;四分位数范围,1.7-3.9 m/s)比肥厚性心肌病组(iVP中位数,1.4 m/s;四分位数范围1.0 ~ 1.8 m/s;P = 0.011)。在CA或肥厚性心肌病患者中,iVP与NT-proBNP (n -末端前b型利钠肽)(ρ=0.498, P=0.003)、细胞外体积(ρ=0.646, P=0.004)、心脏淀粉样蛋白活性(ρ=0.891, PP=0.034)、肌钙蛋白T (P=0.041)、国家淀粉样变性中心期(P=0.031)、间质扩张较小(P=0.014)和淀粉样蛋白负荷较小(P=0.056)相关。结论:内禀心脏弹性成像是一种可靠的无创测量心肌硬度的工具。在这项初步研究中,它与间质扩张和淀粉样蛋白负荷的影像学标志物有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.30
自引率
2.70%
发文量
225
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.
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