利用锰增强核磁共振成像对主动脉瓣狭窄患者的心肌钙摄取进行体内评估

IF 4.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2024-08-02 DOI:10.1016/j.jocmr.2024.101074

Abhishek Dattani, Saadia Aslam, Gaurav S Gulsin, Aseel Alfuhied, Trisha Singh, Shruti S Joshi, Lucy E Kershaw, David E Newby, Gerry P McCann, Anvesha Singh

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引用次数: 0

摘要

背景：缺血性、非缺血性和糖尿病性心肌病均可导致心肌钙处理失调。锰增强磁共振成像（MEMRI）提供了一种独特的方法来量化体内心肌钙摄取，但迄今为止还没有研究将 MEMRI 用于主动脉瓣狭窄（AS）患者。我们试图1）确定严重 AS 患者的心肌钙摄取是否受到干扰；2）评估主动脉瓣置换术（AVR）后钙摄取的变化：在这项前瞻性试点病例对照研究中，患有严重 AS 的成人在主动脉瓣置换术前后接受了 MEMRI 检查。同时还招募了一组健康对照者。主要结果是帕特拉克模型评估的锰摄取率（Ki），作为心肌钙摄取的替代指标。组间 Ki 的比较根据年龄、体重指数（BMI）和收缩压进行了调整：共招募了 28 名对照组和 10 名重度 AS 患者（年龄 72 [61-75] 岁，8 名男性，7 名有症状，瓣膜面积 0.81 [0.74-1.0] 平方厘米），其中 7 名患者在做完 AVR 后返回重复扫描。与对照组相比，强直性脊柱炎患者的体重指数（BMI）和血压更高，高脂血症的发病率也更高。两组患者的基线左心室（LV）容积相似，但AS患者的指数左心室质量更高。AS组的整体纵向应变和舒张早期峰值应变率较低。重度AS患者的Ki与对照组无明显差异（7.09 [6.33-8.99] vs. 8.15 [7.54-8.78] mL/100g组织/分钟，P=0.815）。AVR术后，指数左心室质量（68 [51-79] g/m2降至49 [47-65] g/m2，P=0.018）和质容比（0.94 [0.80-1.13] g/mL降至0.74 [0.71-0.82] g/mL，P=0.028）有所下降，但Ki无变化（7.35 [6.81-8.96] mL/100g组织/分钟降至7.11 [6.16-8.01] mL/100g组织/分钟，P=0.499）：结论：尽管重度强直性脊柱炎患者具有明显的左心室重塑和收缩功能障碍的不良特征，但与对照组相比，其基线钙摄取量没有变化。此外，AVR导致左心室重塑逆转，但钙摄取量未见明显变化。这可能表明，心肌钙处理的改变在强直性脊柱炎中并不扮演重要的病理生理角色。

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In-vivo assessment of myocardial calcium uptake using manganese-enhanced cardiovascular magnetic resonance in aortic stenosis.

Background: Dysregulated myocardial calcium handling has been demonstrated in ischemic, non-ischemic and diabetic cardiomyopathy. Manganese-enhanced MRI (MEMRI) provides a unique method to quantify in-vivo myocardial calcium uptake but no studies have so far utilized MEMRI in patients with aortic stenosis (AS). We sought to: 1) determine whether myocardial calcium uptake is perturbed in people with severe AS, and 2) assess change in calcium uptake following aortic valve replacement (AVR).

Methods: In this prospective, pilot, case-control study, adults with severe AS underwent MEMRI before and after AVR. A group of healthy controls were also recruited. The primary outcome was the rate of manganese uptake (Ki) as assessed by Patlak modeling to act as a surrogate of myocardial calcium uptake. Comparison of Ki between groups was adjusted for age, body mass index (BMI) and systolic blood pressure.

Results: Twenty-eight controls and ten subjects with severe AS (age 72 [61-75] years, 8 male, 7 symptomatic, valve area 0.81 [0.74-1.0] cm²) were recruited, with seven returning for repeat scans post-AVR. AS patients had higher BMI and blood pressure, and a greater incidence of hyperlipidemia compared to controls. Baseline left ventricular (LV) volumes were similar between the groups, but the AS patients had higher indexed left ventricular mass. Global longitudinal strain and peak early diastolic strain rate were lower in the AS group. There was no significant difference in Ki between patients with severe AS and controls (7.09 [6.33-8.99] vs. 8.15 [7.54-8.78] mL/100g of tissue/min, P=0.815). Following AVR, there was regression in indexed LV mass (68 [51-79] to 49 [47-65] g/m², P=0.018) and mass-volume ratio (0.94 [0.80-1.13] to 0.74 [0.71-0.82] g/mL, P=0.028) but no change in Ki was seen (7.35 [6.81-8.96] to 7.11 [6.16-8.01] mL/100 g of tissue/min, P=0.499).

Conclusions: Despite clear features of adverse LV remodeling and systolic dysfunction, patients with severe AS demonstrated no alteration in calcium uptake at baseline compared to controls. Moreover, AVR led to reverse LV remodeling but no notable change in calcium uptake was seen. This may suggest that altered myocardial calcium handling does not play a significant pathophysiological role in AS.

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.