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首页> 外文期刊>JACC. Cardiovascular imaging. >Quantification of extracellular matrix expansion by CMR in infiltrative heart disease
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Quantification of extracellular matrix expansion by CMR in infiltrative heart disease

机译：CMR对浸润性心脏病中细胞外基质扩展的定量

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Objectives: The aim of this study was to perform direct quantification of myocardial extracellular volume fraction (ECF) with T1-weighted cardiac magnetic resonance (CMR) imaging in patients suspected to have infiltrative heart disease. Background: Infiltrative heart disease refers to accumulation of abnormal substances within the myocardium. Qualitative assessment of late gadolinium enhancement (LGE) remains the most commonly used method for CMR evaluation of patients suspected with myocardial infiltration. This technique is widely available and can be performed in a reproducible and standardized manner. However, the degree of extracellular matrix expansion due to myocardial infiltration in the intercellular space has, to date, not been amenable to noninvasive quantification with LGE. Methods: We performed 3-T CMR in 38 patients (mean age 68 ± 15 years) who were referred for assessment of infiltrative heart disease and also in 9 healthy volunteers as control subjects. The T1 quantification by Look-Locker gradient-echo before and after contrast determined segmental myocardial partition coefficients. The ECF was obtained by referencing the tissue partition coefficient for gadolinium to the plasma volume fraction in blood, derived from serum hematocrit. Cine CMR and LGE imaging in matching locations were also performed. Results: Seventeen patients (45%) had cardiac amyloidosis (CA) (biopsy-confirmed or clinically highly probable), 20 (53%) had a non-amyloid cardiomyopathy, and 1 had lysosomal storage disease. Median global ECF was substantially higher in CA patients (0.49) compared with non-amyloid cardiomyopathy patients (0.33, p < 0.0001) and volunteers (0.24, p = 0.0001). The ECF strongly correlated with visually assessed segmental LGE (r = 0.80, p < 0.0001) and LV mass index (r = 0.69, p < 0.0001), reflecting severity of myocardial infiltration. In patients with CA, ECF was highest in segments with LGE, although it remained elevated in segments without qualitative LGE. Conclusions: The CMR ECF quantification identified substantial expansion of the interstitial space in patients with CA compared with volunteers. Further studies using this technique for diagnosis and assessment of the severity of myocardial infiltration are warranted.
机译：目的：本研究的目的是对怀疑患有浸润性心脏病的患者进行T1加权心脏磁共振（CMR）成像直接定量心肌细胞外体积分数（ECF）。背景：浸润性心脏病是指心肌内异常物质的积累。晚期g增强（LGE）的定性评估仍是怀疑心肌浸润患者CMR评估的最常用方法。该技术是广泛可用的，并且可以以可再现和标准化的方式执行。然而，迄今为止，由于心肌在细胞间间隙中的浸润而引起的细胞外基质的扩展程度尚不适合用LGE进行无创定量。方法：我们对38例平均浸润性心脏病患者（平均年龄68±15岁）进行了3-T CMR检查，并以9名健康志愿者作为对照。在对比之前和之后通过Look-Locker梯度回波进行的T1定量确定了节段性心肌分配系数。通过将g的组织分配系数与血液中的血细胞比容得出的血浆中血浆体积分数进行比较，可获得ECF。在匹配位置进行电影CMR和LGE成像。结果：十七名患者（45％）患有心脏淀粉样变性（CA）（经活检证实或临床上很可能），20例（53％）患有非淀粉样蛋白性心肌病，1例患有溶酶体贮积病。与非淀粉样心肌病患者（0.33，p <0.0001）和志愿者（0.24，p = 0.0001）相比，CA患者（0.49）的整体ECF中位数显着更高。 ECF与视觉评估的节段性LGE（r = 0.80，p <0.0001）和LV质量指数（r = 0.69，p <0.0001）密切相关，反映了心肌浸润的严重性。在CA患者中，ECF在LGE段中最高，尽管在没有定性LGE的段中ECF仍然升高。结论：与自愿者相比，CMR ECF定量确定了CA患者间质间隙的实质性扩展。有必要使用该技术进行进一步研究，以诊断和评估心肌浸润的严重性。

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