主动脉瓣置换术后细胞外体积增加：不影响传导速度的反向心室重构足迹。

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2025-08-06 DOI:10.1016/j.jocmr.2025.101936

Vladimír Sobota, Christoph M Augustin, Gernot Plank, Edward J Vigmond, Sarah Nordmeyer, Jason D Bayer

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引用次数: 0

摘要

背景：由心血管磁共振（CMR）测定的细胞外体积（ECV）被认为是弥漫性心肌纤维化的标志和死亡率的预测因子。使用个性化的计算模型，我们研究了主动脉瓣狭窄（AS）患者的ECV、传导速度（CV）和细胞半径之间的关系。方法：对12例AS患者（男6例，女6例）在主动脉瓣置换术（AVR）术前和术后3个月进行CMR检查。所有患者QRS≤110 ms，晚期钆增强（LGE） CMR无瘢痕。从每个CMR数据集开发计算双心室模型。使用患者特异性ECV和时间点之间细胞半径的相对变化作为输入，在每个模型中调整组织电导率以匹配患者的QRS持续时间。通过从5个激活位点同时起搏来模拟心室去极化的生理模式。在模拟心尖起搏期间测量CV，使用位于模型右室间隔的两个点。结果：AVR后左室质量下降（62[58-79]比51 [41-60]g/m2， p=0.0005），而ECV增加（24.2[20.6-24.8]比28.0 [25.1-29.5]%,p=0.0008）。患者QRS持续时间无变化（89.0 [80.5-99.0]vs. 88 [78.5-99.5] ms, p=0.2148）。从模型中获得的CV在时间点之间没有变化（64.3 [61.9-72.8]vs. 66.0 [60.0-74.5] cm/s, p=0.5186），表明弥漫性纤维化没有明显增加。ECV与细胞半径呈负相关（r=-0.5267, p=0.0082），但与模型计算的CV不相关（r=-0.2036, p=0.3399）。结论：无LGE瘢痕且心室传导正常的患者在AVR后3个月的ECV增加似乎是心室反向重构的足迹，并不一定转化为心肌CV的变化。

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Increased extracellular volume after aortic valve replacement: a footprint of reverse ventricular remodeling that does not affect conduction velocity.

Background: Extracellular volume (ECV) determined by cardiovascular magnetic resonance (CMR) is considered a marker of diffuse myocardial fibrosis and a predictor of mortality. Using personalized computational models, we investigated the relationship between ECV, conduction velocity (CV), and cell radius in aortic stenosis (AS) patients.

Methods: CMR was performed on 12 AS patients (6 males, 6 females) before and 3 months after surgical aortic valve replacement (AVR). All patients had a QRS≤110 ms, and no scar on late gadolinium enhanced (LGE) CMR. Computational biventricular models were developed from each CMR dataset. Using patient-specific ECV and the relative change in cell radius between the time points as inputs, tissue conductivity was adjusted in each model to match the patient's QRS duration. A physiological pattern of ventricular depolarization was mimicked by simultaneously pacing each model from 5 activation sites. CV was measured during a simulation of apical pacing, using two points positioned at the right ventricular septum of the model.

Results: Left ventricular mass decreased after AVR (62 [58-79] vs. 51 [41-60] g/m², p=0.0005) while ECV increased (24.2 [20.6-24.8] vs. 28.0 [25.1-29.5] %, p=0.0008). No changes in the patient's QRS duration (89.0 [80.5-99.0] vs. 88 [78.5-99.5] ms, p=0.2148) were observed. No changes in the CV obtained from the models (64.3 [61.9-72.8] vs. 66.0 [60.0-74.5] cm/s, p=0.5186) were found between the time points, suggesting there was no substantial increase in diffuse fibrosis. ECV was negatively correlated with cell radius (r=-0.5267, p=0.0082), but not correlated with CV obtained from the models (r=-0.2036, p=0.3399).

Conclusion: Increased ECV 3 months after AVR in patients with no LGE scar and with normal ventricular conduction appears to be a footprint of reverse ventricular remodeling that does not necessarily translate into changes in myocardial CV.

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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.