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在大动脉狭窄时区分左心室重塑与全身高血压

Masliza Mahmod¹, Kenneth Chan¹, Joao F Fernandes²

¹University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine (M.M., K.C., R.A., B.R., M.R., J.M.F., S.D., S.G.M., S.N.), University of Oxford, United Kingdom.

Circulation. Cardiovascular imaging

|August 20, 2024

概括

大动脉狭窄 (AS) 的左心室缩具有独特的几何特征,包括左右轴转移,使其与高血压 (HTN) 区别开来. 这种AS重塑模式在手术后是不可逆转的,并预测了质量回归.

科学领域:

心血管成像 - 心血管成像
心脏机械学心脏机械学
几何改造几何改造几何改造几何改造

背景情况:

左心室 (LV) 增高在大动脉狭窄 (AS) 和全身高血压 (HTN) 中很常见.
在AS和HTN之间区分LV缩的原因是临床上具有挑战性的.
了解不同的几何改造模式对于诊断和管理至关重要.

研究的目的:

为了研究严重AS的3维几何改造模式.
将AS重塑与全身高血压 (HTN) 和健康对照进行比较.
为了评估AS改造中发生的变化,在主动脉置换 (AVR) 后进行重塑.

主要方法:

在91名受试者 (36名AS,19名HTN,36名对照者) 中利用心脏磁共振 (CMR).
在CMR扫描中的3D网格上进行了主要组件分析,以识别几何特征.
在不同群体中比较形状,应变和痕的传统指标.

主要成果:

确定了一个独特的AS改造特征:增加墙壁厚度,LV左向右轴转移,短轴偏心率下降.
系统性高血压 (HTN) 显示 septal 厚度增加.
结合的签名有效地区分了AS和HTN (AUC=0.792).
在AVR后,LV左右轴转移是不可逆转的,并预测LV质量回归 (R2=0.339).

结论:

清晰的LV重塑特征可以区分LV缩的病因.
LV轴转移是AS改造的一个特征,不可逆转的特征.
这种轴移可能代表一个适应机制,并预测术后LV质量回归.

关键词:

大动脉门的大动脉门大动脉门狭窄症这种高血压,高血压.增大,左心室的左心室主要组件分析的主要组件分析

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