MRI cardiaca e cardiomiopatia ipertrofica
- Dettagli
- Pubblicato Mercoledì, 31 Ottobre 2012 16:49
Giancarlo Todiere e Giovanni Aquaro sono i primi autori di uno studio sulla miocardiopatia ipertrofica sulla prestigiosa rivista Journal of the American College of Cardiology. Allo studio, condotto nell'Unità MRI della Fondazione diretta da Massimo Lombardi, hanno collaborato, oltre ad altri ricercatori della Fondazione (Masci, Barison, Strata), personale del'Università di Pisa, del Sant'Anna, delì'IFC-CNR e del Galliera di Genova. Lo studio presenta risultati originali ed innovativi sulla presenza e progressione della fibrosi miocardica nella cardiomiopatia ipertrofica, ed è accompagnato da un ampio e autorevole Editoriale di David A. Bluemke, Eunice Yang (Bethesda). Questa patologia è la più comune tra le cardiomiopatie a carattere ereditario e l'approccio diagnostico convenzionale vede l'esame ecocardiografico come centrale nella diagnosi e nel follow-up dei pazienti. Lo studio FTGM dimostra come l'imaging cardiaco MRI aggiunga informazioni preziose, non altrimenti ottenibili, non solo sulla presenza ma anche sull'evolutività della fibrosi miocardica, attraverso la "lente d'ingrandimento", come definita dall'editoriale, rappresentata della tecnica di Late Gadolinium Enhancement usata nello studio."
Progression of Myocardial Fibrosis Assessed With Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy
Giancarlo Todiere, MD,* Giovanni Donato Aquaro, MD,* Paolo Piaggi, MS, PHD,† Francesco Formisano, MD,‡ Andrea Barison, MD,§ Pier Giorgio Masci, MD,* Elisabetta Strata, MD,*
Lorenzo Bacigalupo, MD,‡ Mario Marzilli, MD, Alessandro Pingitore, MD, PHD,¶ Massimo Lombardi, MD* Pisa and Genova, Italy
Objectives This study sought to assess the rate of progression of fibrosis by 2 consecutive cardiac magnetic resonance (CMR) examinations and its relation with clinical variables.
Background In hypertrophic cardiomyopathy (HCM) myocardial fibrosis, detected by late gadolinium enhancement (LGE), is associated to a progressive ventricular dysfunction and worse prognosis.
Methods A total of 55 HCM patients (37 males; mean age 43 ± 18 years) underwent 2 CMR examinations (CMR-1 and CMR-2) separated by an interval of 719 ± 410 days. Extent of LGE was measured, and the rate of progression of LGE (LGE-rate) was calculated as the ratio between the increment of LGE (in grams) and the time (months) between the CMR examinations.
Results At CMR-1, LGE was detected in 45 subjects, with an extent of 13.3 ± 15.2 g. At CMR-2, 53 (96.4%) patients had LGE, with an extent of 24.6 ± 27.5 g. In 44 patients, LGE extent increased significantly (≥1 g). Patients with apical HCM had higher increments of LGE (p = 0.004) and LGE-rate (p < 0.001) than those with other patterns of hypertrophy. The extent of LGE at CMR-1 and the apical pattern of hypertrophy were independent predictors of the increment of LGE. Patients with worsened New York Heart Association functional class presented higher increase of LGE (p = 0.031) and LGE-rate (p < 0.05) than those with preserved functional status.
Conclusions Myocardial fibrosis in HCM is a progressive and fast phenomenon. LGE increment, related to a worse clinical status, is more extensive in apical hypertrophy than in other patterns.
Commento editoriale:
"Hypertrophic Cardiomyopathy Refining the Lens of Cardiac Magnetic Resonance to Evaluate Late Gadolinium Enhancement" di David A. Bluemke, MD, PHD, Eunice Yang, BA, same issue.
