Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement.
Outcome in Dilated Cardiomyopathy Related to the Extent, Location, and Pattern of Late Gadolinium Enhancement.
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DOI：
10.1016/j.jcmg.2018.07.015
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发表时间：
2019-08
期刊：
影响因子：
--
通讯作者：
Prasad SK
中科院分区：
文献类型：
--
作者：
Halliday BP;Baksi AJ;Gulati A;Ali A;Newsome S;Izgi C;Arzanauskaite M;Lota A;Tayal U;Vassiliou VS;Gregson J;Alpendurada F;Frenneaux MP;Cook SA;Cleland JGF;Pennell DJ;Prasad SK
本研究旨在调查大型扩张型心肌病（DCM）队列中晚期钆增强（LGE）的程度、位置和模式与结局之间的关系。LGE与DCM预后的关系尚不完全清楚。作者根据扩张型心肌病中LGE的程度、位置和模式，研究了LGE与全因死亡率和心源性猝死（SCD）复合终点之间的关系。874例患者（588例男性，中位年龄52岁）中位随访时间为4.9年，300例（34.3%）发生非缺血性LGE。LGE范围为0 - 2.55%、2.55%-5.10%和> 5.10%的患者的估计校正风险比分别为1.59（95%置信区间[CI]：0.99 - 2.55），1.56（95% CI：0.96 - 2.54）和2.31（95% CI：1.50 - 3.55），SCD终点分别为2.79（95% CI：1.42 - 5.49）、3.86（95% CI：2.09 - 7.13）和4.87（95% CI：2.78 - 8.53）。LGE程度和结果之间存在显著的非线性关系，即使是少量的LGE也预示着风险的大幅增加。间隔LGE的存在与死亡率增加相关，但SCD与间隔和游离壁LGE的联合存在最相关。使用LGE存在和位置的预测模型上级基于LGE程度或模式的模型。在DCM中，间隔LGE的存在与死亡和SCD事件风险的大幅增加相关，即使程度很小。伴发间隔和游离壁LGE的SCD风险最大。LGE的增量价值超出了小额和LGE模式是有限的。
This study sought to investigate the association between the extent, location, and pattern of late gadolinium enhancement (LGE) and outcome in a large dilated cardiomyopathy (DCM) cohort. The relationship between LGE and prognosis in DCM is incompletely understood. The authors examined the association between LGE and all-cause mortality and a sudden cardiac death (SCD) composite based on the extent, location, and pattern of LGE in DCM. Of 874 patients (588 men, median age 52 years) followed for a median of 4.9 years, 300 (34.3%) had nonischemic LGE. Estimated adjusted hazard ratios for patients with an LGE extent of 0 to 2.55%, 2.55% to 5.10%, and >5.10%, respectively, were 1.59 (95% confidence interval [CI]: 0.99 to 2.55), 1.56 (95% CI: 0.96 to 2.54), and 2.31 (95% CI: 1.50 to 3.55) for all-cause mortality, and 2.79 (95% CI: 1.42 to 5.49), 3.86 (95% CI: 2.09 to 7.13), and 4.87 (95% CI: 2.78 to 8.53) for the SCD endpoint. There was a marked nonlinear relationship between LGE extent and outcome such that even small amounts of LGE predicted a substantial increase in risk. The presence of septal LGE was associated with increased mortality, but SCD was most associated with the combined presence of septal and free-wall LGE. Predictive models using LGE presence and location were superior to models based on LGE extent or pattern. In DCM, the presence of septal LGE is associated with a large increase in the risk of death and SCD events, even when the extent is small. SCD risk is greatest with concomitant septal and free-wall LGE. The incremental value of LGE extent beyond small amounts and LGE pattern is limited.
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