心脏磁共振定量评价轻链型心脏淀粉样变患者心肌纤维化的初步研究

郭玉博; 王雪竹; 李潇; 高雅娟; 田庄; 李剑; 霍力; 王怡宁

doi:10.12376/j.issn.2097-0501.2023.01.006

心脏磁共振定量评价轻链型心脏淀粉样变患者心肌纤维化的初步研究

doi: 10.12376/j.issn.2097-0501.2023.01.006

郭玉博^{1, *},
王雪竹^{2, *},
李潇¹,
高雅娟³,
田庄^{4, 5},
李剑³,
霍力^2, ,,
王怡宁^1, ,

1.
中国医学科学院北京协和医院放射科，北京 100730
2.
中国医学科学院北京协和医院核医学科，北京 100730
3.
中国医学科学院北京协和医院血液科，北京 100730
4.
中国医学科学院北京协和医院心内科，北京 100730
5.
中国医学科学院北京协和医院国际医疗部，北京 100730

^*郭玉博和王雪竹为共同第一作者

详细信息

通信作者:
霍力，E-mail：huoli@pumch.cn

王怡宁，E-mail：wangyining@pumch.cn

中图分类号: R445.2; R542.2+3
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出版历程
- 收稿日期: 2022-11-22
- 修回日期: 2022-12-02
- 网络出版日期: 2023-03-07

Preliminary Study on Quantitative Evaluation of Myocardial Fibrosis by CardiacMagnetic Resonance in Patients with Light Chain Cardiac Amyloidosis

GUO Yubo^{1, *},
WANG Xuezhu^{2, *},
LI Xiao¹,
GAO Yajuan³,
TIAN Zhuang^{4, 5},
LI Jian³,
HUO Li^{2
, ,},
WANG Yining^{1
, ,}

1.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China
2.
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China
3.
Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China
4.
Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China
5.
Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing 100730, China

More Information

Corresponding author: HUO Li, E-mail: huoli@pumch.cn; WANG Yining, E-mail: wangyining@pumch.cn

摘要

摘要: 目的心肌纤维化是轻链型淀粉样变性的潜在致病机制，本研究通过将心脏磁共振(CMR)心肌组织特征和形态、功能参数与⁶⁸Ga-成纤维细胞激活蛋白抑制剂(FAPI)PET显像相关联，旨在探索CMR定量参数与心肌纤维化过程的相关性。方法选取2021年8—12月在北京协和医院确诊的轻链型心脏淀粉样变(AL-CA)患者，进行CMR和⁶⁸Ga-FAPI PET/CT检查, 登记患者的临床表现及辅助检查等信息，并进行分析。结果共纳入23例AL-CA患者，15例(65.2%)为男性，平均年龄(58.3±6.5)岁。具有⁶⁸Ga-FAPI-04高摄取的患者心肌细胞外容积(ECV)升高，明显高于阴性组患者(P=0.047)，且患者的心肌ECV与心肌FAPI摄取呈正相关(r=0.628，P=0.001；r=0.727，P＜0.001；r=0.661，P=0.001)。与阴性组患者相比，阳性组患者的左心室(LV)射血分数(EF)(P＜0.001)减低。LVEF(r=-0.798，P＜0.001；r=-0.794，P＜0.001；r=-0.795，P＜0.001)、右心室(RV) EF(r=-0.735，P＜0.001；r=-0.739，P＜0.001；r=-0.684，P＜0.001)与心肌FAPI摄取呈负相关，LV周向应变(r=0.668，P＜0.001；r=0.708，P＜0.001；r=0.705，P＜0.001)、LV纵向应变(r=0.629，P=0.001；r=0.635，P=0.001；r=0.597，P=0.003)、RV纵向应变(r=0.575，P=0.004；r=0.792，P＜0.001；r=0.673，P＜0.001)与心肌FAPI摄取呈负相关。结论 FAPI反映的成纤维细胞活化伴有CMR反映的间质特征异常及其导致的心肌运动功能减低。FAPI摄取增高的AL-CA患者的ECV升高，EF减低，应力减低并形态学异常。
- 心脏淀粉样变 /
- 心脏磁共振 /
- 心肌纤维化 /
- ⁶⁸Ga-成纤维细胞激活蛋白抑制剂
Abstract: Objective Myocardial fibrosis is a potential mechanism of light-chain myocardial amyloidosis(AL-CA). This research aimed at exploring the correlation between multiparameter cardiac magnetic resonance (CMR) and myocardial fibrosis by relating the CMR myocardial tissue characteristics, the morphological and the functional parameters with gallium-68-labeledfibroblast activation protein inhibitor 04 positron emission tomography (⁶⁸Ga-FAPI PET). Methods We gave the patients diagnosed with AL-CA in Peking Union Medical College Hospital from August to December 2021 the examinations of CMR and ⁶⁸Ga-FAPI PET/CT. We recorded and analyzed the information on clinical manifestations and examinations of the patients. Results A total of 23 patients with AL-CA were included, 15 (65.2%)of which were male and the mean age was 58.3±6.5 years. Patients with high ⁶⁸Ga-FAPI-04 uptake had shown growth in myocardial extracellular volume (ECV), significantly higher than those in the negative group (P=0.047). In addition, patients' myocardial ECV was positively correlated with myocardial FAPI uptake (r=0.628, P=0.001;r=0.727, P < 0.001;r=0.661, P=0.001). Patients in the positive group showd reduced left ventricular (LV) ejection fraction (EF)(P < 0.001).LVEF (r=-0.798, P < 0.001;r=-0.794, P < 0.001; r=-0.795, P < 0.001) and right ventricular (RV)EF (r=-0.735, P < 0.001;r=-0.739, P < 0.001;r=- 0.684, P < 0.001) showd negatively correlated with myocardial FAPI uptake, LV circumferential strain (r=0.668, P < 0.001;r=0.708, P < 0.001;r=0.705, P < 0.001), LV longitudinal strain (r=0.629, P=0.001;r=0.635, P=0.001; r=0.597, P=0.003), and RV longitudinal strain (r=0.575, P=0.004; r=0.792, P < 0.001;r=0.673, P < 0.001) were negatively correlated with myocardial FAPI uptake. Conclusions FAPI-related fibroblast activation is concurrent with CMR-related abnormal myocardial interstitial characteristics that leads to the decreased function of the myocardial movement. Patients with increased FAPI uptake present with increased ECV, decreased EF, and decreased strain with morphological abnormalities.
- cardiac amyloidosis /
- cardiac magnetic resonance /
- myocardial fibrosis /
- gallium-68-labeledfibroblast activation protein inhibitor
注释:

作者贡献：王怡宁、霍力负责论文选题、设计及科研经费来源；郭玉博、王雪竹负责论文初稿撰写；郭玉博、王雪竹、李潇、高雅娟、田庄、李剑、霍力、王怡宁负责论文整合与修订。

利益冲突：所有作者均声明不存在利益冲突。

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图 1 AL-CA患者的CMR图像

A.FAPI摄取阳性患者的CMR图像(延迟强化，T1 mapping，ECV，左心室径向、周向及纵向应变); B.FAPI摄取阴性患者的CMR图像(延迟强化，T1 mapping，ECV，左心室径向、周向及纵向应变)

Figure 1. CMR in patients with AL-CA

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图 2 AL-CA患者CMR参数与PET/CT参数相关性

Figure 2. The correlation between CMR parameters and PET/CT parameters in AL-CA patients

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表 1 轻链型心脏淀粉样变(AL-CA)患者临床特征及心脏磁共振(CMR)参数比较

Table 1. The clinical features and cardial magnetic resonance(CMR) parameters of the light chain cardiac amyloidosis(AL-CA) patients

指标	数值(N=23)	⁶⁸Ga-FAPI-04摄取		P值
指标	数值(N=23)	阳性组(n=17)	阴性组(n=6)	P值
男性(例, %)	15 (65.2)	13 (76.5)	2 (33.3)	0.001
年龄(岁)	58.3±6.5	59.2±6.4	55.7±6.8	0.639
NYHA分级≥ Ⅱ(例, %)	17 (73.9)	17 (100.0)	0 (0)	＜0.001
梅奥分期≥ Ⅱ(例, %)	17 (73.9)	16 (94.1)	1 (16.7)	＜0.001
dFLC(mg/L)	251.8 (97.5，451.2)	344.6 (250.6，487.7)	55.3 (29.8，107.6)	＜0.001
肌钙蛋白Ⅰ(μg/L)	0.053 (0.017，0.133)	0.110 (0.028，0.162)	0.017 (0.017，0.017)	0.004
NT-proBNP(pg/mL)	2606 (191，8520)	3931 (2185，10 475)	138.5 (51.5，184.3)	＜0.001
native T1(ms)	1398.0±112.2	1415.2±124.8	1345.7±35.8	0.055
ECV	47.7±14.0	53.1±12.3	32.5±2.9	0.047
T2(ms)	44.5±4.3	45.6±3.7	41.7±5.0	0.149
LVEDVi(mL/m²)	71.9±13.7	73.3±13.7	68.0±14.0	0.920
LVESVi(mL/m²)	30.8 (22.5，39.0)	32.9 (29.5，40.3)	19.3 (17.2，25.9)	＜0.001
LVEF(%)	57.5 (46.4，67.0)	52.0 (40.7，59.0)	70.9 (66.5，71.3)	＜0.001
LVMi(g/m²)	76.3±25.9	85.5±23.4	50.0±9.2	0.067
左心房容积(cm²)	69.4±26.5	74.9±26.3	54.0±22.1	0.668
RVEDVi(mL/m²)	73.1±18.1	77.3±18.3	61.3±11.8	0.390
RVESVi(mL/m²)	35.3 (23.6，48.1)	41.1 (28.3，49.3)	23.1 (15.6，25.9)	0.002
RVEF(%)	51.0±14.7	46.3±14.0	64.4±5.5	0.112
RVMi(g/m²)	19.9 (14.7，26.9)	22.5 (16.7，29.3)	13.9 (10.2，15.1)	0.002
右心房容积(cm²)	73.8±26.8	82.8±24.8	48.7±13.3	0.075
LV周向应变(%)	-17.3±4.93	-15.5±4.5	-22.3±1.6	0.168
LV纵向应变(%)	-9.5±5.0	-7.6±4.2	-14.9±2.2	0.051
LV径向应变(%)	27.1±11.1	23.0±9，2	38.9±6.5	0.644
RV周向应变(%)	-8.2 (-13.2，-5.6)	-7.8 (-13.3，-5.9)	-9.4 (-12.9，7.9)	0.973
RV纵向应变(%)	-8.0±6.7	-5.5±5.8	-15.2±3.1	0.399
RV径向应变(%)	45.2 (25.3，71.6)	35.4 (21.1，78.4)	60.5 (54.9，76.1)	0.062

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表 2 AL-CA患者生物标志物、CMR参数与PET/CT参数相关性分析

Table 2. The correlation between serum biomarkers, CMR parameters, and PET/CT parameters in AL-CA patients

指标	SUVmean		SUVmax		SUVR
指标	r值	P值	r值	P值	r值	P值
dFLC(mg/L)	0.607	0.002	0.603	0.002	0.541	0.008
肌钙蛋白I(μg/L)	0.386	0.069	0.336	0.117	0.366	0.086
NT-proBNP(pg/mL)	0.768	＜0.001	0.722	＜0.001	0.717	＜0.001
native T1(ms)	0.153	0.486	0.166	0.449	0.093	0.673
ECV	0.628	0.001	0.727	＜0.001	0.661	0.001
T2(ms)	0.282	0.193	0.277	0.200	0.157	0.474
LVEDVi(mL/m²)	0.260	0.231	0.271	0.211	0.231	0.288
LVESVi(mL/m²)	0.829	＜0.001	0.811	＜0.001	0.785	＜0.001
LVEF(%)	-0.798	＜0.001	-0.794	＜0.001	-0.795	＜0.001
LVMi(g/m²)	0.524	0.010	0.620	0.002	0.602	0.002
左心房容积(cm²)	0.652	0.001	0.587	0.003	0.504	0.014
RVEDVi(mL/m²)	0.592	0.003	0.474	0.022	0.474	0.022
RVESVi(mL/m²)	0.725	＜0.001	0.675	＜0.001	0.626	0.001
RVEF(%)	-0.735	＜0.001	-0.739	＜0.001	-0.684	＜0.001
RVMi(g/m²)	0.664	0.001	0.583	0.004	0.470	0.024
右心房容积(cm²)	0.687	＜0.001	0.661	0.001	0.615	0.002
LV周向应变(%)	0.668	＜0.001	0.708	＜0.001	0.705	＜0.001
LV纵向应变(%)	0.629	0.001	0.635	0.001	0.597	0.003
LV径向应变(%)	-0.480	0.020	-0.488	0.018	-0.535	0.009
RV周向应变(%)	0.215	0.323	0.153	0.485	-0.002	0.993
RV纵向应变(%)	0.575	0.004	0.792	＜0.001	0.673	＜0.001
RV径向应变(%)	-0.447	0.033	-0.358	0.094	-0.272	0.210

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