サルコイドーシス患者における心筋膜損傷の検出
Manesh R Patel1, Peter J Cawley, John F Heitner
1Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC 27710, USA.
Circulation
|November 4, 2009
まとめ
遅延増強心血管磁気共振 (DE-CMR) は,標準的な方法よりも心臓のサルコイドーシスを検出するのにより敏感です. このイメージング技術は,有害事象と心臓死のリスクの増加に関連した心筋損傷を特定します.
科学分野:
- 心臓病学 心臓病学
- メディカルイマージング (医学イメージング)
- 肺内科 肺内科 肺内科
背景:
- 突然の死は,サルコイドーシス患者の死亡の主な原因であり,しばしば認識されていない心臓の関与によるものです.
- 遅延強化心血管磁気共振 (DE-CMR) は,微妙な心筋損傷を検出することができます.
研究 の 目的:
- サルコイドーシス患者における心臓の関与を特定するための標準的な臨床評価とDE-CMRの有効性を比較する.
- DE-CMRの発見と心血管疾患の有害事象との関連性を評価する.
主な方法:
- バイオプシーで証明されたサルコイドーシスを持つ81人の患者は,DE-CMRと標準的な臨床評価 (ECGと別の心臓研究) の並行してマスクされた比較を受けた.
- 患者は,死亡,除細動器ショック,またはペースメーカーの必要性を含む主要な有害事象について追跡されました.
主要な成果:
- DE-CMRは,患者の26%で心臓の関与を特定し,標準的な基準 (P=0.005) による率の2倍以上 (12%) であった.
- DE-CMRで検出された心筋損傷を有する患者は,9倍の有害事象の発生率と11.5倍の心臓死亡率を示しました.
- 病理学者は,心臓サルコイドーシスを特定する際にDE-CMRのより高い感受性を確認しました.
結論:
- DE-CMRは,サルコイドーシスにおける心臓の関与を検出するための現在のコンセンサス基準よりも有意に敏感です.
- DE-CMRによって特定された心筋損傷は,心臓死を含む将来の有害事象のリスクの増加と関連しており,より大きなコホートでさらなる調査を正当化しています.
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