不律性ミトラ弁の転倒と突然の心臓死
Cristina Basso1, Martina Perazzolo Marra2, Stefania Rizzo2
1From Departments of Cardiac, Thoracic, and Vascular Sciences (C.B., M.P.M., S.R., M.D.L., A.C., A.C.F., I.R. F.M., K.P., E.B., L.C., B.B., D.C., G.T., S.I.) and Radiology (B.G.), Azienda Ospedaliera-University of Padua Medical School, Padua, Italy. cristina.basso@unipd.it.
Circulation
|July 11, 2015
まとめ
ミトラル弁の転落 (MVP) は,若い女性における突然心臓死 (SCD) の重要な原因です. 左心室の繊維症,特に乳頭筋の繊維症は,心室不律症に関連した重要な構造的異常です.
科学分野:
- 心臓病学 心臓病学
- 心臓電気生理学 心臓電気生理学
- 病理学 パトロジー
背景:
- ミトラル弁の転落 (MVP) は,重要な血液動力学的妥協なしに,心房不律および突然心死 (SCD) を引き起こす可能性があります.
- MVPにおけるこの電気的不安定性の根本的な構造的原因は十分に理解されていません.
研究 の 目的:
- MVPの患者における心房不律およびSCDの構造的基礎を調査する.
- MVP患者におけるリスクの階層化のためのイメージングバイオマーカーを特定する.
主な方法:
- MVP症例を特定するために,SCDを持つ650人の若い成人の心臓病理学登録をレビューしました.
- MVPを患ったSCD患者の心臓のヒストポソロジック分析.
- コントラスト強化心磁気共振 (CE-CMR) 画像検査は,複雑な心室不律症とそれ以外のMVP患者で実施されます.
主要な成果:
- MVPは,若い成人の7%,特に女性の13%でSCDの唯一の原因でした.
- ヒストロジーは,MVPのSCD患者におけるパピラリ筋とインフェロバザル壁の左心室線維症を明らかにした.
- CE-CMRは,対照群 (14%),対照群 (93%) と比較して,MVP患者におけるガドリニウム増強の有意な遅延を示した.
結論:
- MVPは,特に若い女性において,不律性SCDの認識されていない原因です.
- 左心室線維症,特にパピラ筋と下下根の壁は,心室動脈不全と関連したMVPの構造的特徴です.
- CE-CMRは,この隠された基質を特定し,MVP患者におけるリスクの階層化を改善することができます.
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