Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy
Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy
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DOI：
10.1093/ehjci/jeu181
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发表时间：
2015-03-01
影响因子：
6.2
通讯作者：
Korosoglou, Grigorios
中科院分区：
文献类型：
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作者：
Buss, Sebastian J.;Breuninger, Kristin;Korosoglou, Grigorios
目的探讨非缺血性扩张型心肌病(DCM)患者左室心肌磁共振(CMR)形变成像对预后的影响，并与晚期增强扫描(LGE)定量和LV射血分数(EF)进行比较。方法与结果对210例DCM患者进行了前瞻性的标准CMR检查，包括测量LGE以定量心肌纤维化，特征跟踪应变成像评估LV变形。预定义的主要终点，即心脏死亡、心脏移植和流产的心脏性猝死的组合，在中位数5.3年的随访期内发生在26名受试者中。左心室径向、周向和纵向应变与预后显著相关。多因素分析显示，整体纵向应变(峰值负应变值的平均值)和平均纵向应变(所有节段平均曲线的负峰值)是超过整体和平均左室径向和周向应变以及NT-proBNP、EF和LGE质量的独立预测参数。即使在EF<；35%的患者(P<；0.01)和存在LGE的患者(P<；0.001)中，整体纵向应变大于-12.5%也可以预测结果。使用临床模型进一步研究平均纵向应变(EF<；35%，存在LGE，NYHA分级，平均纵向应变大于-10%)。平均纵向应变的预测价值高于NYHA、EF和LGE(HR=5.4，P<；0.01)。结论CMR评估的LV纵向应变是DCM患者生存的独立预测因子，并为临床参数、生物标记物和标准CMR以外的危险分层提供了增量信息。
Aims To investigate the prognostic impact of left-ventricular (LV) cardiac magnetic resonance (CMR) deformation imaging in patients with non-ischaemic dilated cardiomyopathy (DCM) compared with late-gadolinium enhancement (LGE) quantification and LV ejection fraction (EF).Methods and results A total of 210 subjects with DCM were examined prospectively with standard CMR including measurement of LGE for quantification of myocardial fibrosis and feature tracking strain imaging for assessment of LV deformation. The predefined primary endpoint, a combination of cardiac death, heart transplantation, and aborted sudden cardiac death, occurred in 26 subjects during the median follow-up period of 5.3 years. LV radial, circumferential, and longitudinal strains were significantly associated with outcome. Using separate multivariate analysis models, global longitudinal strain (average of peak negative strain values) and mean longitudinal strain (negative peak of the mean curve of all segments) were independent prognostic parameters surpassing the value of global and mean LV radial and circumferential strain, as well as NT-proBNP, EF, and LGE mass. A global longitudinal strain greater than -12.5% predicted outcome even in patients with EF < 35% (P < 0.01) and in those with presence of LGE (P < 0.001). Mean longitudinal strain was further investigated using a clinical model with predefined cut-offs (EF < 35%, presence of LGE, NYHA class, mean longitudinal strain greater than -10%). Mean longitudinal strain exhibited an independent prognostic value surpassing that provided by NYHA, EF, and LGE (HR = 5.4, P < 0.01).Conclusion LV longitudinal strain assessed with CMR is an independent predictor of survival in DCM and offers incremental information for risk stratification beyond clinical parameters, biomarker, and standard CMR.