应用心血管磁共振技术评估强直性脊柱炎患者主动脉僵硬度

编者：韩青，西京医院临床免疫科

摘  要：

评估强直性脊柱炎(AS)患者的主动脉僵硬度，并评估其与AS特征及左室(LV)重建的相关性。在这项前瞻性研究中， 14例AS患者分别与没有心血管症状或已知的心血管疾病的对照组相匹配，进行CMR成像（1.5T）评估主动脉弓脉搏波速度(PWV)。为了提高样品的可比性，对样品进行了评估严格筛选。只有超声心动图检查有异常发现的患者才纳入本研究。Cine CMR用于评估LV的几何结构和收缩功能，并进行后期钆（gá）增强以确定心肌超增强信号的存在(如纤维化)。与对照组相比，AS组患者主动脉弓PWV明显增高(中值9.7 m/s, [IQR] 7.1-11.8 vs.6.1 m/s, IQR 4.6-7.6 m/s;P < 0.001)。PWV与BASFI测量的功能障碍呈正相关(R: 0.62;p =0.018)。与11例没有超增强的患者相比(9.0 m/s, IQR 6.6到10.5 m/s;p = 0.022) ，3例(21%)患者非缺血模式的超增强显示PWV增加(11.7, 12.3和16.5 m/s)。PWV与LV射血分数呈负相关(R: - 0.63;p =0.015)，但未发现与LV体积或质量相关。主动脉弓中PWV的升高与功能障碍、非缺血超增强的存在、左心室收缩功能的降低有关。

参考文献：

Assessment ofaortic stiffness in patients with ankylosingspondylitis using cardiovascular magnetic resonance.

Biesbroek PS .et al

Abstract

To evaluate aortic stiffness in patients with ankylosing spondylitis (AS)using cardiovascular magnetic resonance (CMR) and to assess its associationwith AS characteristics and left ventricular (LV) remodeling. In thisprospective study, 14 consecutive AS patients were each matched to two controlswithout cardiovascular symptoms or known cardiovascular disease who underwentCMR imaging for the assessment of aortic arch pulse wave velocity (PWV) at 1.5Tesla. To enhance comparability of the samples, matching was done withreplacement resulting in 20 unique controls. Only AS patients with abnormalfindings on screening echocardiography were included in this exploratory study.Cine CMR was used to assess LV geometry and systolic function, and lategadolinium enhancement was performed to determine the presence of myocardialhyperenhancement (i.e., fibrosis). Aortic arch PWV was significantly higher inthe AS group compared with the control group (median 9.7 m/s, interquartilerange [IQR] 7.1 to 11.8 vs. 6.1 m/s, IQR 4.6 to 7.6 m/s; p < 0.001). PWV waspositively associated with functional disability as measured by BASFI (R: 0.62;p = 0.018). Three patients (21%) with a non-ischemic pattern ofhyperenhancement showed increased PWV (11.7, 12.3, and 16.5 m/s) as compared tothe 11 patients without hyperenhancement (9.0 m/s, IQR 6.6 to 10.5 m/s;p = 0.022). PWV was inversely associated with LV ejection fraction (R: - 0.63;p = 0.015), but was not found to be statistically correlated to LV volumes ormass. Aortic arch PWV was increased in our cohort of patients with AS. HigherPWV in the aortic arch was associated with functional disability, the presenceof non-ischemic hyperenhancement, and reduced LV systolic function.

Clin Rheumatol. 2018 May 12. doi:10.1007/s10067-018-4135-x. [Epub ahead of print]