Association of Fibrosis With Mortality and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy
Association of Fibrosis With Mortality and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy
复制标题
DOI：
10.1001/jama.2013.1363
复制
发表时间：
2013-03-06
影响因子：
120.7
通讯作者：
Prasad, Sanjay K.
中科院分区：
文献类型：
--
作者：
Gulati, Ankur;Jabbour, Andrew;Prasad, Sanjay K.
非缺血性扩张型心肌病患者的重要危险分层主要基于左心室射血分数(LVEF)。更好的预后因素可能会改善植入心脏复律除颤器(ICD)和其他管理决策的患者选择。目的确定心肌纤维化(通过晚期Gd增强心血管磁共振[LGE-CMR]成像检测)是否是扩张型心肌病死亡率和心脏性猝死(SCD)的独立和增量预测因子。设计、设置和患者前瞻性研究472例扩张型心肌病患者，在确定中壁置换纤维化的存在和程度后，于2000年11月至2008年12月期间提交英国CMR成像中心进行纵向研究。随访至2011年12月。主要观察指标主要终点为全因死亡率。次要终点包括心血管死亡或心脏移植；心律失常由SCD或流产的SCD(适当的ICD休克、非致命性室颤或持续性室性心动过速)组成；以及HF死亡、HF住院或心脏移植的组合。结果在142例中壁纤维化患者中，在330例无纤维化的患者中，38例死亡(26.8%)对35例死亡(10.6%)(危险比[HR]，2.96[95%CI，1.87-4.69]；绝对风险差异，16.2%[95%CI，8.2%-24.2%]；P
Importance Risk stratification of patients with nonischemic dilated cardiomyopathy is primarily based on left ventricular ejection fraction (LVEF). Superior prognostic factors may improve patient selection for implantable cardioverter-defibrillators (ICDs) and other management decisions.Objective To determine whether myocardial fibrosis (detected by late gadolinium enhancement cardiovascular magnetic resonance [LGE-CMR] imaging) is an independent and incremental predictor of mortality and sudden cardiac death (SCD) in dilated cardiomyopathy.Design, Setting, and Patients Prospective, longitudinal study of 472 patients with dilated cardiomyopathy referred to a UK center for CMR imaging between November 2000 and December 2008 after presence and extent of midwall replacement fibrosis were determined. Patients were followed up through December 2011.Main Outcome Measures Primary end point was all-cause mortality. Secondary end points included cardiovascular mortality or cardiac transplantation; an arrhythmic composite of SCD or aborted SCD (appropriate ICD shock, nonfatal ventricular fibrillation, or sustained ventricular tachycardia); and a composite of HF death, HF hospitalization, or cardiac transplantation.Results Among the 142 patients with midwall fibrosis, there were 38 deaths (26.8%) vs 35 deaths (10.6%) among the 330 patients without fibrosis (hazard ratio [HR], 2.96 [95% CI, 1.87-4.69]; absolute risk difference, 16.2% [95% CI, 8.2%-24.2%]; P