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Late effects of pediatric hematopoietic stem cell transplantation on left ventricular function, aortic stiffness and myocardial tissue characteristics.
Journal of Cardiovascular Magnetic Resonance ( IF 6.4 ) Pub Date : 2019-01-17 , DOI: 10.1186/s12968-018-0513-4
Elisabeth H M Paiman 1 , Marloes Louwerens 2 , Dorine Bresters 3, 4 , Jos J M Westenberg 1 , Qian Tao 1 , Rob J van der Geest 1 , Arjan C Lankester 3 , Arno A W Roest 3 , Hildo J Lamb 1
Affiliation  

BACKGROUND Pediatric hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of cardiovascular disease later in life. As HSCT survival has significantly improved, with a growing number of HSCT indications, tailored screening strategies for HSCT-related late effects are warranted. Little is known regarding the value of cardiovascular magnetic resonance (CMR) for early identification of high-risk patients after HSCT, before symptomatic cardiovascular disease manifests. This study aimed to assess CMR-derived left ventricular (LV) systolic and diastolic function, aortic stiffness and myocardial tissue characteristics in young adults who received HSCT during childhood. METHODS Sixteen patients (22.1 ± 1.5 years) treated with HSCT during childhood and 16 healthy controls (22.1 ± 1.8 years) underwent 3 T CMR. LV systolic and diastolic function were measured as LV ejection fraction (LVEF), the ratio of transmitral early and late peak filling rate (E/A), the estimated LV filling pressure (E/Ea) and global longitudinal and circumferential systolic strain and diastolic strain rates, using balanced steady-state free precession cine CMR and 2D velocity-encoded CMR over the mitral valve. Aortic stiffness, myocardial fibrosis and steatosis were assessed with 2D velocity-encoded CMR, native T1 mapping and proton CMR spectroscopy (1H-CMRS), respectively. RESULTS In the patient compared to the control group, E/Ea (9.92 ± 3.42 vs. 7.24 ± 2.29, P = 0.004) was higher, LVEF (54 ± 6% vs. 58 ± 5%, P = 0.055) and global longitudinal strain (GLS) ( -20.7 ± 3.5% vs. -22.9 ± 3.0%, P = 0.063) tended to be lower, while aortic pulse wave velocity (4.40 ± 0.26 vs. 4.29 ± 0.29 m/s, P = 0.29), native T1 (1211 ± 36 vs. 1227 ± 28 ms, P = 0.16) and myocardial triglyceride content (0.47 ± 0.18 vs. 0.50 ± 0.13%, P = 0.202) were comparable. There were no differences between patients and controls in E/A (2.76 ± 0.92 vs. 2.97 ± 0.91, P = 0.60) and diastolic strain rates. CONCLUSION In young adults who received HSCT during childhood, LV diastolic function was decreased (higher estimated LV filling pressure) and LV systolic function (LVEF and GLS) tended to be reduced as compared to healthy controls, whereas no concomitant differences were found in aortic stiffness and myocardial tissue characteristics. When using CMR, assessment of LV diastolic function in particular is important for early detection of patients at risk of HSCT-related cardiovascular disease, which may warrant closer surveillance.

中文翻译:

小儿造血干细胞移植对左心室功能,主动脉僵硬和心肌组织特征的后期影响。

背景技术小儿造血干细胞移植(HSCT)接受者在以后的生命中罹患心血管疾病的风险增加。随着HSCT生存率的显着提高,以及越来越多的HSCT适应症,有针对性的针对HSCT相关晚期效应的筛查策略是必要的。在有症状的心血管疾病显现之前,对于早期识别HSCT后高危患者的心血管磁共振(CMR)的价值知之甚少。这项研究旨在评估在儿童期接受HSCT的年轻成年人中CMR衍生的左心室(LV)的收缩和舒张功能,主动脉僵硬度和心肌组织特征。方法16例(22.1±1.5岁)儿童期接受HSCT治疗的患者和16例健康对照(22.1±1.8岁)接受了3 T CMR。左室收缩和舒张功能测量为左室射血分数(LVEF),经前早期和晚期峰值充盈率(E / A)的比值,估计的左室充盈压(E / Ea)以及整体纵向和周围收缩压和舒张期在二尖瓣上使用平衡的稳态自由进动电影CMR和2D速度编码CMR来获得最大应变率。分别使用2D速度编码CMR,天然T1映射和质子CMR光谱(1H-CMRS)评估主动脉僵硬,心肌纤维化和脂肪变性。结果与对照组相比,患者的E / Ea(9.92±3.42 vs. 7.24±2.29,P = 0.004)更高,LVEF(54±6%vs. 58±5%,P = 0.055)和整体纵向应变(GLS)(-20.7±3.5%vs.-22.9±3.0%,P = 0.063)倾向于降低,而主动脉脉搏波速度(4.40±0.26 vs. 4.29±0)。29 m / s,P = 0.29),天然T1(1211±36 vs. 1227±28 ms,P = 0.16)和心肌甘油三酯含量(0.47±0.18 vs.0.50±0.13%,P = 0.202)是可比的。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。天然T1(1211±36 vs. 1227±28 ms,P = 0.16)和心肌甘油三酯含量(0.47±0.18 vs. 0.50±0.13%,P = 0.202)是可比的。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。天然T1(1211±36 vs. 1227±28 ms,P = 0.16)和心肌甘油三酯含量(0.47±0.18 vs. 0.50±0.13%,P = 0.202)是可比的。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。16)和心肌甘油三酯含量(0.47±0.18对0.50±0.13%,P = 0.202)是可比的。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。16)和心肌甘油三酯含量(0.47±0.18对0.50±0.13%,P = 0.202)是可比的。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,LV舒张功能降低(估计的LV充盈压更高),并且LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。患者和对照组之间的E / A(2.76±0.92 vs. 2.97±0.91,P = 0.60)和舒张压应变率没有差异。结论与健康对照相比,在儿童期接受HSCT的年轻成年人中,左室舒张功能降低(估计的左室充盈压更高),左室收缩功能(LVEF和GLS)趋于降低,但主动脉僵硬度未发现差异和心肌组织特征。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。与健康对照组相比,LV舒张功能降低(较高的估计LV充盈压),LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度和心肌组织特征均未发现差异。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。与健康对照组相比,LV舒张功能降低(较高的估计LV充盈压),LV收缩功能(LVEF和GLS)趋于降低,而主动脉僵硬度和心肌组织特征均未发现差异。当使用CMR时,评估LV舒张功能对早期发现具有HSCT相关心血管疾病风险的患者尤其重要,这可能需要更密切的监视。
更新日期:2019-11-01
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