扩张型心肌病左心室几何学构型的磁共振评价
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摘要
左心室重构是扩张型心肌病重要的病理生理基础,是神经内分泌系统异常激活介导下发生的心肌组织特征以及心室形态结构改变。随着对左心室重构、治疗后逆转重构现象的关注和深入研究,过去曾被忽视的左心室几何学构型再次成为近年的研究热点之一,尤其是利用心脏磁共振成像技术,获取球形指数、相对室壁厚度、左心室质量/容积,以及新型的重构指数、长轴应变等分析指标。逐渐增多的磁共振研究显示左心室几何学构型对扩张型心肌病有明确的预后价值,可能优于单独使用射血分数来进行危险分层,并发现几何学构型的改变与心肌纤维化的程度有显著的相关性,其临床应用价值仍需进一步的验证与拓展。
Left ventricular(LV) remodeling is the most important pathophysiologic mechanism of dilated cardiomyopathy(DCM)which is defined as the changes in myocardial tissue characteristics and ventricular morphology triggered by overactivated neuroendocrine system.With the attention on LV remodeling and reverse remodeling after therapy in DCM,LV geometry that used to be overlooked has become a clinical research hotspot recently.In particular,cardiac magnetic resonance(CMR) is a preferred imaging modality that used for the analysis of sphericity index,relative wall thickness,LV mass/volume,new remodeling index and long-axis strain as major parameters of LV geometry.Accumulated CMR studies revealed that LV geometry had an independent prognostic value in DCM,superior to using LV ejection fraction alone for risk stratification.In addition,it was found that there was a significant correlation between geometry change and myocardial fibrosis.However,further investigation is warranted for verification and expansion of its clinical application.
Left ventricular(LV) remodeling is the most important pathophysiologic mechanism of dilated cardiomyopathy(DCM)which is defined as the changes in myocardial tissue characteristics and ventricular morphology triggered by overactivated neuroendocrine system.With the attention on LV remodeling and reverse remodeling after therapy in DCM,LV geometry that used to be overlooked has become a clinical research hotspot recently.In particular,cardiac magnetic resonance(CMR) is a preferred imaging modality that used for the analysis of sphericity index,relative wall thickness,LV mass/volume,new remodeling index and long-axis strain as major parameters of LV geometry.Accumulated CMR studies revealed that LV geometry had an independent prognostic value in DCM,superior to using LV ejection fraction alone for risk stratification.In addition,it was found that there was a significant correlation between geometry change and myocardial fibrosis.However,further investigation is warranted for verification and expansion of its clinical application.
引文
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[4]Adhyapak SM,Parachuri VR.Response to heart failure therapy:ventricular volume changes vs.shape changes[J].Asian Cardiovasc Thorac Ann,2012,20(2):210-213.
[5]Silva Marques J,Pinto FJ.Clinical use of multimodality imaging in the assessment of dilated cardiomyopathy[J].Heart,2015,101(7):565-572.
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[11]Krittayaphong R,Boonyasirinant T,Saiviroonporn P,et al.Correlation between NT-pro BNP levels and left ventricular wall stress,sphericity index and extent of myocardial damage:a magnetic resonance imaging study[J].J Card Fail,2008,14(8):687-694.
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[13]Nakamori S,Ismail H,Ngo LH,et al.Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction:a comprehensive cardiovascular magnetic resonance study[J].J Cardiovasc Magn Reson,2017,19(1):79.
[14]Levine YC,Matos J,Rosenberg MA,et al.Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy[J].Heart Rhythm,2016,13(2):490-497.
[15]Liang Y,Li W,Zeng R,et al.Left ventricular spherical index is an independent predictor for clinical outcomes in patients with nonischemic dilated cardiomyopathy[J].JACC Cardiovasc Imaging,2019,Feb 11.pii:s1936-878X(19)30055-5[Epub ahead of print].
[16]Imanishi J,Kaihotsu K,Yoshikawa S,et al.Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry[J].Int J Cardiovasc Imaging,2018,34(2):185-192.
[17]Tsao CW,Gona PN,Salton CJ,et al.Left ventricular structure and risk of cardiovascular events:a Framingham Heart Study Cardiac Magnetic Resonance Study[J].J Am Heart Assoc,2015,4(9):e002188.
[18]Pozo E,Kanwar A,Deochand R,et al.Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis[J].Heart,2014,100(21):1688-1695.
[19]Vadakkumpadan F,Trayanova N,Wu KC.Image-based left ventricular shape analysis for sudden cardiac death risk stratification[J].Heart Rhythm,2014,11(10):1693-1700.
[20]Garg S,de Lemos JA,Ayers C,et al.Association of a 4-tiered classification of LV hypertrophy with adverse CV outcomes in the general population[J].JACCCardiovasc Imaging,2015,8(9):1034-1041.
[21]Rodrigues JC,Amadu AM,Dastidar AG,et al.Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes[J].Heart,2016,102(20):1671-1679.
[22]Goh VJ,Le TT,Bryant J,et al.Novel index of maladaptive myocardial remodeling in hypertension[J].Circ Cardiovasc Imaging,2017,10(9):e006840.
[23]Arenja N,Riffel JH,Fritz T,et al.Diagnostic and prognostic value of long-axis strain and myocardial contraction fraction using standard cardiovascular MR imaging in patients with nonischemic dilated cardiomyopathies[J].Radiology,2017,283(3):681-691.
[24]Ismail TF,Prasad SK,Pennell DJ.Prognostic importance of late gadolinium enhancement cardiovascular magnetic resonance in cardiomyopathy[J].Heart,2012,98(6):438-442.
[25]Kim J,Kochav JD,Gurevich S,et al.Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging[J].Int J Cardiovasc Imaging,2014,30(8):1559-1567.
[26]aus dem Siepen F,Buss SJ,Messroghli D,et al.T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance:quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy[J].Eur Heart J Cardiovasc Imaging,2015,16(2):210-216.
[27]Mewton N,Liu CY,Croisille P,et al.Assessment of myocardial fibrosis with cardiovascular magnetic resonance[J].J Am Coll Cardiol,2011,57(8):891-903.
[28]Kramer J,Bijnens B,Stork S,et al.Left ventricular geometry and blood pressure as predictors of adverse progression of Fabry cardiomyopathy[J].PLo SOne,2015,10(11):e0140627.
[29]Cheng H,Lu M,Hou C,et al.Comparison of cardiovascular magnetic resonance characteristics and clinical consequences in children and adolescents with isolated left ventricular non-compaction with and without late gadolinium enhancement[J].J Cardiovasc Magn Reson,2015,17(1):44.
[2]Pinto YM,Elliott PM,Arbustini E,et al.Proposal for a revised definition of dilated cardiomyopathy,hypokinetic non-dilated cardiomyopathy,and its implications for clinical practice:a position statement of the ESC working group on myocardial and pericardial diseases[J].Eur Heart J,2016,37(23):1850-1858.
[3]Merlo M,Pivetta A,Pinamonti B,et al.Long-term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy:changing mortality over the last 30 years[J].Eur J Heart Fail,2014,16(3):317-324.
[4]Adhyapak SM,Parachuri VR.Response to heart failure therapy:ventricular volume changes vs.shape changes[J].Asian Cardiovasc Thorac Ann,2012,20(2):210-213.
[5]Silva Marques J,Pinto FJ.Clinical use of multimodality imaging in the assessment of dilated cardiomyopathy[J].Heart,2015,101(7):565-572.
[6]Jacobs LD,Salgo IS,Goonewardena S,et al.Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data[J].Eur Heart J,2006,27(4):460-468.
[7]Kalisz K,Rajiah P.Computed tomography of cardiomyopathies[J].Cardiovasc Diagn Ther,2017,7(5):539-556.
[8]Ky B,Plappert T,Kirkpatrick J,et al.Left ventricular remodeling in human heart failure:quantitative echocardiographic assessment of 1,794 patients[J].Echocardiography,2012,29(7):758-765.
[9]Marchal P,Lairez O,Cognet T,et al.Relationship between left ventricular sphericity and trabeculation indexes in patients with dilated cardiomyopathy:a cardiac magnetic resonance study[J].Eur Heart J Cardiovasc Imaging,2013,14(9):914-920.
[10]Cheng H,Zhao S,Jiang S,et al.Comparison of cardiac magnetic resonance imaging features of isolated left ventricular non-compaction in adults versus dilated cardiomyopathy in adults[J].Clin Radiol,2011,66(9):853-860.
[11]Krittayaphong R,Boonyasirinant T,Saiviroonporn P,et al.Correlation between NT-pro BNP levels and left ventricular wall stress,sphericity index and extent of myocardial damage:a magnetic resonance imaging study[J].J Card Fail,2008,14(8):687-694.
[12]Ambale-Venkatesh B,Yoneyama K,Sharma RK,et al.Left ventricular shape predicts different types of cardiovascular events in the general population[J].Heart,2017,103(7):499-507.
[13]Nakamori S,Ismail H,Ngo LH,et al.Left ventricular geometry predicts ventricular tachyarrhythmia in patients with left ventricular systolic dysfunction:a comprehensive cardiovascular magnetic resonance study[J].J Cardiovasc Magn Reson,2017,19(1):79.
[14]Levine YC,Matos J,Rosenberg MA,et al.Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy[J].Heart Rhythm,2016,13(2):490-497.
[15]Liang Y,Li W,Zeng R,et al.Left ventricular spherical index is an independent predictor for clinical outcomes in patients with nonischemic dilated cardiomyopathy[J].JACC Cardiovasc Imaging,2019,Feb 11.pii:s1936-878X(19)30055-5[Epub ahead of print].
[16]Imanishi J,Kaihotsu K,Yoshikawa S,et al.Acute pulmonary edema in patients with reduced left ventricular ejection fraction is associated with concentric left ventricular geometry[J].Int J Cardiovasc Imaging,2018,34(2):185-192.
[17]Tsao CW,Gona PN,Salton CJ,et al.Left ventricular structure and risk of cardiovascular events:a Framingham Heart Study Cardiac Magnetic Resonance Study[J].J Am Heart Assoc,2015,4(9):e002188.
[18]Pozo E,Kanwar A,Deochand R,et al.Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis[J].Heart,2014,100(21):1688-1695.
[19]Vadakkumpadan F,Trayanova N,Wu KC.Image-based left ventricular shape analysis for sudden cardiac death risk stratification[J].Heart Rhythm,2014,11(10):1693-1700.
[20]Garg S,de Lemos JA,Ayers C,et al.Association of a 4-tiered classification of LV hypertrophy with adverse CV outcomes in the general population[J].JACCCardiovasc Imaging,2015,8(9):1034-1041.
[21]Rodrigues JC,Amadu AM,Dastidar AG,et al.Comprehensive characterisation of hypertensive heart disease left ventricular phenotypes[J].Heart,2016,102(20):1671-1679.
[22]Goh VJ,Le TT,Bryant J,et al.Novel index of maladaptive myocardial remodeling in hypertension[J].Circ Cardiovasc Imaging,2017,10(9):e006840.
[23]Arenja N,Riffel JH,Fritz T,et al.Diagnostic and prognostic value of long-axis strain and myocardial contraction fraction using standard cardiovascular MR imaging in patients with nonischemic dilated cardiomyopathies[J].Radiology,2017,283(3):681-691.
[24]Ismail TF,Prasad SK,Pennell DJ.Prognostic importance of late gadolinium enhancement cardiovascular magnetic resonance in cardiomyopathy[J].Heart,2012,98(6):438-442.
[25]Kim J,Kochav JD,Gurevich S,et al.Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging[J].Int J Cardiovasc Imaging,2014,30(8):1559-1567.
[26]aus dem Siepen F,Buss SJ,Messroghli D,et al.T1 mapping in dilated cardiomyopathy with cardiac magnetic resonance:quantification of diffuse myocardial fibrosis and comparison with endomyocardial biopsy[J].Eur Heart J Cardiovasc Imaging,2015,16(2):210-216.
[27]Mewton N,Liu CY,Croisille P,et al.Assessment of myocardial fibrosis with cardiovascular magnetic resonance[J].J Am Coll Cardiol,2011,57(8):891-903.
[28]Kramer J,Bijnens B,Stork S,et al.Left ventricular geometry and blood pressure as predictors of adverse progression of Fabry cardiomyopathy[J].PLo SOne,2015,10(11):e0140627.
[29]Cheng H,Lu M,Hou C,et al.Comparison of cardiovascular magnetic resonance characteristics and clinical consequences in children and adolescents with isolated left ventricular non-compaction with and without late gadolinium enhancement[J].J Cardiovasc Magn Reson,2015,17(1):44.