CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy.
CMR quantification of myocardial scar provides additive prognostic information in nonischemic cardiomyopathy.
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DOI：
10.1016/j.jcmg.2013.05.013
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发表时间：
2013-09
影响因子：
14
通讯作者：
Kwong, Raymond Y.
中科院分区：
文献类型：
--
作者：
Neilan, Tomas G.;Coelho-Filho, Otavio R.;Danik, Stephan B.;Shah, Ravi V.;Dodson, John A.;Verdini, Daniel J.;Tokuda, Michifumi;Daly, Caroline A.;Tedrow, Usha B.;Stevenson, William G.;Jerosch-Herold, Michael;Ghoshhajra, Brian B.;Kwong, Raymond Y.
关键词：
本研究旨在确定晚期钆增强（LGE）的程度是否可以为非缺血性扩张型心肌病（NIDC）患者提供额外的预后信息，这些患者有植入式心律转复除颤器（ICD）治疗的指征，用于心脏性猝死（SCD）的一级预防。数据表明，LGE的存在是NIDC患者事件的一个强有力的证据。关于长期均衡量化作用的数据有限。对162例NIDC患者在植入ICD进行SCD一级预防之前的LGE程度和临床随访进行了评估。使用基于标准差（2-SD）的方法和半峰全宽（FWHM）方法对LGE程度进行定量。我们研究了162例NIDC患者（65%为男性;平均年龄：55岁;左心室射血分数[LVEF]：26 ± 8%），并对主要不良心脏事件（MACE）进行了随访，包括心血管死亡和适当的ICD治疗，平均随访时间为29 ± 18个月。LGE患者的年MACE发生率（24%）显著高于无LGE患者（2%）。通过单变量关联，LGE的存在和程度与MACE的关联最强（LGE存在，风险比[HR]：14.5 [95%置信区间（CI）：6.1至32.6; p < 0.001]; LGE程度，HR：LGE体积每增加1%，HR为1.15 [95% CI：1.12至1.18; p < 0.0001]）。多变量分析显示，在MACE的最佳总体模型中，LGE程度是最强的预测因子，在校正患者年龄、性别和LVEF后，每10% LGE程度观察到7倍风险（校正HR：7.61; p < 0.0001）。通过2-SD和FWHM进行的LGE定量均显示出稳健的预后相关性，在累及>6.1% LV心肌的LGE患者中观察到最高的MACE率。LGE程度可为NIDC患者提供进一步的风险分层，目前有ICD植入的指征，用于SCD的一级预防。通过心脏磁共振对NIDC患者ICD治疗的战略指导值得进一步研究。
This study sought to determine whether the extent of late gadolinium enhancement (LGE) can provide additive prognostic information in patients with a nonischemic dilated cardiomyopathy (NIDC) with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary prevention of sudden cardiac death (SCD). Data suggest that the presence of LGE is a strong discriminator of events in patients with NIDC. Limited data exist on the role of LGE quantification. The extent of LGE and clinical follow-up were assessed in 162 patients with NIDC prior to ICD insertion for primary prevention of SCD. LGE extent was quantified using both the standard deviation–based (2-SD) method and the full-width half-maximum (FWHM) method. We studied 162 patients with NIDC (65% male; mean age: 55 years; left ventricular ejection fraction [LVEF]: 26 ± 8%) and followed up for major adverse cardiac events (MACE), including cardiovascular death and appropriate ICD therapy, for a mean of 29 ± 18 months. Annual MACE rates were substantially higher in patients with LGE (24%) than in those without LGE (2%). By univariate association, the presence and the extent of LGE demonstrated the strongest associations with MACE (LGE presence, hazard ratio [HR]: 14.5 [95% confidence interval (CI): 6.1 to 32.6; p < 0.001]; LGE extent, HR: 1.15 per 1% increase in volume of LGE [95% CI: 1.12 to 1.18; p < 0.0001]). Multivariate analyses showed that LGE extent was the strongest predictor in the best overall model for MACE, and a 7-fold hazard was observed per 10% LGE extent after adjustments for patient age, sex, and LVEF (adjusted HR: 7.61; p < 0.0001). LGE quantitation by 2-SD and FWHM both demonstrated robust prognostic association, with the highest MACE rate observed in patients with LGE involving >6.1% of LV myocardium. LGE extent may provide further risk stratification in patients with NIDC with a current indication for ICD implantation for the primary prevention of SCD. Strategic guidance on ICD therapy by cardiac magnetic resonance in patients with NIDC warrants further study.
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DOI：
10.1161/circimaging.108.842096
发表时间：
2010-11
期刊：
Circulation. Cardiovascular imaging
影响因子：
--
作者：
Broberg CS;Chugh SS;Conklin C;Sahn DJ;Jerosch-Herold M
通讯作者：
Jerosch-Herold M
影响因子：
24
作者：
Amado, LC;Gerber, BL;Lima, JAC
通讯作者：
Lima, JAC
影响因子：
24
作者：
Assomull, Ravi G.;Prasad, Sanjay K.;Pennell, Dudley J.
通讯作者：
Pennell, Dudley J.
DOI：
10.1016/s0735-1097(86)80476-4
发表时间：
1986-03-01
影响因子：
24
作者：
HAMMOND, IW;DEVEREUX, RB;LARAGH, JH
通讯作者：
LARAGH, JH
影响因子：
24
作者：
Bogun, Frank M.;Desjardins, Benoit;Good, Eric;Gupta, Sanjaya;Crawford, Thomas;Oral, Hakan;Ebinger, Matthew;Pelosi, Frank;Chugh, Aman;Jongnarangsin, Krit;Morady, Fred
通讯作者：
Morady, Fred